Obamacare Ain't Lookin' Too Caring

Are you confused about Obamacare?  Sick of listening to spin when your life is on the line?  We thought so.  It is still difficult to obtain a concise, clear picture on what is happening to America's health care.  We gather below a few critical snippets of information which point to more impending disaster for the individually insured.

 

The Tech

First there is the failure of the website.  This should be no surprise that the financial back end contract was a no bid award to BlueCross BlueShield via their subsidiary.

Invisible to consumers are what Chao called the "back office systems." Those include accounting and payment systems to send premiums to insurers and transfer funds to insurers that attract more than their share of customers with high medical costs.

The no-bid contract awarded to Novitas includes these systems. Novitas is a subsidiary of Diversified Service Options, which is wholly-owned by Blue Cross and Blue Shield of Florida.

The costs and timelines for these websites are astounding and goes to show how the U.S. government contract system is major bloatware to the U.S. taxpayer.  Over and over America pays and gets little in return when it comes to tech contracts.  So far, 24 states have been paid $4.4 billion to set up websites.  The Federal site has already racked up a huge bill and is expected to cost $634 million.  Now reports are surfacing 40% of the site hasn't even been implemented.  As it stands, government has paid $714 per person needed to sign up for on-line health care exchange websites.  Websites that do not actually work.

Up to 40 percent of the technology needed to run the new Obamacare health insurance marketplace has not yet been built and will not be ready when insurance companies start sending in bills when coverage begins January 1.

That's not the 500 million lines of bloatware code America has been told about on the healthcare.gov site, this is completely missing software.  Forty percent of a missing design is vaporware.  Vaporware is a term used for fraudulent startups who bilk inventors by claiming they are making a product which doesn't actually exist.  Indeed experts looking into healthcare.gov are recommending the entire site be scuttled and rebuilt from scratch.  Costs to $634 million and this is the end result, bloatware and vaporware.  Oregon's site is so bad, not one person has been able to sign up with it.  Oracle, yet another company loaded with H-1B foreign guest workers, has 44 major functions on the site not working at all.

The tech situation is not surprising considering government officials were involved in technical design decisions.  A key critical component in any website design is the database.  Surprise, government officials insisted on using a proprietary noSQL database from MarkLogic, a privately held company.  This is an astounding revelation for scalability in enterprise sites is a key feature and going with an unproven database is just asking for trouble.

 

The Costs

Horror stories on the costs of insurance are pouring in.  Obamacare is supposed to give subsidies for anyone making less than $45,900 a year, or 138% to 400% above the poverty line.  Yet CNN found many will not receive a subsidy, simply because the insurance premium is lower than expected.  In other words, the subsidy calculator by itself is a complex absurdity maze.

To calculate premium subsidies, the government sets a maximum amount that low-income customers will have to pay for insurance as a percentage of their income. That cap is then subtracted from the cost of a mid-level insurance plan in the individual's region, and the difference is their subsidy. The insurance companies knock that amount off the price of premiums before the customer pays. But if the baseline plan is cheap enough, the formula is thrown off and the subsidy is zero.

Subsidies are additionally based on geographical location as well as age.  Now think about geographical location in a semi-rural area and health insurance being based on that region.  First, people are more mobile, at least for working and second, one can have no competent doctors for miles in semi-rural areas and people need to drive to a city 100 miles away.  Guess what, Obamacare is trying to define where someone can obtain healthcare to very small geographical areas as implemented by most insurance companies.  This is horrific and creates captive customers, almost micro-monopolies where one's health is captured by what address one resides at.

In cities, children's hospitals and even the Mayo Clinic are not covered by the new policies.

Many of the people who buy health plans on the exchanges have fewer hospitals and doctors to choose from than those with coverage through their employers. A number of the nation’s top hospitals — including the Mayo Clinic in Minnesota, Cedars-Sinai in Los Angeles, and children’s hospitals in Seattle, Houston and St. Louis — are cut out of most plans sold on the exchange. In most cases, the decision was about the cost of care. In Seattle, the region’s predominant insurer, Premera Blue Cross, decided not to include the children’s hospital as an in-network provider except in cases where the service sought cannot be obtained anywhere else.

Generally speaking policies are severely restricting the physicians and facilities one can go to.  While this is especially bad news for people in semi-rural areas where to find a decent Doctor often requires a two hour drive, there are severe limitations on choice in large cities as well.  The limits to geographical areas for health care severely impacts rural areas, where there are more self-employed and people needing individual health insurance policies, yet almost half of the physicians and facilities in large cities are also not covered under individual policies being offered.

The costs are on average 41% higher than before Obamacare for premiums.  Pundits will talk about the terrible coverage allowed under previous plans yet Obamacare allows for 40% copays under the so called bronze plans while premiums are much higher.  The specific cost and policy details are still so hidden and complex some in the press are offering an interactive map as well as a subsidy calculators to help navigate even a portion of the costs.  Yet obtaining the actual contract, along with the coverage details is still next to impossible to come by.  Generally speaking people finally obtaining even the insurance premiums quotes with out the policy details are having major sticker shock.  The bronze level plan 60% coverage is simply horrible in terms of deductibles and copays.  Overall, health insurance deductibles are on average 27% higher with Obamacare.

The average prices for the most popular plans are twice as high in the most expensive states as those with the lowest average prices,

PPOs, the most popular type of health care plan, carry monthly premiums that range from an average of $819 a month in the most expensive state to $437 in the least expensive. Plans on the federal and state exchanges are grouped into four categories that cover 60% to 90% of out-of-pocket costs.

While all of this is going on for individuals, hospital and medical bills are outrageous with nothing forcing the health care industry to publish prices and be actually competitive.  In fact secret pricing on health care costs is one of the main reasons America pays three times more in health care than any other industrialized nation.

 

The Latest

When Obamacare passed, most knew true health care reform just died and the entire bill was a gift to the for profit health care business.  Some are pointing out Obama's rollback to allow older policies as yet another blank check for insurance companies:

The text of the law is clear, and it places no limits on how much this program may pay insurers. It gives, in essence, a blank check to the secretary of health and human services to make payments to insurers to cover their losses.

Politicians are still spinning this disaster by claiming a surge of enrollments, around 200,000 out of the needed 7 million, have occurred, about 3% of the people needed.  Political football with people's health continues as the Obamcare open enrollment has been pushed back by a month.  This puts Obamacare open enrollment after the 2014 elections, a point not missed by the GOP.

Republican lawmakers are pushing back hard against the Obama administration's decision to delay next year's open enrollment season for health coverage under ObamaCare until after the 2014 midterm elections.

The Department of Health and Human Services announced Friday it would allow consumers to start signing up for coverage under ObamaCare on Nov. 15, 2014, a month later than originally scheduled.

Pushing back dates, backpedaling on existing policy temporary continuances still does little for the self-employed.  The individual is still getting churned and burned in Obamacare political swampland.  While politicians spin and play political football, real people with real health care needs are being turned inside out and upside down trying to obtain and retain coverage along with competent care.  The extension of existing policies for a year does little beyond buying time.  After all such crappy individual health insurance with their swiss cheese coverage and to the moon deductibles was a major reason for health care reform in the first place.  Now instead of healing the sick, America is being buried under a sea of spin.  The costs, the geographical limitations and choice of provider limitations the ACA brings is being buried and thus not seeing the public outrage light of day.  People are going to die from all of this and once again we have lobbyists, the for profit health care industry and their political puppets to thank.

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Comments

Just pray never get sick or old?

Honestly, in the US, what are we supposed to do? I mean EVERY PERSON has to face these issues. Any disease or an accident could literally bankrupt someone and their family. And we all get old, so there's that inevitable health issue. Add in unforeseen accidents on the road or while making bank for someone else in a factory or warehouse job or mining job while risking life and limb without any medical or other benefits = disaster. (Time for the "any job is better than no job" reply unless of course it kills you or takes a limb). Toss in a spouse's pregnancy, or a sick kid, or cancer, or asthma, diabetes, MS, etc. Anything could bankrupt us. A single trip to the hospital could do it. A year's worth of medication could. There's no answer, none. I wish I didn't have to get old and could avoid all accidents and any risk of a disease. If only . . . But it looks like no healthcare and crappy jobs are here to stay.

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Why did they choose MarkLogic DB?

I suspect MarkLogic’s relationship to Zynx Health was a primary reason it was selected. Zynx Health is a “care plan” development system used by hospitals and other medical facilities. MarkLogic (Zynx Health) has been used for an “evidence-based clinical decision support” system at Cedar Sinai. For example— the DB would help the admitting physician create “care plans” for patients being discharged from the facility. That plan would rely on medical data (“evidence”) collected from the patient during hospitalization. This data could be compared to values (such as DRGs) used for classifying the patient’s diagnoses. The DB would be capable of accessing individual patients’ electronic health records (EHRs) and using it for actuarial purposes to help set premiums in the future. Ultimately clinical data used for supporting clinical decisions and actuarial decisions would be contained in the same DB.

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mixing patient records with insurance, SS numbers what?

Mixing private, protected by HIPAA law sounds nuts and the wrong application. A database that is not designed for real time responses, i.e. internal and on a LAN at best, for a website needing to process financial data in real time sounds nuts.

In other words, more and more it sounds like they didn't bother to hire some American engineers who know what they are doing and put them in charge of the architecture and system design. In any tech/engineering firm, one would have a CTO and a VP Engineering and that is where design decisions would come from, not bureaucrats with lobbyists and no bid contracts.

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Mixing patient records

I have been interested in medical record systems for many years but I never heard of NoSQL. Apparently, MarkLogic is an Enterprise NoSQL system that can manage many different formats like radiology images, pdfs and it can easily sort demographic. I think CMS wanted to integrate population data (clinical) with insurance data (actuarial). They want robust system that can be used for data mining. Some people think there was a “political” reason for choosing MarkLogic but I doubt this is true. Some people are confused by HIPAA rules with regard to mixing different kinds of data. The financial aspect of this is interesting. HIPAA prohibits “marketing,” which means a private company cannot purchase demographic information for data mining. But it allows “fundraising.” This means a health care provider (usually a hospital) can use limited data mining to target potential donors.

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social media troll pimping for MarkLogic?

I find this interesting and if you want to promote this company as comment spam, probably making 10¢ to write a comment, this is the last one here.

Most databases handle different mime types (image, pdf, text, etc.), noSQL is simply a type of database, if they wanted noSQL, they should have chosen MondoDB, it is already proved to scale and is utilized in high traffic sites, many with numerous transactions, sensitive financial and personal data, security, such as eBay. Or plain talk to Amazon for Amazon obviously has one of the most complex, dynamic systems in the world plus they do pretty gosh darn good at cloud architecture.

It has to be political, it obviously is for there are already proved databases, Erlang as a backend language, etc. which are robust, known to scale and some funky little startup gets the contract, don't think so.

There is no good reason to mix financial data with clinical data in an online system on the web. That's also just putting a big invite system to hackers to steal financial data and also gain access to personal medical records.

Gez, this is just unbelievably stupid and once again shows how Government contracts, bureaucratic, lobbyists with their H-1B, foreign Visa labor equals guaranteed failure.

That's the bottom line, there are plenty of Americans, many who need a job, who could have solved this and had a solid system implemented in probably 1 year.

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ProPublica on California, success, not

ProPublica did an article just on California and it's fairly shocking. They confirm in California what we report here, yet they also expose some serious spin by the press. CA is not the success touted.

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Obamacare website

is supposedly functioning now, although what functioning is yet to be seen. They did bring in someone from Google, so I expect this will start to get fixed, although how fast he can do it is in question. That still leaves the coverage, the lack of available physicians and higher premiums, which should actually be the focus on the problems, not the website.

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She’s a 29er

By CASEY B. MULLIGAN

"Employees in families with income of less than 400 percent of the poverty line will lose access to generous federal subsidies if they make themselves eligible for employer health coverage by working full time at an employer that offers coverage to such employees. In other words, employees may have something to gain, or less to lose than they did before this year, by limiting themselves to a 29-hour work schedule....As the new law goes into full effect the next couple of years, I expect that more than 2 percent of workers will be 29ers."

economix.blogs.nytimes.com/2014/01/29/shes-a-29er/

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