A (Lack of) Progress Report


The car was careening down the hill.  The driver, desperate to stop, never touched the brake pedal.  Instead, he grabbed the emergency parking lever with both hands and violently pulled it towards himself.  It snapped off!  The car picked up speed.  The driver opened the door and abandoned the car.  He got up.  Dusted himself off.  And as he watched the out-of-control vehicle continue down the hill he declared that whatever happens, happens.  It was not his problem since he was no longer driving the car.

The Patient Protection and Affordable Car Act (PPACA) was signed into law March 23, 2010.  We have seen plenty of changes in how we pay for our health care delivery system over the last 3 ½ years.  But the biggest changes are scheduled for October 1, 2013.

Are we ready?

If you are a regular reader of this blog, you know the answer – Not Quite.

Let’s start with the policies.  As of right now, the cupboard is empty.  Anthem, Medical Mutual of Ohio, etc… are waiting for final approval.  Even if the policies are all approved on Monday, September 23rd, how do they all get loaded into the various computer quoting systems in eight days?  Brochures?  Ads?  Supporting documentation?  Is it realistic to believe that everything can be up and running in a week?

The new online insurance shopping portal, the Exchange, is another area of concern.  Once policies are loaded into the computers, how will we access them?  The insurers and agents are still wading through a convoluted system that is being created on the fly.  We are spending big bucks to create websites that will allow individuals to go to one site, plug in their information to determine their personal premium subsidies, and then apply for coverage.  Those connections are not in place.

The government is also not ready.  The software created to determine how much premium subsidy someone would receive is still not functioning at 100%.  Brian Cook of the Centers for Medicare and Medicaid Services (CMS) states that they have been rigorously testing the software for a year.  OK, but it is still failing.  Many people will base their choice of coverage on the net price of the policies.  If the subsidy calculations are wrong, we have the potential for real problems.  Can this be resolved in the next week?  That may be possible.

Those are some of the challenges we face to implement the President’s health care law.  Are these insurmountable?  Not really.

First and foremost, the October 1 date is not a drop-dead deadline.  If everything was working, Americans could begin to purchase policies on October 1st that would become effective on January 1, 2014.  It doesn’t matter whether the policy is purchased on October 1st or December 7th, the policy is still not going to start until January.  If the exchanges aren’t ready until November 1st, we can still have people covered January 1st.

The PPACA is a poorly written bill that attempted to do too much in too little time.  I have talked to our elected representatives, staffers, and Health and Human Services (HHS) employees.  They are not evil.  They mean well, but they may be in over their heads.

And that brings us to Senator Ted Cruz.  Mr. Cruz spends an inordinate amount of time talking about defunding “Obamacare”.  Let’s be clear – we are not repealing nor defunding the PPACA.  Mr. Cruz’s entire cynical campaign is a tactless fundraiser and a desperate cry for attention.  Shockingly, even political commentators on FOX are now calling him out as a huckster.

The insurance industry has spent millions upon millions of dollars to comply with this law.  The states have spent as much if not more.  Every business, even ones with only one employee, has had to complete forms and make decisions about health insurance.  Most of the policies for sale today will no longer be available in a few months.

Repeal the PPACA?  Will all of the money, the time, and the effort of the last 3 ½ years be for naught?  Which of the regulations stay on the books?  Which disappear?  Who will tell the sick that their insurance will cease on December 31st?

The people leading the charge to repeal the PPACA or worse, to simply defund it, will only serve to make a muddled mess worse.  They understand that the Patient Protection and Affordable Care Act could have been slowed or stopped by gently applying the brakes sometime over the last 3 years.  But they never touched the brakes.  Now the PPACA can’t be stopped.

The legislators who never tried to constructively modify the PPACA would like you to believe that they bear no responsibility for any of the problems.  They jumped out of the car.

We’re at the bottom of the hill.

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