[kenberg]

Cthulhu D, on 2013-December-11, 18:35, said:

As an Australian we have negotiated 'shared coverage' with a bunch of nations - so if a New Zealander gets treated here they quality for government assistance and visa versa. The US does not partake in these arrangements obviously, so you have to buy private travel insurance or get stuck with a huge bill - but private travel insurance for a trip to the US is almost twice the price of any other country because the US is a higher insurance risk due to the insanely high prices of care.

This is one of the reasons I hate travelling to the US.

I believe criticism of the U. S. is very valid on this point. In general, I think we do a very poor job of making visitors welcome here, both officially and unofficially.

I have never needed medical help while traveling (exception: In Cuzco I somehow thought that the way to get used to a high altitude was to go out and exercise vigoroiusly. Someone snapped an oxygen mask on me before I expired, no charge) but clearly it is a potential issue and, in my opinion, it wouldn't take all that much effort to reach a reasonable deal. The fact that Australia has agreements with many countries would seem to support this view.

[Cthulhu D]

We have 11 - but all are with countries that hold a single payer system (including Slovenia of all places), which suggests what the main challenge is. Coverage varies by country - I count as an NHS patient and am entitled to free healthcare and heavily subsided medication, but I must pay for dental care. In NZ I am covered for free emergency hospital treatment only and nothing else.

kenberg, on 2013-December-11, 18:58, said:

I have never needed medical help while traveling (exception: In Cuzco I somehow thought that the way to get used to a high altitude was to go out and exercise vigoroiusly. Someone snapped an oxygen mask on me before I expired, no charge) but clearly it is a potential issue and, in my opinion, it wouldn't take all that much effort to reach a reasonable deal. The fact that Australia has agreements with many countries would seem to support this view.

It's unlikely that you will be able to do so - the relative costs are hugely disadvantageous for you because it's so much cheaper for us to deliver healthcare. Its interesting to note that for me travel insurance is cheaper for countries where the promised response is 'we medivac you to a Singaporean or private Thai hospital via a charter flight if necessary' is cheaper than the US where they only promise the local hospital or clinic.

[kenberg]

I am coming to realize (well, fully realize) that I have very little feel for the scale of the ACA. I was stunned when an article about Kentucky had twice as many new Medicare sign-ups as new non-Medicaid policy sign-ups, but I thought maybe that would change, and then the national numbers in the article I cited showed this ratio still holding. But the total numbers are still small, where small means in terms of expected final totals. So I suggest some letters to represent numbers that are not yet known.

x= the number of people who will have signed up for non-Medicaid policies by December 23.
y=the number of people who will have signed up for non-Medicaid policies after December 23but before the end of March.
z=the number of people who are legally required to sign up for non-Medicaid policies before the end of March but don't do so.
m=.the number of people who sign up for Medicaid by the end of March.

My reason for distinguishing between x and y is that it seems the former represents people who are enthusiastic about the ACA. December 23 is (I think) the deadline for getting a policy on January 1. Those who sign up later are more likely to be doing so because it is required, rather than because they are eager.


The relevant values at the time of the NYT article I cited, http://www.nytimes.c...dayspaper&_r=1 , are
x=243,000 and m=567,000. Of course y and z are not yet meaningful.

Correction: According to MedPage at http://www.medpageto...ch/Reform/43359, the correct value for x at the end of November is x=364,682 . The smaller number was just for November. I don't think this corrected number leads me to any change in outlook. They also assert "Also, more than 803,000 people have been determined to be eligible for Medicaid, HHS said Monday.". That's a little vague. I suppose if they have been determined to be eligible they have signed up, but it doesn't say that.

If I understand it correctly, the Obama administration expects x+y to be about 7 million at the end of March. The cited MedPage article gives this figure, and I have seen it elsewhere. I don't know the administration's estimate for the eventual value of m, but I suppose that they have one. This all makes 364,682 a small number compared to 7 million, and so it is difficult to draw any reliable conclusions. I suppose that the current situation of having about 2 Medicais for every non-Medicaid policy is an anomaly and will change as the numbers get larger.

One thing that I get from the MedPage article is that others, more informed than I, are also wary of drawing conclusions.

I suppose that the CBO has estimates and predictions of all these numbers, and estimates of how they will break into more refined categories.

There is a story today about how it is going in Maryland

Quote

As of last Saturday, about 5,200 people had enrolled in private plans through the state-run exchange. O’Malley said he remains committed to a goal of signing up 260,000 people by the end of March — 150,000 in private plans and the rest in Medicaid.

Part of my interest is the Maryland estimate of 150,000 in private plans and 260,000-150,000=110,000 in Medicaid. So Maryland is expecting about 42% of the sign-ups to be Medicaid when all is done. This seems more reasonable than the 70% that appears to be the current national figure.

From what I have read, the Maryland health website makes the federal one look good by comparison. See http://www.washingto...ry.html?hpid=z3
The guy with the responsibility for running it is the frontrunner to be next year's Democratic nominee for governor. Dems may want to re-think this choice.

[kenberg]

Well, here we are at the 23rd. But where are we? Ezra Klein on Wonkbook mostly seems to just be trying to figure out what's up. Here is a link,

http://www.washingto...ewly-uninsured/

From the link:

Quote

As Sarah Kliff reported on Friday, Obamacare's four million Medicaid enrollments should ensure that the ranks of uninsured fall on January 1st. But it's also possible that hundreds of thousands — and, depending on whose numbers you believe, perhaps even millions — of people who had private insurance in 2013 will not have it on the first day of 2014.

What I have been seeing repeatedley is that the Medicaid portion of this initiative seems to be going a great deal better than the individual enrollment portion. I guess this should not be all that surprising.

Today is the last day to enroll so as to be on board on January 1. It seems reasonable to say that those who are enrolled by the end of the day are the ones who are at least reasonably happy with the idea. Or they accept it as necessary at least. Those who enroll later, in a plan starting later, are doing so because the law requires it, if they do it at all.

As far as I know, Klein has no agenda either against Obama or against the ACA, but he seems a little discouraged by the way this is going. I can see why.

The Sarah Kliff article referred to is at
http://www.washingto...age-next-month/

[PassedOut]

kenberg, on 2013-December-23, 11:38, said:

What I have been seeing repeatedley is that the Medicaid portion of this initiative seems to be going a great deal better than the individual enrollment portion. I guess this should not be all that surprising.

I've seen those reports too, so quite a few folks must have had problems enrolling. I don't know anyone who has had a problem with it.

I do know two people here in Upper Michigan who signed up individually and have already paid their premiums for January. They both waited until November and say they encountered no problems signing up. (One did say that it was tough to decide whether to go for a low premium or a low deductible, but at least the list of choices was easy to find.)

Usually what one reads in the news corresponds at least roughly with one's own experiences, but not in this case. I did get a HealthCare.gov account for business purposes in November (although I don't need a new policy for myself) and had no problem there either. I can't help but wonder how much of the complaining is based on reality and how much is propaganda from those politically opposed to the whole thing.

[kenberg]

Just out of curiosity, does MI have a state site or do you use the federal one? It seems, and again maybe predictably so, that the state sites are a real mixed bag. The Maryland one has been quite poorly implemented. The last time I went there it was an embarrassment to the state. I gather Oregon's is much worse. But there are, I think, some good ones. As near as I could tell from the Maryland site, you are not offered the option of just bypassing it and using the federal site.

It's probably a safe bet that it will take a while before anyone can say anything definitive about it all. The Klein article seems to accept as fact that a large number of previously insured people will no longer be insured as of Jan. 1. It is of course harder to say just why that is so. A lot of cases, so probably a lot of reasons. This will take time.

An added thought. As you say, usually experience and what you read have at least some match up. For me, part of this problem is that I have no direct involvement at all. I am watching from the outside and, with people whom I know that might be directly affected, mostly I don't know them well enough to ask a lot of personal questions. So, like Will Rogers, I only know what I read in the papers.

[PassedOut]

kenberg, on 2013-December-23, 13:39, said:

Just out of curiosity, does MI have a state site or do you use the federal one? It seems, and again maybe predictably so, that the state sites are a real mixed bag. The Maryland one has been quite poorly implemented. The last time I went there it was an embarrassment to the state. I gather Oregon's is much worse. But there are, I think, some good ones. As near as I could tell from the Maryland site, you are not offered the option of just bypassing it and using the federal site.

It's probably a safe bet that it will take a while before anyone can say anything definitive about it all. The Klein article seems to accept as fact that a large number of previously insured people will no longer be insured as of Jan. 1. It is of course harder to say just why that is so. A lot of cases, so probably a lot of reasons. This will take time.

An added thought. As you say, usually experience and what you read have at least some match up. For me, part of this problem is that I have no direct involvement at all. I am watching from the outside and, with people whom I know that might be directly affected, mostly I don't know them well enough to ask a lot of personal questions. So, like Will Rogers, I only know what I read in the papers.

Michigan does not have a site, so we use the federal site in our state. I just looked up to see when I created our account and it was October 20, not November as I posted above.

One problem we have here is that only in the last couple of days did Michigan vote to expand Medicaid and accept the federal reimbursement. So I expect that quite a few folks here are under some time pressure now.

[awm]

Of course, there is some question what it means to "have private insurance" especially prior to Obamacare. It seems that some people had "private insurance" which really didn't cover much of anything, in which case it's arguable that they were "always uninsured" rather than "lost their insurance." Further, insurance companies are known to cancel policies and raise rates every year for a long time prior to the Affordable Care Act, to the degree that blaming Obamacare for all the people who had their policies canceled is quite an exaggeration!

I've been seeing a lot of advertising recently for Covered California (our CA website for Obamacare), especially in places targeted to a younger audience (i.e. Hulu). Despite the rocky start we are also seeing a large number of signups. The "medicare expansion" type signups also happened a lot faster than the private insurance signups when this health care plan was implemented in MA so it's no huge surprise.

[mike777]

we see puplic employees often

they make points

too be fair...they win and make laws

[kenberg]

In the spirit of Christmas I was not going to say anything here, but then I read the Post. An article explains about efforts to reach the young.
http://www.washingto...ry.html?hpid=z1


An excerpt:

Quote

Though ads targeted at all age groups have generally been upbeat, those aimed at the young are markedly edgier, featuring sex, birth control pills, keg stands and knife accidents.

In one controversial ad, a young woman stands next to a man with his arm around her. “OMG, he’s hot!” she thinks. “Let’s hope he’s as easy to get as this birth control. My health insurance covers the pill, which means all I have to worry about is getting him between the covers.”

And later a response:

Quote

Laurel White, 25, a journalism graduate student at Northwestern University, said the ads could aim higher. “I wish that whoever is behind these efforts would have a little more faith in the intelligence and real-world concerns of 20-somethings,” she said.

We could so hope, but hope seems to have caught the last train heading south.

[Winstonm]

kenberg, on 2013-December-25, 08:11, said:

In the spirit of Christmas I was not going to say anything here, but then I read the Post. An article explains about efforts to reach the young.
http://www.washingto...ry.html?hpid=z1


An excerpt:


And later a response:




We could so hope, but hope seems to have caught the last train heading south.

One thing I think we all need to be careful about is the differentiation between federal website and federal ads and state websites and state ads. Although the basic driving force is the ACA, the ads quoted above are distinct to Colorado it appears to me.

In the old days, tv stations would provide free air time in the public interest to promote changes in the law - but I guess now that is not required as it cuts into the stations' profit margins.

[kenberg]

Winstonm, on 2013-December-25, 15:56, said:

One thing I think we all need to be careful about is the differentiation between federal website and federal ads and state websites and state ads. Although the basic driving force is the ACA, the ads quoted above are distinct to Colorado it appears to me.

In the old days, tv stations would provide free air time in the public interest to promote changes in the law - but I guess now that is not required as it cuts into the stations' profit margins.

Yes it's a state one and I trust many are better but it seems like an act of desperation.
Imagine an ad for a commercial product. I guy is standing near a women talking about how hot she is and hoping it's as easy to get her into bed as it was to get a loan at Friendly Freddie's.
I think a station wouldn't carry it. Or maybe I am just stuck in the last century.
And for that matter, my guess is that more than a few people, if they saw such an ad, would write off Freddie as a loser. I guess we will see how the people of Colorado respond to it.

I guess I will go back to ignoring this issue for a while.

[Winstonm]

kenberg, on 2013-December-25, 19:15, said:

Yes it's a state one and I trust many are better but it seems like an act of desperation.
Imagine an ad for a commercial product. I guy is standing near a women talking about how hot she is and hoping it's as easy to get her into bed as it was to get a loan at Friendly Freddie's.
I think a station wouldn't carry it. Or maybe I am just stuck in the last century.
And for that matter, my guess is that more than a few people, if they saw such an ad, would write off Freddie as a loser. I guess we will see how the people of Colorado respond to it.

I guess I will go back to ignoring this issue for a while.

For myself, I am encouraged that the healthcare problem was addressed but am disappointed in the method chosen to effect change. Worse yet, I am disgusted by the repeated attempts by opposition parties to derail even this modest healthcare progress.

[kenberg]

Winstonm, on 2013-December-26, 09:41, said:

For myself, I am encouraged that the healthcare problem was addressed but am disappointed in the method chosen to effect change. Worse yet, I am disgusted by the repeated attempts by opposition parties to derail even this modest healthcare progress.

You might like the following:
http://www.washingto...1fac_story.html

This is probably about as positive a view as can be managed, and in fact I am less favorably disposed. As I recall, Cassandra's life did not go so well after her predictions so I will hold off.

[Winstonm]

kenberg, on 2013-December-26, 10:18, said:

You might like the following:
http://www.washingto...1fac_story.html

This is probably about as positive a view as can be managed, and in fact I am less favorably disposed. As I recall, Cassandra's life did not go so well after her predictions so I will hold off.

Thanks, Ken. I still withhod judgement on how effective this thing will be - perhaps all it can really be is a small first step.

[Winstonm]

Huffington Post has an update on the rollout:

Quote

A December surge propelled health care sign-ups through the government's rehabilitated website past the 1 million mark, the Obama administration said Sunday, reflecting new signs of life for the problem-plagued federal insurance exchange.

Of the more than 1.1 million people now enrolled, nearly 1 million signed up in December, with the majority coming in the week before a pre-Christmas deadline for coverage to start in January. Compare that to a paltry 27,000 in October —the website's first, error-prone month — or 137,000 in November.

The figures tell only part of the story. The administration has yet to provide a December update on the 14 states running their own exchanges. While California, New York, Washington, Kentucky and Connecticut have performed well, others are still struggling.

It appears between California and New York another 650,000 have enrolled making an estimated, when the other states are added in, more than 2 million signed up.

[y66]

Guest post from Kathleen Sebelius via Tampa Bay Times:

Quote

As we wish our friends and family a happy, healthy new year, these words have renewed meaning in 2014.

Today is a new day in health care for millions of families and individuals throughout Florida.

It's now against the law for insurance companies to deny you coverage or charge you more because of a pre-existing medical condition like diabetes, high blood pressure, or asthma. And they can no longer drop you from coverage just because you get sick or get into an accident.

What's more, insurance companies can no longer impose an annual cap on your health benefits. They can't deny you coverage simply because you made a mistake on your paperwork. Most plans must now cover preventive services like cholesterol and cancer screenings, at no out-of-pocket cost. And, being a woman is no longer a pre-existing condition.

It's all thanks to the health care law: the Affordable Care Act.

If you do not have health insurance through your job, you have an opportunity to obtain quality, affordable coverage through HealthCare.gov. In fact, you may even qualify for financial assistance to help lower the cost of your premiums.

The Health Insurance Marketplace has brought choice and competition to Florida that were previously unavailable: In the Tampa Bay area you can choose from 102 qualified health plans.

As millions of Americans learn about their new options, they're finding just how affordable health coverage can be under the new law. A family of four in Tampa earning $50,000 per year can obtain affordable coverage for as little as $165 per month (with premium tax credits).

Nationwide, six in 10 uninsured Americans can obtain coverage for as little as $100 a month or less.

And make no mistake: The plans offered on the Marketplace are actual, honest-to-goodness health insurance. By law, they must cover a set of essential benefits, including visits with doctors, prescription medications, hospital stays, ambulatory care, maternity and newborn care and preventive services.

You still have three more months to enroll in affordable coverage — the deadline is March 31, 2014.

If you want your health insurance to begin Feb. 1, you'll need to sign up by Jan. 15.

You can enroll online at HealthCare.gov, by phone at 1-800-318-2596/TTY 1-855-889-4325, on paper, or directly through an insurer, agent or broker. You can also find in-person assistance in your own community at LocalHelp.HealthCare.gov.

This is a milestone for the many families who have waited too long for affordable health insurance because of a broken system that was stacked against them. Before today, Americans could be dropped from coverage when they got sick, or locked out of the system if they had a health condition, or priced out in the first place because of their health status. Now, not only are there new rights and benefits, we are also seeing the slowest health care price inflation in 50 years.

Whenever I travel to Florida, I meet folks who tell me how long they've been waiting for the opportunity to obtain affordable coverage. Some have even been waiting their entire lives.

I keep thinking about Mick, a Florida college student who I met recently. Using HealthCare.gov, Mick was able to enroll in coverage through the Marketplace for $47 per month. He's already paid his first month's premium, and now has secure, quality coverage that he can afford because of the financial assistance available to him through the law.

For Mick and for millions of Americans like him, it's a new day in health care because of the Affordable Care Act. And we continue to work together toward the goal of making affordable coverage accessible to every American who wants it.

This woman deserves the John Paul Jones award for 2013.

[mike777]

why?

I thought she spends your money...

[kenberg]

Mostly for Marylanders, but we are still part of the union.

Here in Maryland the state run plan is so badly fouled upo that the governor is now thinking (now? good grief!) of cancelling the site and telling people to use the federal site. See
http://www.washingto...ca3b_story.html

The numbers fly in and out. For example:

Quote

Maryland announced Friday that 61,322 people had enrolled through the exchange, although the bulk of those were through Medicaid. Perhaps as many as 5,000 remained mired in the Web site. That number is “an estimate, it may be more; it may be less,” said Maryland Health Benefit Exchange spokeswoman Dori Henry.

How many are on Medicaid, how many on private plans? Later we see

Quote

“Total private coverage enrollment of 18,257 Marylanders is only 12 percent of the private enrollment goal of 150,000 Marylanders, meaning the national level is outperforming Maryland,” Rep. John K. Delaney (D-Md.) said in a statement.

The population of Md is about six million.
What sort of problems are there?

Quote

State officials said they did not know how many people were unable to sign up on the exchange’s Web site, Maryland Health Connection, but estimated that it could be anywhere from a few hundred to as many as 5,000.

Translation: They have no clue.
Help is on the way. There will be some state aid for people who tried to use the state system but couldn't (the definition of "tried" is not given).

Quote

Officials said this short-term fix could cost the state $5 million to $10 million, depending on how many people enroll and how much medical care they need.

Yes, "depending on".

And:

Quote

State officials say they have made a series of improvements to the site and will continue to perfect it

Perfect it???? The options seem to be to try to get it marginally functional or junk it.


Of course the Marylad fiasco is not Obama's fault but it is still relevant. Early explanations of the federal site's problems were that fewer states than expected had put up their own sites. Maybe we should be thankful that they hadn't. As I understand it, in rankings of the state sites Maryland does not come in last, although iy is hard to imagine how someplace could be worse.

From the beginning, locally and nationally, this plan gas been subject to repeatedly stunning denial of problems. How can someone in January, when people should be enjoying their new health plans, be thinking that maybe the site needs more perfecting so that someone has some idea of what is going on?

I don't see how anyone can have any realistic confidence that this will end well. Maryland is, or was, regarded as a fairly well run state. This is truly embarrassing.

[Winstonm]

kenberg, on 2014-January-06, 08:04, said:

Mostly for Marylanders, but we are still part of the union.

Here in Maryland the state run plan is so badly fouled upo that the governor is now thinking (now? good grief!) of cancelling the site and telling people to use the federal site. See
http://www.washingto...ca3b_story.html

The numbers fly in and out. For example:

How many are on Medicaid, how many on private plans? Later we see

The population of Md is about six million.
What sort of problems are there?

Translation: They have no clue.
Help is on the way. There will be some state aid for people who tried to use the state system but couldn't (the definition of "tried" is not given).

Yes, "depending on".

And:

Perfect it???? The options seem to be to try to get it marginally functional or junk it.


Of course the Marylad fiasco is not Obama's fault but it is still relevant. Early explanations of the federal site's problems were that fewer states than expected had put up their own sites. Maybe we should be thankful that they hadn't. As I understand it, in rankings of the state sites Maryland does not come in last, although iy is hard to imagine how someplace could be worse.

From the beginning, locally and nationally, this plan gas been subject to repeatedly stunning denial of problems. How can someone in January, when people should be enjoying their new health plans, be thinking that maybe the site needs more perfecting so that someone has some idea of what is going on?

I don't see how anyone can have any realistic confidence that this will end well. Maryland is, or was, regarded as a fairly well run state. This is truly embarrassing.

It is a mixed bag. California, Kentucky, and Connecticut have the best sites - Hawaii the worst, ironically enough.