Obamacare rollout status report: central place for updates

[michal1980]

Actually he did, an NPR blog summarizing a study showing 40% higher emergency room use by people enrolling in Medicaid via the ACA. That should surprise no one; people eligible for Medicaid are by defintion poor and/or low income and would have to prioritize medical expenses to important things. Now that we're all paying and with no ER premium to themselves, these people will naturally go more often for less-important health issues.

I doubt it stays 40% though. Besides being more expensive for those paying their own way, the ER is also typically slower for non-emergencies. I believe we'll see a lower increase in ER use as these people acquire family GPs. Even though they pay no ER premium, surely they value their time. We may also see a reduction in very expensive ER visits as these people can get something checked out before it becomes advanced and complicated to treat.

I don't see how you come to that conclusion where a very good study for the exact opposite result.

a 40% increase in er use is probably near the upper limit. But it being that large it would seem to reason that more people on Medicaid will lead to higher ER use not lower. Which means expanding Medicaid will increase spending on health care, not decrease it as Obama and the CBO estimated.

My point was even larger then that. By first own posts, ~4-6 million of the newly insured are on Medicaid. IE they are not paying for insurance. This can only lead to increased costs for everyone, especially in light of new evidence that those on Medicaid tend to use the most expensive care possible.

I can see the federal governments fix being exactly what the states that rejected expansion feared: lower federal reimbursements.

 

[michal1980]

You don't sign up for Medicaid through healthcare.gov.



Isolated study /= fact. Additionally, we don't know the exact additional cost.

how is it isolated? Its one state with that had a truly random distribution of expanded benefits.

That's far far better then some CBO pencil pusher moving decimal points around to make the numbers work for Obama

 

[tracerbullet]

Agreed, the study is a good one and worth looking into. I'm generally for the ACA and glad someone had the balls to try and make the system better, but it won't (at best) be without its hiccups. This study and likely others in the future are worth paying attention to for help in identifying problems before they occur on a larger scale.

If something can't proactively be put in place, hopefully something can be decided to be acted on if the time comes. Educating people when they don't need to go to the ER, making them at least partially responsible for the cost, not sure. I am however sure this study has merit and while not a harbinger of doom it is worth taking action on.

 

[werepossum]

I don't see how you come to that conclusion where a very good study for the exact opposite result.

a 40% increase in er use is probably near the upper limit. But it being that large it would seem to reason that more people on Medicaid will lead to higher ER use not lower. Which means expanding Medicaid will increase spending on health care, not decrease it as Obama and the CBO estimated.

My point was even larger then that. By first own posts, ~4-6 million of the newly insured are on Medicaid. IE they are not paying for insurance. This can only lead to increased costs for everyone, especially in light of new evidence that those on Medicaid tend to use the most expensive care possible.

I can see the federal governments fix being exactly what the states that rejected expansion feared: lower federal reimbursements.

It's of necessity a very short term study as Obamacare is squeaky new. My logic is this:
(A) Responsible person without health insurance spits up blood, decides to wait to see if it goes away. Some percentage of such cases will go away without treatment and some won't be materially affected by a delay, but some will be cancer, ulcers, and similar problems for which the cost to treat will exponentially increase if allowed to progress untreated.
(B) Same scenario with Medicaid, person probably gets checked out because his cost is minimal. In the first group, this costs society more for unnecessary treatment. In the second group, society's cost is unchanged. But in the third group, society's cost may go way down because cancer (and many other serious ailments) cost much less to treat if caught early and treatment for life-threatening problems is provided regardless of ability to pay. Even the best study hasn't had time to account for this effect. Also, there are indirect societal costs that are real but not easily counted. Obviously the loss of a productive worker is apparent, but less quantifiable things like children being raised without one parent (and statistically being less likely to grow up a productive citizen) also affect society's economic costs.

Clearly those claiming lower overall costs are lying for political purposes and I have no problems with this particular study, I'm just saying I can see some factors which in time should mitigate these additional costs to some extent. I am not a fan of Obamacare, but if we can end up providing health insurance for the roughly 15% of Americans without it for ultimately 25% or so increase in total costs, that's not such a bad deal.

 

[First]

Some more additional good news on the potential makeup of the risk pool of Obamacare enrollees, based on study done here. Excerpt:

Chances for keeping insurance premiums down and getting many more people enrolled under new Affordable Care Act policies this year are looking good, according to a new survey.

The survey found that about 1 in 4 adults visited an Obamacare exchange by the end of December. And more significantly, the vast majority of those who visited and are potentially eligible for coverage there—a total of 77 percent of those surveyed—reported being in either excellent, very good or good health, according to a statistical snapshot taken by the Commonwealth Fund.

And they were not disproportionately old as has been the case in the limited demographic data released by the Obamacare health exchanges to date.

In fact, 41 percent of the exchange visitors were 19- to 34-years-old, tracking their share of the general population of people eligible for coverage via the exchanges in either private plans or Medicaid, according to the Commonwealth Fund.

If those trends in health status and age hold up among the people who actually enrolled—and who will ultimately enroll—it increases the likelihood that insurers will not have to raise premium prices excessively next year to compensate for a bad risk pool that comes from having too many sick and old people signed up.

Slowly but surely, talking points fall by the wayside. Most predictable shit in the world.

 

[Fern]

Some more additional good news on the potential makeup of the risk pool of Obamacare enrollees, based on study done here. Excerpt:



Slowly but surely, talking points fall by the wayside. Most predictable shit in the world.

A quick read suggests this survey is about those who merely visited the site. That's irrelevant. The only thing that matters is who actually buys HI.

Fern

 

[First]

A quick read suggests this survey is about those who merely visited the site. That's irrelevant. The only thing that matters is who actually buys HI.

Fern

This is the only data we have at these early stages of ACA development, so your point, while true, isn't exactly news and hasn't been challenged.

 

[JEDI]

Jan. 10 (Bloomberg) –- Bloomberg’s Peter Cook reports on why Accenture is taking control over HealthCare.gov from CGI Group. He speaks to Emily Chang on Bloomberg Television’s “Bloomberg West.” (Source: Bloomberg)

 

[Bowfinger]

Jan. 10 (Bloomberg) –- Bloomberg’s Peter Cook reports on why Accenture is taking control over HealthCare.gov from CGI Group. He speaks to Emily Chang on Bloomberg Television’s “Bloomberg West.” (Source: Bloomberg)

From the Washington Post:

Obama administration to end contract with CGI Federal, company behind HealthCare.gov

The Obama administration has decided to jettison CGI Federal, the main IT contractor that was responsible for building the defect-ridden online health insurance marketplace and has been immersed in the work of repairing it.

Federal health officials are preparing to sign a 12-month contract worth roughly $90 million, probably early next week, with a different company, Accenture, after concluding that CGI has not been effective enough in fixing the intricate computer system underpinning the federal Web site, HealthCare.gov, according to a person familiar with the matter. ...

 

[chucky2]

Oh gezus, Accenture. Next they'll bring in IBM. <shudder> This might be getting worse before it gets better...

 

[boomerang]

Collateral damage. Hey, it happens when you try to assume control of a nation's economy.

Disabled Family Sees 300 Percent Increase In Health Insurance Costs Under Obamacare

Video report: An Obamacare odyssey for special needs family

 

[Matt1970]

Collateral damage. Hey, it happens when you try to assume control of a nation's economy.

Disabled Family Sees 300 Percent Increase In Health Insurance Costs Under Obamacare

Video report: An Obamacare odyssey for special needs family

"Their health insurance bill has gone up 300 percent and the family is looking at taking out loans and returning to work while on disability to pay the increased costs."

I get it, their premiums went up, but why the hell are they on disability of they can work?

 

[boomerang]

"Their health insurance bill has gone up 300 percent and the family is looking at taking out loans and returning to work while on disability to pay the increased costs."

I get it, their premiums went up, but why the hell are they on disability of they can work?

All I know is what is contained in the link. But they are probably on SSDI which has a cap on what they can earn. Getting on SSDI is a very lengthy process with a lot of hoops to jump through. They were probably smart and started the process immediately when the seriousness of their conditions became known. This is all conjecture.

 

[JEDI]

if on ssdi, don't they also get Medicaid? thus free healthcare

 

[spacejamz]

Jan. 10 (Bloomberg) –- Bloomberg’s Peter Cook reports on why Accenture is taking control over HealthCare.gov from CGI Group. He speaks to Emily Chang on Bloomberg Television’s “Bloomberg West.” (Source: Bloomberg)

The last update we heard was that everything was smelling like roses and all would be well by Jan 1...Now all of sudden, CGI has dropped the ball and is under performing...wonder if this why we haven't seen any updates on the obamacare system in awhile...

 

[theeedude]

Sounds like they are barking up the wrong tree.

Their children, Austin and Michaela, received coverage through a private Blue Cross plan and a state program that pays for uncovered care related to the bone disease. This fall, like millions of others, the family learned that the private plan was canceled.

So, the Republican run state doesn't want to pay for their bone disease program anymore, and refuses to accept Medicaid expansion to help these folks, and Obamacare is to blame? There is nothing stopping the state from subsidizing an Obamacare plan like they were subsidizing the old Blue Cross plan. At the very least, they should get out of the way and let these kids get expanded Medicaid they would be getting if their state wasn't run by Republicans.

 

[berzerker60]

how is it isolated? Its one state with that had a truly random distribution of expanded benefits.

That's far far better then some CBO pencil pusher moving decimal points around to make the numbers work for Obama

Why would the CBO give a shit about making numbers work for Obama? He doesn't appoint its director, and he sure doesn't appoint its pencil pushers.

Do you just not like them because they don't always tell you what you want to hear?

 

[JEDI]

how did millions more people wind up on Medicaid because of obamacare?
thought most repub states refused Medicaid expansion?

 

[sactoking]

how did millions more people wind up on Medicaid because of obamacare?
thought most repub states refused Medicaid expansion?

If a serious question:

The publicity and mandate is likely the cause. For example, we have 10,000 more Medicaid enrollees through 12/31/13 than normal. Even though we're a Medicaid expansion state, none of the additional 10,000 enrollees are newly eligible, since coverage wasn't effective for them 12/31/13 they're not counted in the enrollment statistics for Medicaid. This can only mean that they were previously eligible for Medicaid and, for whatever reason, finally decided to enroll.

What recent factors could possibly cause someone who has been eligible for months or years to finally enroll?

 

[theeedude]

If a serious question:

The publicity and mandate is likely the cause. For example, we have 10,000 more Medicaid enrollees through 12/31/13 than normal. Even though we're a Medicaid expansion state, none of the additional 10,000 enrollees are newly eligible, since coverage wasn't effective for them 12/31/13 they're not counted in the enrollment statistics for Medicaid. This can only mean that they were previously eligible for Medicaid and, for whatever reason, finally decided to enroll.

What recent factors could possibly cause someone who has been eligible for months or years to finally enroll?

A lot of people live outside Republican obstructionist states.
BTW, we'd be a lot better off financially letting more people buy into Medicaid than subsidizing their private coverage on the exchanges.

http://content.healthaffairs.org/content/27/4/w318.full

Of course, GOP filibuster + Lieberman (whose wife is a lobbyist for private insurers) killed the public option. But that is one area where Obamacare can be improved.

 

[Matt1970]

A lot of people live outside Republican obstructionist states.
BTW, we'd be a lot better off financially letting more people buy into Medicaid than subsidizing their private coverage on the exchanges.

We would be better off just paying 100% of someone's healthcare than only having to pay a portion of their private coverage? That must be another Obama promise.

 

[fskimospy]

If a serious question:

The publicity and mandate is likely the cause. For example, we have 10,000 more Medicaid enrollees through 12/31/13 than normal. Even though we're a Medicaid expansion state, none of the additional 10,000 enrollees are newly eligible, since coverage wasn't effective for them 12/31/13 they're not counted in the enrollment statistics for Medicaid. This can only mean that they were previously eligible for Medicaid and, for whatever reason, finally decided to enroll.

What recent factors could possibly cause someone who has been eligible for months or years to finally enroll?

Most likely publicity, enrollment resources, and an individual mandate. Emphasis on publicity and enrollment resources.

 

[fskimospy]

We would be better off just paying 100% of someone's healthcare than only having to pay a portion of their private coverage? That must be another Obama promise.

Medicaid is dramatically more efficient than private insurance so in a sense, yes.

So if you're talking about Medicaid vs no insurance the costs are likely higher bit of you're talking Medicaid vs the private sector, Medicaid wins pretty easily.

 

[JEDI]

If a serious question:

The publicity and mandate is likely the cause. For example, we have 10,000 more Medicaid enrollees through 12/31/13 than normal. Even though we're a Medicaid expansion state, none of the additional 10,000 enrollees are newly eligible, since coverage wasn't effective for them 12/31/13 they're not counted in the enrollment statistics for Medicaid. This can only mean that they were previously eligible for Medicaid and, for whatever reason, finally decided to enroll.

What recent factors could possibly cause someone who has been eligible for months or years to finally enroll?

so people who could have gotten free healthcare and possible suffered because they didn't know any better finally enrolled because of obamacare publicity?

+1 for obamacare in my book.
(I guess -10 if yur a repub state.)

 

[theeedude]

We would be better off just paying 100% of someone's healthcare than only having to pay a portion of their private coverage? That must be another Obama promise.

The 100% would be less than the subsidy. But the idea of the public option was to let people buy into Medicaid with their own money.