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Obama faces huge challenge in setting up (Commiecare™) insurance exchanges
The Hill ^ | 11/25/12 | Elise Viebeck

Posted on 11/25/2012 10:21:41 PM PST by Libloather

Obama faces huge challenge in setting up insurance exchanges
By Elise Viebeck - 11/25/12 02:45 PM ET

The Obama administration faces major logistical and financial challenges in creating health insurance exchanges for states that have declined to set up their own systems.

The exchanges were designed as the centerpiece of President Obama’s signature law, and are intended to make buying health insurance comparable to booking a flight or finding a compatible partner on Match.com.

Sixteen states — most of them governed by Republicans — have said they will not set up their own systems, forcing the federal government to come up with one instead.

Another five states said they want a federal-state partnership, while four others are considering partnerships.

It's a situation no one anticipated when the Affordable Care Act was written. The law assumed states would create and operate their own exchanges, and set aside billions in grants for that purpose.

“There's no way around it — this is a big job,” said Sabrina Corlette, a health policy expert at Georgetown University.

Since different states have different insurance markets and different eligibility requirements for Medicaid, Obama’s Health and Human Services Department can’t simply take a system off the shelf as a one-size-fits all failsafe.

"You can't simply deploy one federal exchange across the board," said Jennifer Tolbert, director of state health reform at the Kaiser Family Foundation.

"Each state is different — their eligibility systems are different, their insurance markets are different. [HHS is] going to have to build these exchanges to fit into the context of each state."

Every state must have an exchange by Jan. 1, 2014, meaning HHS doesn’t have a lot of time to do a massive amount of work. The department could quickly run through a $1 billion fund designated for implementing the exchanges.

Experts have predicted that the department will soon have to tap budgets from its other programs to cover exchange costs. Other have said it might charge fees on the insurance purchased in its exchanges once they are launched.

And as it moves forward, the department will continue to deal with political battles. Speaker John Boehner (R-Ohio) on Wednesday said repealing Obama’s law should be one of the topics discussed in budget discussions in the lame-duck session.

The idea behind the exchanges is to match the uninsured with plans that meet their needs and reflect their eligibility (or not) for government help.

In practice, the process will require websites that can process massive amounts of personal information from users and yield search results for everyone.

An exchange portal might tell an uninsured woman she is eligible for a premium tax credit, for example, after processing her Social Security number and tax-return figures. Officials hope that woman would go on to compare relevant health plans available in her state and then enroll online.

Constructing these sites is just one task facing HHS when it comes to states that have decided not to do the job themselves.

Each portal will require a front end — the interface consumers will use to submit their information and shop for plans — and a specialized back end that is customized based on the state.

HHS will also construct a range of other systems: a federal data hub for verifying user identity; programs for user assistance; a way to certify that health plans meet federal standards; a way to navigate the exchanges via phone, or apply for coverage by mail; and so on.

While HHS has pushed back the cutoff points for states to choose how to run their markets, the department has indicated that the Jan. 1, 2014 deadline is holding firm.

“I personally haven't heard any discussion of a delay,” healthcare reform opponent Rep. Phil Gingrey (R-Ga.) recently told The Hill.

The administration faces challenges beyond the financial and technical, too.

The department has no knowledge of local insurance markets compared with state insurance regulators. It is also not likely to see its markets as a way to grapple with state-by-state health issues.

Dan Mendelson, CEO of consulting firm Avalere Health, gave obesity as an example.

“Say there's a really big obesity problem in a Southern state,” he said.

“If that state were running its exchange, it could say to insurers 'We want to make sure you have a plan that encourages diet and exercise.' Medicaid frequently does this. The program is always tailored to the specific needs of the state.

“By ceding the prerogative on their exchanges, states lose the opportunity to make those choices."

This might be the biggest difference between state- and federally-run exchanges, experts said, though consumers are not likely to notice as they shop for insurance.

“States that are moving forward with their own exchanges have a long history of regulating their insurance markets. These are states that are more likely to selectively contract with certain health plans," said Tolbert.

"States that are defaulting to a federally run exchange typically do much less regulation. If they had run their exchanges, they probably would have adopted a clearinghouse approach, which is what the federal exchange is going to do."

Experts expressed one main concern across the board — that people eligible for Medicaid but not for the exchanges might fall through the cracks in federally run systems, since enrollment in the program is run by states.

“That's the thing I'm most worried about,” said Judy Solomon, vice president for health policy at the Center on Budget and Policy Priorities.

“There has to be a smooth way to connect people with Medicaid.”


TOPICS: Crime/Corruption; Extended News; Government; News/Current Events
KEYWORDS: commiecare; exchanges; insurance; obamacare
I've got a *crazy* idea - leave people alone and have them find whatever insurance they wish to purchase. No need for the feds to butt in. Really.
1 posted on 11/25/2012 10:21:53 PM PST by Libloather
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To: Libloather

“Sixteen states — most of them governed by Republicans — have said they will not set up their own systems, forcing the federal government to come up with one instead.”

Any way of knowing which 16?


2 posted on 11/25/2012 10:30:10 PM PST by HokieMom (Pacepa : Can the U.S. afford a president who can't recognize anti-Americanism?)
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To: HokieMom

16 of 57 states...hard to tell.


3 posted on 11/25/2012 10:32:32 PM PST by max americana (Make the world a better place by punching a liberal in the face)
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To: max americana

;^)


4 posted on 11/25/2012 10:34:24 PM PST by HokieMom (Pacepa : Can the U.S. afford a president who can't recognize anti-Americanism?)
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To: Libloather

These exchanges look like a massive dating mining operation for the federales


5 posted on 11/25/2012 10:34:51 PM PST by Arthurio
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To: HokieMom

I’ve found these names so far in various articles. I hope they’re still correct:

Alabama
Alaska
Georgia
Indiana
Kansas
Louisiana
Missouri
Nebraska
North Carolina
Ohio
South Carolina.
Texas
Wisconsin


6 posted on 11/25/2012 10:39:52 PM PST by BlessedBeGod
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To: Libloather

Cardinal Dolan and the USCCB which he heads still SUPPORT Obamacare.

This means that the bishops of my Church are my ENEMIES, because they support totalitarianism. They supported it for decades, including the four decades in which the U.S. Government has been in the hands of the pro-abortion eugenics movement. During that time, they have refused to declare that politicians who promote abortion are bad Catholics. During that time, the Popes have continued to appoint bishops to the U.S. who will not oppose the destruction of my country.

The Church to which I belong is committed to the destruction of my country.


7 posted on 11/25/2012 10:44:42 PM PST by Arthur McGowan (If you're FOR sticking scissors in a baby girl's neck and sucking out her brains, you are PRO-WOMAN!)
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To: HokieMom

http://www.cbpp.org/files/CBPP-Analysis-on-the-Status-of-State-Exchange-Implementation.pdf

According to the link, there are 19 states declining to participate.


8 posted on 11/25/2012 10:45:13 PM PST by Montanabound
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To: BlessedBeGod

AFAIK, North Dakota is one of the states refusing to set up an exchange.


9 posted on 11/25/2012 10:45:41 PM PST by Arthur McGowan (If you're FOR sticking scissors in a baby girl's neck and sucking out her brains, you are PRO-WOMAN!)
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To: BlessedBeGod

You can add Maine to the list.


10 posted on 11/25/2012 10:51:10 PM PST by july4thfreedomfoundation (November 6, 2012.....A day that will live in infamy!)
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To: Libloather

They will never ever make the 2014 deadline. We have had some HIPAA mandates which were to be effective beginning in 2012 which are still being postponed. Private insurance carriers are good to go but Medicare isn’t.

Your idea isn’t crazy at all IMO. People who want insurance are going to get it on their own, those that don’t won’t. I don’t mind so much everyone having to have some level of coverage what I object to is BO telling me what I need to have covered. Personally I think all policies should be high deductible and primarily for inpatient services only, no carve outs to third party, no case management for outpatient services and no networks. Cut out everyone in the middle. Most doctors I know and work with will negotiate outpatient fees if you want to pay cash and there is no insurance paperwork necessary. I also have a real problem with pre-existing conditions being covered. Probably partially because it’s something I don’t have to worry about, but also because there simply is not enough money in the world to cover everything for everybody.


11 posted on 11/25/2012 11:05:37 PM PST by Grams A (The Sun will rise in the East in the morning and God is still on his throne.)
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To: Libloather
Constructing these sites is just one task facing HHS when it comes to states that have decided not to do the job themselves.

I hear Romney's IT team is available.

12 posted on 11/25/2012 11:16:49 PM PST by Vince Ferrer
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To: Montanabound

bfl


13 posted on 11/26/2012 12:15:04 AM PST by Brad’s Gramma (Psalm 83)
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To: july4thfreedomfoundation; Arthur McGowan; Montanabound

and South Dakota makes nineteen.


14 posted on 11/26/2012 12:54:54 AM PST by wita
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To: Libloather

“CommieCare”....better than “ObamaCare” because there are actually stupid people who believe he deserves credit for destroying our medical system and killing old people.


15 posted on 11/26/2012 4:18:25 AM PST by txrefugee
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To: Libloather

“No individual, company, business, nonprofit entity, or health insurance issuer offering group or individual health insurance coverage shall be required to participate in any Federal health insurance program created under this Act (or any amendments made by this Act), or in any Federal health insurance program expanded by this Act (or any such amendment), and there shall be no penalty or fine imposed upon any such issuer for choosing not to participate in such programs.”

http://www.coachisright.com/the-law-itself-says-virtually-no-one-has-to-participate-in-obamacare/

Does this work? It’s from the Obamacare law itself.


16 posted on 11/26/2012 4:18:32 AM PST by BuffaloJack (Children, pets, and slaves get taken care of. Free Men take care of themselves.)
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To: Libloather

The lousy federal government hasn’t even made a decent beginning in writing the regulations for the 2500 pages of CommieCare. How in Hades is anyone going to implement an enormous system when the bureaucrats are still trying to figure out what they are doing? No wonder thousands of physicians are planning to retire when this disaster kicks in.

And we thought that Amtrak and the USPS were badly run. At least, they couldn’t kill our parents and children.


17 posted on 11/26/2012 4:26:55 AM PST by txrefugee
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To: BlessedBeGod

Virginia has got to be on that list.


18 posted on 11/26/2012 4:28:56 AM PST by albie
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To: Libloather

The reason commiecare is a debacle is because it is about social engineering, not the delivery of good and affordable healthcare.

Commiecare was designed to kill off old people and seize the freedom of the younger people using their future health needs to bully them into submission.

This is what happens when communist dems get control. Everyone suffers.


19 posted on 11/26/2012 4:37:14 AM PST by dforest
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To: BlessedBeGod

Wonder why Florida isn’t on the list. I just picked up my retirement bunker down in beautiful red Lee County. Didn’t Pam Bondi and Florida lead the anti-commie care charge?


20 posted on 11/26/2012 4:40:25 AM PST by jersey117
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To: Libloather
Ask liberals which part of the description they disagree with:

The national, or the socialist?


21 posted on 11/26/2012 4:42:55 AM PST by Travis McGee (www.EnemiesForeignAndDomestic.com)
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To: dforest
This is what happens when communist dems get control. Everyone suffers.

The Democrats' Fallback Plan For When Obamacare Inevitably Fails

Congressional Democrats unmistakably anticipate the failure of ObamaCare, given they had already asked the CBO to price a formal public option for 2014. The proposal’s co-sponsor Rep. Raul Grijalva (D-Ariz.), now reelected to a sixth term, said “By reintroducing it, we make sure that people don’t forget this is a viable option…. as the health bill is implemented, more and more people are going to come to the realization that cost containment and competition aren’t as robust as they should be, because of the absence of the public option”. Later, John Conyers (D-Mich.) in 2011 re-introduced his nationalized single payer system called “Expanded and Improved Medicare for All Act” in his H.R. 676 bill to the House of Representatives, following President Obama’s State of the Union in which the president said that the ACA was open to change “if you have ideas about how to improve this law.” Conyers was quite direct when he unabashedly stated the Democrats’ end-game along with their standard canard: “Improved and Expanded Medicare for All is inevitable in America– it is just a matter of when it will happen. Single-payer health care systems have successfully contained health care costs and provided high quality health care in countries in Europe, Taiwan, Japan, and Canada.” And let’s not overlook proposed legislation aiming for total take-over of health care by Democrat-dominated state governments, such as in Vermont and Delaware.

Second, or perhaps in advance of single payer legislation, watch for the federal government to restrict doctors from practicing, or possibly even criminalize them, unless they accept all patients with insurance paying government-defined rates for medical tests and treatments.

22 posted on 11/26/2012 4:48:54 AM PST by Libloather (The epitome of civility.)
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To: txrefugee

“No individual, company, business, nonprofit entity, or health insurance issuer offering group or individual health insurance coverage shall be required to participate in any Federal health insurance program created under this Act (or any amendments made by this Act), or in any Federal health insurance program expanded by this Act (or any such amendment), and there shall be no penalty or fine imposed upon any such issuer for choosing not to participate in such programs.”

http://www.coachisright.com/the-law-itself-says-virtually-no-one-has-to-participate-in-obamacare/

Does this work? It’s from the Obamacare law itself.


23 posted on 11/26/2012 4:54:40 AM PST by BuffaloJack (Children, pets, and slaves get taken care of. Free Men take care of themselves.)
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To: jersey117
The governor of Florida appears to be waffling badly. At first he was against a Florida exchange, now he's saying he's only going to do "what's best for the people of Florida".

Well, you know what that means......

Leni

24 posted on 11/26/2012 4:56:28 AM PST by MinuteGal (Please Restore Former Format on FR "Latest Posts" Page ASAP !)
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To: jersey117
The more I think about it, the more that I am convinced the whole court thing was just for show and to placate the sheep. obama had to know the fix was in before agreeing to fast track the case to the Supreme Court.

The Republican Party redrew Allen West's District to include an area where thry were fairly sure he would be defeated and to add insult to injury, the State Republicans remained silent as a mouse in church and were as useless as a one leg man at an ass kicking contest while the Democrats stole the election from under his [Allen's]nose. Had the situation been reversed and the Democrat candidate, with a Democrat Governor, Atty.General, Secretary of State, the howls of protest would have resounded through out the universe.

25 posted on 11/26/2012 4:57:30 AM PST by sport
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To: Libloather
It doesn't matter. The more impossible the better.

His only goal is to "overwhelm the system."

26 posted on 11/26/2012 7:05:28 AM PST by E. Pluribus Unum (Labor unions are the Communist Party of the USA.)
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To: HokieMom

GA, TX, Ala for sure.


27 posted on 11/26/2012 10:22:01 AM PST by Georgia Girl 2 (The only purpose of a pistol is to fight your way back to the rifle you should never have dropped.)
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To: Libloather

28 posted on 11/26/2012 10:37:03 AM PST by COBOL2Java (The GOP-e said "Beat a Marxist with a Liberal!" What a colossal blunder.)
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To: Grams A

I don’t mind so much everyone having to have some level of coverage .... I also have a real problem with pre-existing conditions being covered. Probably partially because it’s something I don’t have to worry about,
- - - - - - -
Well I have a problem with both. ALL of my conditions are pre-existing, so I will be force to pay for health insurance that I can’t use.

Secondly, I have a RELIGIOUS OBJECTION to insurance and ALL Western Medical care, but they don’t care about that.


29 posted on 12/01/2012 8:31:28 AM PST by reaganaut (Kyrie eleison...Christe eleison...Kyrie eleison)
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To: jersey117
Didn’t Pam Bondi and Florida lead the anti-commie care charge?

Wasn't she the one on Romney's "healthcare team", who said he wanted RomneyCare nationwide?

30 posted on 12/01/2012 8:39:31 AM PST by Jane Long (Philippians 2:11)
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