Why haven’t the exchanges done more for us?

Cancer Patients Snagged in Health Law’s Tangled Paperwork

By Ricardo Alonso-Zaldivar
Associated Press, February 15, 2016

Hundreds of thousands of people lose subsidies under the health law, or even their policies, when they get tangled in a web of paperwork problems involving income, citizenship and taxes. Some are dealing with serious illnesses like cancer. Advocates fear the problems, if left unresolved, could undermine the nation's historic gains in health insurance.

The government says about 470,000 people had coverage terminated through Sept. 30 last year because of unresolved documentation issues involving citizenship and immigration. During the same time, more than 1 million households had their financial assistance "adjusted" because of income discrepancies. Advocates say "adjusted" usually means the subsidies get eliminated.

"When people get that bill for a full-price plan, they panic and they cancel the insurance," said Elizabeth Colvin of Foundation Communities, an Austin nonprofit that serves low-income people. Some worry the problem could undermine the law's insurance markets, now in their third year.

"These problems can grow, and they can contribute to undermining consumer faith in the system, and that could lead to attrition," said Rachel Klein of Families USA, an advocacy group that supports the health law.

Pressured by a Republican-led Congress hostile to Obama's overhaul, the administration is highly sensitive to criticism that some people may be getting benefits they're not legally entitled to. But Health and Human Services Secretary Sylvia M. Burwell recently acknowledged the paperwork tangle is more likely to trap the innocent than fraudsters.


Costs, changes led Obamacare enrollment to fall short of earlier estimates

By Jayne O'Donnell
USA TODAY, February 16, 2016

The number of people who signed up for health insurance for 2016 on the state and federal exchanges was up to 40% lower than earlier government and private estimates, which some say is evidence that the plans are too expensive and that people would rather pay a penalty than buy them.

In 2010, the non-partisan Rand Corporation estimated 27 million people would have exchange policies this year and the Congressional Budget Office at that time was estimating 21 million for 2016. CBO even said last June that 20 million people would have plans purchased on the exchanges this year. Just 12.7 million signed up for plans, however, by the end of open enrollment Jan. 31 and about 1 million people are expected to drop their plans — or be dropped when they don't pay their premiums.



By Don McCanne, M.D.

Participation in the ACA exchanges is coming in at a much lower level than were the original predictions. Furthermore, significant numbers drop out each year, and many find that they receive significantly less financial assistance than they expected at enrollment.

Since the exchanges are not working as hoped, perhaps we need incremental innovations that would improve their functioning - you know, those incremental improvements some politicians and policy wonks keep telling us is all that we need to make ACA a universal, affordable system.

But what incremental change would expand coverage to absolutely everyone? What incremental change would make the plans affordable for everyone? What incremental change would ensure that access to care is affordable when facing very high deductibles? What incremental change would ensure that everyone would remain covered by their plans throughout the year, especially when there are so many different reasons that individuals lose their plans?

As mentioned many times before, the flawed health care financing infrastructure is not amenable to simple incremental patches. Keeping the same infrastructure will only perpetuate the severe deficiencies of our dysfunctional financing model. Many will remain uninsured. Many will not be able to afford health care, even if insured. And, worst of all, many will suffer and die.

Maybe we should start tallying the financial hardship, suffering and death in increments so that we can gradually feed that information to the incrementalists who insist this is a small price to pay for keeping intact the model that protects so well our private insurance industry. Maybe then they will understand the evil of defaulting to incrementalism.

Single payer would fix it.