Tuesday, November 26, 2013

Guess what! Obamacare is working . . .

…quite well, in some places, for quite a large number of people.  But you wouldn’t know that from the constant media drumbeat about the problems with the www.healthcare.gov enrollment portal and the relatively small percentage (fewer than 6%) of the population whose individual insurance policies have to be replaced because they don’t meet the law’s benefits and ratings standards.

Now, before I get a rash of comments about how I can be so naïve about the problems with the Obamacare launch (I know, I will probably get them anyway), let me state from the outset that it is inexcusable that the administration launched an enrollment website, www.healthcare.gov, that clearly was not ready.   It is completely inexcusable that a toxic combination of poor management, politics, under-performing contractors, and an apparent complete lack of transparency and accountability resulted in such a chaotic launch.  It is also clear that the President’s promise—“if you like your health plan, you can keep it”—was false.

The website problems, the cancellations, and Obama’s broken promise have led to weeks of negative news stories about Obamacare.  Support for Obamacare has fallen as result, although most Americans do not want it repealed.

Some have pointed to the roll-out problems as evidence that Obamacare is fundamentally doomed because, as Bill O’Reilly claims, “the federal government is not capable of running the health care system.”

But the fact is that Obamacare already is working as it is supposed to in many states.  Just look at California and Kentucky.  California is a “blue” (reliably Democratic) state that is so large that it often is a national trendsetter, although it also is the state with the biggest numbers of uninsured behind Texas.  Kentucky is a small, poor, southern state that votes “red” (reliably Republican) in presidential elections, although it has a conservative Democratic governor and legislature.  They couldn’t be more different, except when it comes to the ACA: both states are fully on board with Obamacare, and both are having very promising initial success in signing people up.

Kaiser Health News reports that as of November 19, 80,000 people had signed up for coverage in California’s ACA marketplace, and nearly 23% were between the ages of 18 and 34, which “more or less matches their makeup statewide.”

Kentucky’s rollout also is going smoothly.  The Washington Post published a striking account of the poor, rural Kentuckians who are signing up in droves for ACA coverage, and what it means for them and their families. “If the health-care law is having a troubled rollout across the country, Kentucky — and Breathitt County in particular — shows what can happen in a place where things are working as the law’s supporters envisioned,” writes Post reporter Stephanie McCrummen.  She tells us about Courtney Lively, “who has been signing people up since the exchanges opened in early October.” Lively told her that, “people have been ‘pouring into’ her office” and “one woman cried when she was told she qualified for Medicaid under the new law.”

But it isn’t just California and Kentucky where Obamacare enrollment is picking up.  The fourteen states running their own marketplaces are reporting an “enrollment surge,” doubling enrollment to about 150,000 from 79,000, according to state and federal statistics.

So if Obamacare is fundamentally unworkable, as it critics claim, then how can it be working in California, Kentucky and most of the other 12 states that are running their own ACA marketplaces?  And if it isn’t working so well, so far, in the remainder that are being funneled through the troubled www.healthcare.gov website, isn’t that at least partly the fault of the governors of those states that chose not to set up their own marketplaces, leaving it to the feds to do the job for them?  And if the federal government fundamentally is incapable of running a health care system, then how do we account for the fact that it has been successfully running Medicare for 48 years now, and very few Americans (even die-hard conservatives) are in favor of ending government-run Medicare as we know it?

It would take Rose-colored glasses to not see that the federal government’s  incompetence in rolling out the www.healthcare.gov web portal has been nothing short of disastrous.  But one would have to be blinded by ideology to not see that Obamacare is working the way it is supposed to in California, Kentucky and many other states, signing up tens of thousands of people who otherwise would be without affordable health insurance coverage.

With apologies to New York City and Frank Sinatra, if Obamacare can make it there (in California and Kentucky), it can make it anywhere.  Once the feds get that darn www.healthcare.gov website fixed, that is.

Today’s question: What do you think the promising rollout of the ACA in California, Kentucky and most of the other states that are running their own marketplaces bodes for Obamacare?


Unknown said...

It is telling when the best that ACA supporters can do is point to the very modest enrollment success in a few states as evidence the "Obamacare is working". The Affordable Care Act, in its present form, cannot work . Politics aside, the math tells the story. Your declaration of victory is remarkable premature.

Harrison said...

It will take more than the website to make it work.
The Republican politcal goal is quite cynical.
Do not accept the Medicaid expansion, and there is a chance that the 2014 rates will go up because relatively healthy people will still be shut out.
If they can run on that in 2014 they may be able to win state election victories, and prolong their efforts at voter suppression and control of at least the House, and perhaps the Senate.

And all it costs them is harming people who were not gonna vote for them anyway.
No cost.
Only gain.

Cynical as hell.


Unknown said...

83..except you need physicians to treat pts. Are they signing up to acept pts from the exchanges ?

ryanjo said...

The federal government is successfully running Medicare? Are you for real? The program is a budget sinkhole, a fraud magnet, and overbalanced so much toward procedural reimbursement that it singlehandedly has almost destroyed primary care adult medicine.

And the reason that the public doesn't demand to eliminate Obamacare is the lack of acceptable alternatives from a predatory insurance industry. Plus the national lottery mentality of something for nothing.

Unknown said...

Given the political reality of having to build a system on top of the private insurance model the ACA is fundamentally a great leap forward in insuring all of us have medical insurance. As the states wanted, via their federal delegations, it was built to preserve state's rights but then many states reneged at the last minute placing the responsibility on the Feds without much warning. No wonder it don't work in those states. The same can be said about those states that did not accept medicaid expansion - they are punishing their own people. Go ACA

Unknown said...

Given the political reality of having to build a system on top of the private insurance model the ACA is fundamentally a great leap forward in insuring all of us have medical insurance. As the states wanted, via their federal delegations, it was built to preserve state's rights but then many states reneged at the last minute placing the responsibility on the Feds without much warning. No wonder it don't work in those states. The same can be said about those states that did not accept medicaid expansion - they are punishing their own people. Go ACA

james gaulte said...

The problems with ACA are much bigger and probably much more long lasting that the website clown show.The insurance exchanges may not survive and of course slow enrollment of the young and healthy because of the website failure may play some role in that but other factors are at work. Paul Krugman offered similar comments to yours to the effect that at least some states were not doing too badly.The new web site ACA Death Spiral is a storehouse of nuanced analysis of many of the multiple problems regarding the economic viability of the Rube Goldberg system that ACA seems to be turning out to be.Maybe some ACP paying members would be interested in a serious discussion of those issues rather than a somewhat lame defense of ACA based on some states not failing with their signup numbers.At least now you admit statement by the administration were false,a more accurate descriptor that "misleading"

Ashok V. Daftary, MD, FACP. said...

One is entitled to one's opinions even if they are flawed as as those of the author of this blog. However, if they reflect the opinion of the American College of. Pyhsicians as the title of the blog suggests the blog should be more balanced and reflect other points of view The American Enterprise Institute has sponsored a multiple author publication which is more balanced....http://www.aei.org/issues/best-of-both-worlds/#mbl.
Today the New York Times no supporter of Republican politics offers a more balanced view than this blog. http://www.nytimes.com/2013/12/01/us/politics/inside-the-race-to-rescue-a-health-site-and-obama.html

Harrison said...


I couldn't agree with you more in criticizing Medicare.
It is all of those things.
And yet, it has a 2% operating budget, and it pays us promptly and it gives patients access to doctors and it took the place of a system that allowed elderly people to die more than they should have.

The private insurance industry for the elderly was a terrible failure, and so Medicare passed in the 60's with great support.

It has been run well enough that many in the Tea Party shouted to keep the government out of their Medicare.

Anyway -- for patients it has been a positive.
For doctors -- it is mixed.
It has made many doctors rich.
We have emphasized specialists over primary care for many reasons but it is absolutely true that Medicare has been a harmful force in that trend.
Medicare has also funded research -- at least indirectly by creating the market.
Cancer happens in the elderly.
If they were not getting funding to treat cancers, then who would do research into cancer?
The same is true for heart disease.

Medicare is too big to judge it with a summary "good" or "bad".

But it is absolutely run by the government, and it is a huge part of our health care system, and so it does serve as a good counterpoint to the argument that the federal government cannot run health care programs.
Of course it can.
It runs the biggest one.


Unknown said...

Dear Mr. Doherty,
I live in California. I currently have a Kaiser Permanente HMO policy that is costs over $900/Monthly for just my wife and me.
The matching healthcare policy under ObamaCare is $1974/monthly. THAT'S $23,688/ANNUALLY!
That's not healthcare, that's GRAND THEFT ROBBERY!
Get a clue Bob. Check the price comparisons and LEARN there's no free lunch.
Wouldn't you agree Bob, I'VE BEEN ROBBED!

Harrison said...

To Sergey

I live in So Cal, and I'm not sure that the numbers you are reporting are comparisons's of apples to apples.

Kaiser did over bid everyone else in the individual markets.
Some think they did it on purpose.
It was a strategy, close to the strategy that United Health Care used.
United Health Care chose to sit out 2014.
They felt that sick people would sign up first, and so their costs would be high.
So they plan to put out bids for the second year, when they expect healthier people to sign up -- with lower costs.
Kaiser didn't do that, but decided to put in high bids to dissuade people from joining them, to keep down costs from sicker people.

But none of the numbers on the California Covered exchanges reach the level that you are suggesting.

I admit that I could be reading it wrong, and I have insurance through work and so I don't have to use the Covered California website -- but it can be viewed and I didn't see numbers that high.

I concede that I could be wrong.


Brock2118 said...

It's been a bit disconcerting watching my two self employed brothers struggle to find insurance after their insurers both left the business. The quoted rates seem higher than their old policies and they haven't been able to find if they qualify for subsidies or not, so its a very uneasy time.