A New Worry Looms Online For The Affordable Care Act

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Insurance companies say they are finding numerous mistakes on a digital form that's essential for signing up through HealthCare.gov.

AP

Insurance companies say they are finding numerous mistakes on a digital form that's essential for signing up through HealthCare.gov.

AP

Saturday is the day the Obama administration promised it would have HealthCare.gov working smoothly for the majority of people who need to sign up for health insurance.

As the Obama administration scrambles to fix the glitch-plagued site, experts are beginning to worry about another problem that may further impair the rollout of the Affordable Care Act.

Health insurance companies say they're seeing numerous errors in a form that plays a vital part in the enrollment process. The problems are manageable so far, but many worry about what will happen if enrollment surges in the weeks to come.

The 834

It's safe to say that the vast majority of consumers have never heard of an 834 EDI transmission form, despite its crucial role in the process of signing up for health insurance. It's a kind of digital resume that tells an insurance company's computer everything it needs to know about an applicant, says Bob Laszewski, a health policy consultant.

"It contains all of the person's enrollment information, all the information that [an] insurance company needs to get this person entered as a policy holder," Laszewski says.

The 834 has been around for a long time. The architects of the Affordable Care Act intended for it to play a central role in the sign-up process, says Tim Jost, a professor of law at Washington and Lee University.

"The 834 information is information the insurers have to have to get people enrolled in coverage, which of course is the point of going through the marketplace," Jost says.

Multiple Mistakes Make Insurers' Jobs Harder

But health insurance companies say the 834s they are receiving from applicants on the federal and state exchanges have sometimes been riddled with errors, Laszewski says.

"Duplicate enrollments, people enrolling and unenrolling, inaccurate data about who's a child and who's a spouse, files just not being readable," he says.

Highmark Blue Cross Blue Shield of West Virginia has been steadily processing new customers ever since the launch of Obamacare this fall. But Highmark President Fred Earley says mistakes in the 834s are making the job harder.

"We've had some situations where the records don't track, or we've seen duplicates," Earley says. "We've had situations where we'll get a record to show that someone canceled coverage when we've never had a record to show they enrolled in the first place."

Earley says his firm has been dealing with the problems by calling up state and federal officials and correcting the mistakes. The exact cause of the problems is unclear. The Obama administration has been slowly making fixes, and officials say they're making progress. But Laszewski says the fixes are not fast enough.

"The error rates have been falling," he says. "HealthCare.gov has been making progress, but we're not to the point yet where people can trust that high-volume enrollment can occur and we won't have serious customer service problems."

Laszewski says the test will come over the next few weeks. People who want coverage to begin on Jan. 1 have until just before Christmas to sign up, and there's likely to be a surge of new applicants in the weeks to come.

"What happens if we start getting hundreds of thousands or millions of people signing up by the Dec. 23 deadline, and the insurance industry is receiving hundreds or thousands of these a day?" he says. "That's what everyone's worried about."

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3 Ways Obamacare Is Changing How A Hospital Cares For Patients

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3 Ways Obamacare Is Changing How A Hospital Cares For Patients

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These Californians Greeted Canceled Health Plans With Smiles

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Inequality Is (Literally) Killing America

Only a few miles separate the Baltimore neighborhoods of Roland Park and Upton Druid Heights. But residents of the two areas can measure the distance between them in years�twenty years, to be exact. That�s the difference in life expectancy between Roland Park, where people live to be 83 on average, and Upton Druid Heights, where they can expect to die at 63.

Underlying these gaps in life expectancy are vast economic disparities. Roland Park is an affluent neighborhood with an unemployment rate of 3.4 percent, and a median household income above $90,000. More than 17 percent of people in Upton Druid Heights are unemployed, and the median household income is just $13,388.

It�s no secret that this sort of economic inequality is increasing nationwide; the disparity between America�s richest and poorest is the widest it�s been since the Roaring Twenties. Less discussed are the gaps in life expectancy that have widened over the past twenty-five years between America�s counties, cities and neighborhoods. While the country as a whole has gotten richer and healthier, the poor have gotten poorer, the middle class has shrunk and Americans without high school diplomas have seen their life expectancy slide back to what it was in the 1950s. Economic inequalities manifest not in numbers, but in sick and dying bodies.

On Wednesday, Senator Bernie Sanders convened a hearing before the Primary Health and Aging subcommittee to examine the connections between material and physiological well-being, and the policy implications. With Congress fixed on historic reforms to the healthcare delivery system, the doctors and public health professionals who testified this morning made it clear that policies outside of the healthcare domain are equally vital for keeping people healthy�namely, those that target poverty and inequality.

�The lower people�s income, the earlier they die and the sicker they live,� testified Dr. Steven Woolf, who directs the Center on Society and Health at Virginia Commonwealth University. In America, people in the top 5 percent of the income gradient live about nine years longer than those in the bottom 10 percent. It isn�t just access to care that poor Americans lack: first, they are more likely to get sick. Poor Americans are at greater risk for virtually every major cause of death, including cancer, heart disease and diabetes. As Woolf put it, �Economic policy is not just economic policy�it�s health policy.�

Tracing health disparities back to their socioeconomic roots adds context to growing calls for pro-worker policies like raising the minimum wage and providing paid sick leave. Lisa Berkman, director of Harvard�s Center for Population and Development Studies, presented a range of evidence indicating that policies supporting men and women in the labor force�particularly low-wage and female workers�lead to better health for themselves and their families.

Continue reading…

Inequality Is (Literally) Killing America

Only a few miles separate the Baltimore neighborhoods of Roland Park and Upton Druid Heights. But residents of the two areas can measure the distance between them in years�twenty years, to be exact. That�s the difference in life expectancy between Roland Park, where people live to be 83 on average, and Upton Druid Heights, where they can expect to die at 63.

Underlying these gaps in life expectancy are vast economic disparities. Roland Park is an affluent neighborhood with an unemployment rate of 3.4 percent, and a median household income above $90,000. More than 17 percent of people in Upton Druid Heights are unemployed, and the median household income is just $13,388.

It�s no secret that this sort of economic inequality is increasing nationwide; the disparity between America�s richest and poorest is the widest it�s been since the Roaring Twenties. Less discussed are the gaps in life expectancy that have widened over the past twenty-five years between America�s counties, cities and neighborhoods. While the country as a whole has gotten richer and healthier, the poor have gotten poorer, the middle class has shrunk and Americans without high school diplomas have seen their life expectancy slide back to what it was in the 1950s. Economic inequalities manifest not in numbers, but in sick and dying bodies.

On Wednesday, Senator Bernie Sanders convened a hearing before the Primary Health and Aging subcommittee to examine the connections between material and physiological well-being, and the policy implications. With Congress fixed on historic reforms to the healthcare delivery system, the doctors and public health professionals who testified this morning made it clear that policies outside of the healthcare domain are equally vital for keeping people healthy�namely, those that target poverty and inequality.

�The lower people�s income, the earlier they die and the sicker they live,� testified Dr. Steven Woolf, who directs the Center on Society and Health at Virginia Commonwealth University. In America, people in the top 5 percent of the income gradient live about nine years longer than those in the bottom 10 percent. It isn�t just access to care that poor Americans lack: first, they are more likely to get sick. Poor Americans are at greater risk for virtually every major cause of death, including cancer, heart disease and diabetes. As Woolf put it, �Economic policy is not just economic policy�it�s health policy.�

Tracing health disparities back to their socioeconomic roots adds context to growing calls for pro-worker policies like raising the minimum wage and providing paid sick leave. Lisa Berkman, director of Harvard�s Center for Population and Development Studies, presented a range of evidence indicating that policies supporting men and women in the labor force�particularly low-wage and female workers�lead to better health for themselves and their families.

Continue reading…

21 Ways the Canadian Health Care System is Better than Obamacare

Dear America:

Costly complexity is baked into Obamacare. No health insurance system is without problems but Canadian style single-payer full Medicare for all is simple, affordable, comprehensive and universal.

In the early 1960s, President Lyndon Johnson enrolled 20 million elderly Americans into Medicare in six months. There were no websites. They did it with index cards!

Below please find 21 Ways the Canadian Health Care System is Better than Obamacare.

Repeal Obamacare and replace it with the much more efficient single-payer, everybody in, nobody out, free choice of doctor and hospital.

Love, Canada

Number 21:
In Canada, everyone is covered automatically at birth � everybody in, nobody out.

In the United States, under Obamacare, 31 million Americans will still be uninsured by 2023 and millions more will remain underinsured.

Number 20:
In Canada, the health system is designed to put people, not profits, first.

In the United States, Obamacare will do little to curb insurance industry profits and will actually enhance insurance industry profits.

Number 19:
In Canada, coverage is not tied to a job or dependent on your income � rich and poor are in the same system, the best guaranty of quality.

In the United States, under Obamacare, much still depends on your job or income. Lose your job or lose your income, and you might lose your existing health insurance or have to settle for lesser coverage.

Number 18:
In Canada, health care coverage stays with you for your entire life.

In the United States, under Obamacare, for tens of millions of Americans, health care coverage stays with you for as long as you can afford your share.

Number 17:
In Canada, you can freely choose your doctors and hospitals and keep them. There are no lists of �in-network� vendors and no extra hidden charges for going �out of network.�

In the United States, under Obamacare, the in-network list of places where you can get treated is shrinking � thus restricting freedom of choice � and if you want to go out of network, you pay for it.

Number 16:
In Canada, the health care system is funded by income, sales and corporate taxes that, combined, are much lower than what Americans pay in premiums.

In the United States, under Obamacare, for thousands of Americans, it�s pay or die � if you can�t pay, you die. That�s why many thousands will still die every year under Obamacare from lack of health insurance to get diagnosed and treated in time.

Number 15:
In Canada, there are no complex hospital or doctor bills. In fact, usually you don�t even see a bill.

In the United States, under Obamacare, hospital and doctor bills will still be terribly complex, making it impossible to discover the many costly overcharges.

Number 14:
In Canada, costs are controlled. Canada pays 10 percent of its GDP for its health care system, covering everyone.

In the United States, under Obamacare, costs continue to skyrocket. The U.S. currently pays 18 percent of its GDP and still doesn�t cover tens of millions of people.

Number 13:
In Canada, it is unheard of for anyone to go bankrupt due to health care costs.

In the United States, under Obamacare, health care driven bankruptcy will continue to plague Americans.

Number 12:
In Canada, simplicity leads to major savings in administrative costs and overhead.

In the United States, under Obamacare, complexity will lead to ratcheting up administrative costs and overhead.

Number 11:
In Canada, when you go to a doctor or hospital the first thing they ask you is: �What�s wrong?�

In the United States, the first thing they ask you is: �What kind of insurance do you have?�

Number 10:
In Canada, the government negotiates drug prices so they are more affordable.

In the United States, under Obamacare, Congress made it specifically illegal for the government to negotiate drug prices for volume purchases, so they remain unaffordable.

Number 9:
In Canada, the government health care funds are not profitably diverted to the top one percent.

In the United States, under Obamacare, health care funds will continue to flow to the top. In 2012, CEOs at six of the largest insurance companies in the U.S. received a total of $83.3 million in pay, plus benefits.

Number 8:
In Canada, there are no necessary co-pays or deductibles.

In the United States, under Obamacare, the deductibles and co-pays will continue to be unaffordable for many millions of Americans.

Number 7:
In Canada, the health care system contributes to social solidarity and national pride.

In the United States, Obamacare is divisive, with rich and poor in different systems and tens of millions left out or with sorely limited benefits.

Number 6:
In Canada, delays in health care are not due to the cost of insurance.

In the United States, under Obamacare, patients without health insurance or who are underinsured will continue to delay or forgo care and put their lives at risk.

Number 5:
In Canada, nobody dies due to lack of health insurance.

In the United States, under Obamacare, many thousands will continue to die every year due to lack of health insurance.

Number 4:
In Canada, an increasing majority supports their health care system, which costs half as much, per person, as in the United States. And in Canada, everyone is covered.

In the United States, a majority � many for different reasons � oppose Obamacare.

Number 3:
In Canada, the tax payments to fund the health care system are progressive � the lowest 20 percent pays 6 percent of income into the system while the highest 20 percent pays 8 percent.

In the United States, under Obamacare, the poor pay a larger share of their income for health care than the affluent.

Number 2:
In Canada, the administration of the system is simple. You get a health care card when you are born. And you swipe it when you go to a doctor or hospital. End of story.

In the United States, Obamacare�s 2,500 pages plus regulations (the Canadian Medicare Bill was 13 pages) is so complex that then Speaker of the House Nancy Pelosi said before passage �we have to pass the bill so that you can find out what is in it.�

Number 1:
In Canada, the majority of citizens love their health care system.

In the United States, the majority of citizens, physicians, and nurses prefer the Canadian type system � single-payer, free choice of doctor and hospital , everybody in, nobody out.

Mass. Gov. hopeful: Consider “single payer” care

From the AP –

Democratic candidate for governor Donald Berwick is pushing Massachusetts to take a second look at creating a truly universal health care system.

The former top Obama administration health care official said Thursday that the state should “seriously explore the possibility of a single payer system in Massachusetts” – a system which would effectively guarantee health coverage for all residents.

Massachusetts currently has the highest percentage of insured residents, but the system relies on a patchwork of private and subsidized care and falls short of universal coverage.

Many liberal Democrats have long said the best way to fix the health care system is to essentially offer Medicare to everyone, arguing that it would provide more coverage and is less cumbersome.

Berwick formerly headed the federal Centers for Medicare and Medicaid Services.

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Making Moves In Food Delivery, Chess And Health Care

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All Things Considered

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The online magazine Ozy covers people, places and trends on the horizon. Co-founder Carlos Watson joins All Things Considered regularly to tell us about the site's latest discoveries.

This week, Watson tells host Arun Rath about a delivery service that allows you to track your food in real time, a chess master who is making the board game sexy and his recent interview with President Bill Clinton.

The New And The Next Shaking Up The Food Delivery Model Enlarge image i Radius Images/Corbis Radius Images/Corbis

"A couple of young guys who were UC Berkeley grads � food obsessed � were finding that they couldn't get their favorite foods delivered. So, they starteda new service called Caviar, that for a flat fee is creating quite the Uber-like stir around San Francisco and now in Seattle and New York. ...

"They've got a lot of your basics, whether it's fish tacos or pulled pork sandwiches, but they also have some of the higher-end restaurants who in the past have been a little hesitant about delivery who have agreed to do it."

Read 'Caviar: Like Uber For Eaters' At Ozy.com

Sexy Moves In The World Of Chess Enlarge image i Courtesy of Ozy.com Courtesy of Ozy.com

"Chess is not always the sexiest sport. But the No. 1 chess player in the world is a young guy from Norway named Magnus Carlsen, who is becoming quite the sensation. He is not only a champion chess player but he is also a male model and that's a very different look from Bobby Fischer or Garry Kasparov, who were two other famous chess champions of the past. ... Guys like Kasparov and others are saying, 'I hope he does really well and puts chess back into the larger mainstream conversation.' "

Read 'Meet the New Ambassador of Chess' At Ozy.com

President Bill Clinton Talks Health Care With Ozy Youtube/YouTube

"He reminded us that when President George W. Bush rolled out the Medicare Part D plan that there also were a number of hiccups in the early days. So, that was his way of offering context to the current troubles with HealthCare.gov. And saying, be a little bit patient. While there may be a number of troubles in the first couple months with HealthCare.gov, they ultimately should be fixable and this won't have been the first time that we've had to smooth over some things in the early going."

Read 'Assessing the Healthcare Rollout' At Ozy.com

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Obama Moves To Delay Cancellations Of Insurance Plans

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Insurers Aren't Keen On Obama's Pledge To Extend Coverage

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'Holy Cow' And 'Kangaroo Court': Panel Grills HealthCare.gov Officials

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How The Affordable Care Act Pays For Insurance Subsidies

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Single-payer healthcare vs. Obamacare

“Medicare for all” isn’t perfect, but it does what the ACA can’t: Guarantee better healthcare and a simpler system

From Salon –

Whenever scandal arises in Washington, D.C., the fight between the two parties typically ends up being a competition to identify a concise message in the chaos � or, as scientists might say, a signal in all the noise. This week confirms that truism, as glitches plagued the new Obamacare website and as insurance companies canceled policies for many customers on the individual market.

Amid the subsequent noise of congressional debate and cable TV outrage, Republicans argued that the signal is about government � more specifically, they claim the controversies validate their age-old assertions that government can�t do anything right. Democrats countered that the signal in the noise is about universal healthcare � Obamacare is a big undertaking, they argue, and so there will be bumps in the road as the program works to provide better health services to all Americans.

This back and forth is creating an even more confusing cacophony � and further obscuring the signal that neither the two parties nor their health industry financiers want to discuss. That signal is about the need for single-payer healthcare, otherwise known as Medicare for all.

One way to detect this signal is to consider the White House guest list.

In trying to show that he was successfully managing the Obamacare rollout, the president last week staged a high-profile White House meeting with private health insurance executives � aka Obamacare�s middlemen. The spectacle of a president begging these middlemen for help was a reminder that Obamacare did not limit the power of the insurance companies as a single-payer system would. The new law instead cemented the industry�s profit-extracting role in the larger health system � and it still leaves millions without insurance.

The second way to see this single-payer signal is to behold the Obamacare-related congressional hearings. During the proceedings, you�ve been hearing a lot about the insurance enrollment website that the government is paying millions to insurer UnitedHealth Group to build. But you�re not hearing much about actual health care. That�s because the insurance industry wrote the Affordable Care Act, meaning the new statute�s top priority isn�t delivering health services. Obamacare is primarily about getting the insurance industry more customers and government contracts, whether or not that actually improves health services.

Continue reading…

Insurance Cancellations: The Price Of Mending A Broken System?

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