Exactly What have We Accomplished???

The past couple of days, I have been following the news items relating to the Oregon Health Insurance Exchange imploding and defaulting to the Federal Government. While for most people, Oregon is far away, and potentially not relevant, I am saddened to see yet another state knuckling under to this tidal wave of craziness. Ironically, the justification for closing down their own exchange and defaulting to the government hinges on the exchange technology working improperly, and being too costly to repair or revise. Excuse me, but isn't that the same exact complaints voiced about the federal exchange program? Exactly what will improve for the residents of Oregon under the federal health exchange system?

Further reading revealed that the majority of applications processed in Oregon are of the paper variety which are lengthy and confusing. And, up to this point, by almost a 3-1 margin, those who have registered ( approximately 240,000 give or take a few) consist of those newly eligible for Medicaid, free insurance. The total number of people served in Oregon, after the exchange was open for six months constitutes approximately 6% of the total population for the state. And at just below 4 million residents, the total population of Oregon is smaller than some of our major cities nationwide....This is truly spit in the ocean as far as measuring success at making healthcare affordable for everyone in the United States

But lest I be accused of being biased or unfair, we will turn our attention south to California, neighbor of Oregon, and another state to "successfully" operate its own exchange. California is, obviously, much larger by population, and in fact, represents 12% of our nation's population and yet comprises more than 17% of the total enrollment in ACA policies....(That total of 8 million signed up isn't looking so spectacular now, is it?) Well, California came in with 1.4 million of that 8 million total. In California, 88% of folks who enrolled will receive aid or subsidy to help pay the costs of their premiums. And aside from that, 1.9 million new Medicaid subscribers (free insurance again) were added to the over 3 million person expansion of Medicaid nationwide. A pattern is emerging here, and those who are going to get insurance free, or almost free seem to be the demographic make-up of participants.

And for those of you who are thinking that all my examples come from the "left coast", we will bring the discussion home to the state of Illinois, who expended something like 80 million dollars over 3 1/2 years to implement an exchange, only to default to the federal government instead at the last moment, because they simply could not make it work (At least the Oregon exchange sort of functioned for awhile, and residents of that state can feel that they got something for their dollars) And, Illinois residents experienced the full gamut of delay and frustration with an online process that simply didn't work right from the first day forward under the federal system.

The state claims home to 12.8 million, which is about three times the size of Oregon. A total of 113,733 completed health insurance applications through the exchange, so less than 1/10th of the total population signed up for ACA on the exchange. Yet our demographics on Wikipedia indicate that almost 14% of the residents of this state live below the poverty level. New federal guidelines say that you qualify for Medicaid benefits up to 138% of the poverty level, the the number of eligible is higher still. Combined with a recent Tribune article that stated almost 200,000, who thought that they had registered for Medicaid, did not actually have policies in place. Well, our records, as a state that is part of the federal exchange program, isn't so hunky dorey. So, one has to wonder why Oregon is so anxious to buy into the federal exchange system. Based upon the information available, Oregon was doing par for the course.

An article in the Motley Fool indicated that there is actually a grading scale for evaluating how an given state is doing regarding getting folks out to sign up for ACA. Illinois ranks at approximately 14th, and even garners a grade of "B". Basically, the grades are awarded, not so much on how successful you were, but rather how little you screwed it up. Illinois was only short by it's enrollment goals by 6% and therefore gets a B, just missing the "A" tier with the first 13 states (ironic number there) Also interesting to note that the 6% statistic pointed out is identical to the percentage of people assisted in Oregon. We seem to have come full circle and that Oregon, without the federal exchange served its population every bit as well as its neighbor California and better than Illinois, who even with the government exchange in place, is excited to announce that it is less than 25% behind on projected enrollment participation goals.

The success story of the ACA rollout includes the claim that 3 million have gained insurance due to the fact that they can stay on parent programs until they are 26 years old. But here is an interesting facet. In some states, the parents buy their programs on the exchange, and the kids are put into a state medical plan separate from their parents. I am not sure how that is a good thing, when the exchange supposedly needed the young and healthy to offset the older, the ill, and the uninsured. Reading further, however; I discovered that the goal was to insure that everyone had preventative wellness care, not necessarily sick care. So are we to assume that the same old same old applies?

If you are young and healthy, chances are you aren't going to the doctor anyway. Why would you? An accident perhaps? But according to the definition of preventative and wellness care, you are still going to be paying out of pocket for that accident. And if you are well, there is no yearly cap on benefits or maximum lifetime cap-on wellness and preventative care. Nothing was ever said about unlimited benefit for sickness issues. Supposedly, you cannot be denied coverage, but they are allowed to rate your program up by as much as 40% for pre-existing illness above what a healthy person would be charged, and they still may charge more for the guy who is 50 over the guy who is 25. (Although I am struggling with how they can claim 28% of new enrollees are between 18-35 if you are supposed to stay on the parent coverage until 26?) Fuzzy math, maybe.

And the biggest question is how many of the new enrollees were due to the ACA policy eliminating their jobs which eliminated their benefits? How many folks were notified that their insurance was to be cancelled, because it wasn't good enough, by ACA standards? In other words, did we actually address the 40+ million who were supposedly without coverage of any kind? At best, we might have covered 20% of that, but at what cost? If Illinios alone spent close to 80 million dollars preparing for the rollout of ACA, and we multiply that number as a median by 50 states, wouldn't it have been cheaper for the government to insure the 40 million directly, and offer subsidies to those who needed extended coverage due to pre-existing conditions? Exactly what have we accomplished for the vast sums of taxpayer dollars spent both at the state and federal level?

It seems that we have totally frustrated the American people. We have aggravated those who had insurance. We have upset employers, who in many cases were paying far more than the penalty to give their workers insurance programs. We have the insurance companies trying to figure the odds like a Vegas bookie in order to determine what will need to be charged next year to insure coverage for the policies that are in place. Some of the insurers on the exchange are already appealing to the federal government for bailout as they forsee their expenditures outstripping income before the year is out. In other words.....SNAFU. It is a military term used by our government's military personnel, but it is pretty reflective of what has gone on here, when government tries to take over the health care industry.

Filed under: Musings

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