Tag: Health insurance exchange

Hoist By Their Own Petard

Let’s remember, for just a moment, how Obamacare was passed. It was cobbled together by a team of industry insiders to cater to all the special interests. It was then sent to Congress, where it would be honed and passed. But when Scott Brown won the election in Massachusetts, they suddenly did not have a filibuster-proof majority. So they rushed it through on a budget reconciliation. As a result, the bill contains a lot of bad language, poor wording and unclear statutes. Nancy Pelosi famously said we had to pass it find out what was in it. And now we’re finding out that what’s in it could destroy it.

Earlier this week, the DC Circuit Court ruled that the Obamacare subsidies could not be given to people whose states had not set up insurance exchanges because the law did not specify it. Liberals screamed blue murder about activist courts and people losing insurance and other arguments from the “Oh Come On!” school of jurisprudence. They said that Michael Cannon and Cato and other people arguing that the subsidies were meant to be withheld to force states to set up exchanges were “sociopaths” who would say anything to take insurance away from the poor. They’re livid that Obamacare might be overturned by what they’re calling “a typo”:

his week, Jonathan Gruber appeared on MSNBC to assert that the DC Circuit appellate court got the ObamaCare statute all wrong in its Halbig decision. Gruber, one of the key architects of the ACA and of the Massachusetts “RomneyCare” law that preceded it, insisted that the state exchange requirement for subsidy payment was purely accidental. “It is unambiguous this is a typo,” Gruber told Chris Matthews. “Literally every single person involved in the crafting of this law has said that it`s a typo, that they had no intention of excluding the federal states.”

Even if that were true, these kind of typos are what you get when you shove a law through without reconciliation. And while “everyone” might agree that Congress intended the mandates to be universal, it’s difficult to tell what Congress intended because Congress barely debated the fucking thing.

But is it true that Congress intended the subsidies to be universal? For that, we should ask one of the architects of Obamacare such as … um … Jonathan Gruber?

Two years ago, though, Gruber gave a much different explanation for this part of the ObamaCare statute. Speaking at a January 2012 symposium for a tech organization that this was no typo. It was, Gruber said, a deliberate policy to twist the arms of reluctant states to set up their own exchanges — and that a failure to do so would mean no subsidies for their citizens.

You can go to Hot Air and watch the video, including the full video that shows this was not taken out of context. Gruber has since said his words were a “speak-o” and he was mistaken. If so, this Obamacare architect — who was paid a cool $400,000 for his contribution — now appears to have made that “speak-o” multiple times.

As Ed Morrissey points out, this doesn’t really matter for the court case. The Court will be considering Congressional intent not consultant intent. And to be perfectly frank, Gruber is a hack who will say whatever the Obama Administration wants him to say. If he got a memo saying that Obamacare was actually French Toast, he’d be handing out eggs and butter at these meetings.

But it does make for some great entertainment to watch these guys flounder around trying to explain what the bill really means.

The Foreseen Disaster

The Obamacare website is failure, the exchanges aren’t working and the President held a press conference yesterday that amounted to, “it was on fire when I got here”. Oh, well, I’m sure this disaster was a complete surpri … oh:

Days before the launch of President Obama’s online health ­insurance marketplace, government officials and contractors tested a key part of the Web site to see whether it could handle tens of thousands of consumers at the same time. It crashed after a simulation in which just a few hundred people tried to log on simultaneously.

Despite the failed test, federal health officials plowed ahead.

When the Web site went live Oct. 1, it locked up shortly after midnight as about 2,000 users attempted to complete the first step, according to two people familiar with the project.

Obama is trying to blame everyone else: it’s Republicans fault for not setting up state exchanges, it’s the media’s fault for harping on the failures, it’s the public’s fault for loving Obamacare too much. But in the end, they had three years and tens of millions of dollars to make it work and it’s not anywhere close to working.

A responsible “transparent” President would have acknowledged this in advance. He might have acknowledged that creating a national insurance exchange was a huge technical challenge and maybe even (gasp!) delayed implementation. But they pressed on anyway, afflicted the public with this cowpat of a website and are now desperately trying to pretend things are not so bad.

The Obamacare Stumble

I am Hal’s complete lack of surprise:

By the end of this week, states must decide whether they will build a health-insurance exchange or leave the task to the federal government. The question is, with as many as 17 states expected to leave it to the feds, can the Obama administration handle the workload.

“These are systems that typically take two or three years to build,” says Kevin Walsh, managing director of insurance exchange services at Xerox. “The last time I looked at the calendar, that’s not what we’re working with.”

These marketplaces often get described as a Travelocity or Expedia for health benefits. While that might be the case for the consumer experience, experts say the underlying technology is hugely more complex, a maze of interconnecting computer systems meant to deliver health insurance to 30 million Americans.

“The reality is, states and the federal government are building something new,” says Pat Howard, who runs state health issues for consulting firm Deloitte. “There’s a rough blueprint in terms of federal regulations, but there’s still a number of decisions that need to happen to operationalize this.”

Read the whole thing, including a lovely chart on the complexity underpinning these exchanges. It’s going to take years and cost immense amounts of money to get these exchanges going. And then we’ll see if it works. I expect the entire thing to fall over at least a few dozen times.

As I said, I’m not surprised at all. It’s difficult enough to build complex insurance markets from the bottom up. Building them from the top down, to borrow a phrase from P.J. O’Rourke, is like building the Great Pyramid from the top down. Right now, Obama is holding up a big pointy piece and the states are scrambling around for two million blocks of stone.

Update: Here’s the graphic of how the exchange system will work. No one could set up something like this on a timescale of months.