Federation of Connecticut Taxpayer Organizations

Before HealthCare.gov [1], the federal health insurance marketplace, was fixed late last month, supporters of the Affordable Care Act looked to the law�s expansion of Medicaid for solace. In October, many more people enrolled in coverage through Medicaid, the federal-state program for the poor, than chose private plans in the health insurance marketplace, the New York Times reported earlier this month [2].

But the news involving Medicaid isn�t all good.

Last week, I wrote about a public radio reporter [3] in Missouri who is too rich for Medicaid in her state, but too poor for a subsidy to buy private insurance. Missouri is among 25 states that have decided not to expand their Medicaid programs to cover adults with incomes below 138 percent of the federal poverty level ($15,856 for one person), as called for in the act. The Supreme Court gave states the option to refuse the expansion without consequence, even though the federal government has agreed to pick up the entire bill for the first three years.

Some other recent news on the Medicaid front:

USA Today [4] reported Monday that HealthCare.gov �is incorrectly determining that some people are eligible for Medicaid when they clearly are not, leaving them with little chance to get the subsidized insurance they are entitled to as the Dec. 23 deadline for enrollment approaches.�

Here�s what happens, per the paper:

When consumers applying for insurance put their income information into subsidy calculators on HealthCare.gov � the exchange handling insurance sales for 36 states � it tells them how much financial assistance they qualify for or that they are eligible for Medicaid. If it�s the latter, consumers aren�t able to obtain subsidies toward the insurance, although they could buy full-priced plans.

If a consumer is told he or she is eligible for Medicaid, and is actually not, valuable time and perhaps money may be wasted.

The USA Today story follows reports by Politico [5] and The Washington Post [6] about how the federal government isn�t correctly transferring enrollments from HealthCare.gov to Medicaid programs.

�Although Medicaid sign-ups through HealthCare.gov have been considered a rare bright spot in the flawed Obamacare rollout, the federal portal has been unable to send those Medicaid applications to the states for final processing,� Politico reported. �If states can�t receive and complete their work on Medicaid applications by the end of the year, people could go without Medicaid coverage in early 2014 despite having an eligibility determination.�

The solution has been to create to circumvent the system and allow states to �use an incomplete set of data � known as a �flat file� � to enroll people in Medicaid, even though those files lack critical information that states normally use to verify eligibility,� Politico wrote.

The National Association of Medicaid Directors reported Monday [7] that states are seeing an influx of new enrollees and are struggling to keep up. The association�s update said:

Several states (both expansion and non-expansion) reported there is growing concern and questions coming in from some consumers leading up to January 1. Medicaid coverage in all states is retroactive, but applicants are beginning to express some frustration if they have not received more information about their eligibility and enrollment. In states that have opted to expand their Medicaid income eligibility levels, there are many individual applicants who need to be processed and enrolled in Medicaid. Other applicants do not qualify for Medicaid and need to be transferred to the state or federal health insurance marketplace in a timely manner.

Finally, the Commonwealth Fund reported last week [8] that states that chose not to expand Medicaid will be subsidizing the states that do expand. A report prepared by Sherry Glied and Stephanie Ma of New York University found:

By choosing not to participate, Texas, for example, will forgo an estimated $9.58 billion in federal funding in 2022. Taking into account federal taxes paid by Texas resi�dents, the net cost to taxpayers in the state in 2022 will be more than $9.2 billion. Similarly, Florida�s decision to not participate will cost its taxpayers more than $5 billion in 2022. In Georgia, the state will forgo $4.9 billion in federal funding without the expansion of Medicaid, and in turn, $2.8 billion will flow out of the state in 2022. In other states, the costs of not participat�ing will be lower. In South Dakota and Wyoming, for instance, taxpayers will face a net cost of $224 million and $166 million in 2022, respectively.

Look up what your state is doing here [9].

Editor�s Note: This post is adapted from Ornstein�s �Healthy buzz [10]� blog. Have you tried signing up for coverage through the new exchanges? Help us cover the Affordable Care Act by sharing your insurance story [11].

More coverage: Obamacare and You

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For Medicare Drug Plans, the High Cost of Doing Nothing

by Charles Ornstein� ProPublica, Dec. 2, 2013

There's a steep price for doing nothing when it comes time for open enrollment for Medicare prescription drug plans.

My Thanksgiving ritual each year consists of heaps of turkey, corn casserole and apple pie � as well as quiet time devoted to helping relatives choose Medicare prescription drug plans for the following year.

Most people partake in similar gorging, but not enough spend the time to compare health plans for their relatives. My experience this past weekend is a particularly instructive example of how costly it can be to do nothing.

With open enrollment for 2014 drawing to a close this Saturday, there�s little time for delay. (The process of picking a drug plan in Medicare is totally different from using healthcare.gov, the federal health insurance exchange for people under age 65 who are not in Medicare.)

Unlike Medicare�s hospital and doctor benefits, which are managed by the federal government, seniors and disabled people needing drug coverage must choose a subsidized, privately run plan under contract with Medicare. The 36 million enrollees in the program usually have dozens of choices that offer an array of monthly premiums, deductibles and copayments. The plans have different preferred drugs and different requirements for prior approval for expensive generics.�� Continue reading at �.. http://www.propublica.org/article/for-medicare-drug-plans-the-high-cost-of-doing-nothing?utm_source=et&utm_medium=email&utm_campaign=dailynewsletter

More coverage: ��Six Questions About HealthCare.gov's Future

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Rate Hikes Hidden in California's Glowing Obamacare Reviews

by Charles Ornstein�� ProPublica, Nov. 26, 2013

Half those whose insurance is being canceled will pay more for plans meeting the Affordable Care Act requirements.

More coverage: Obamacare and You

During a meeting last week, officials at Covered California, the state�s much-touted health insurance marketplace, made a pretty stark admission: Half of the approximately 1 million consumers whose health plans are being canceled will pay more under the Affordable Care Act.

The numbers, it seems, have been overshadowed by other, more positive headlines. First, the state signed up more consumers in October thanHealthCare.gov, the federal marketplace handling enrollments for 36 states. Second, the board governing Covered California voted last week not to allow insurers to offer their canceled policies for another year, rejecting President Obama�s recommendation earlier this month.

But the figures do call into question the sweeping plaudits California has received � including from New York Times columnist Paul Krugman in Monday�s newspaper � for signing up so many people (about 80,000, as of last week).

By way of background, many of these consumers� plans are being canceled because they were �non-grandfathered,� meaning they were purchased after the Act was signed by President Obama in March 2010 and their benefits do not meet its requirements (some were pretty skimpy).

Although the federal law allowed these plans to be renewed for another year, Covered California�s contracts with health insurers require them to be canceled at the end of this year. Officials said the idea was to create stability in the new marketplace and provide consistency for all consumers.

As cancellation letters went out, supporters of the law contended that the canceled policies either had inferior coverage or would cost far less in the exchanges. California�s numbers show that is only half the story.

�It�s not a success story,� said Jamie Court, president of Consumer Watchdog, a group that supports a California ballot measure to regulate insurance rates. �It�s a success story only if you consider that the federal website didn�t work and ours did. It�s not a success story because people are in open revolt about how much they�re paying. The only people who are happy are people who have subsidized policies. The middle class is outraged.�

Let�s look at the numbers: Continue reading at �.. http://www.propublica.org/article/rate-hikes-hidden-in-californias-glowing-obamacare-reviews?utm_source=et&utm_medium=email&utm_campaign=dailynewsletter

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A Cheat Sheet For The Obamacare Hearings

by Charles Ornstein� ProPublica, Nov. 25, 2013

Over a month, 10 hearings plumb the problems with HealthCare.gov.

Every few days, it seems, there�s another hearing into one problem or another with rolling out the Affordable Care Act. It�s hard to keep track.

Since late October, by my count, there have been 10 House and Senate hearings. Eight were by House committees led by Republicans who oppose the law; two were before Senate panels run by Democrats.

The most memorable of the hearings was Oct. 30 when Health and Human Services Secretary Kathleen Sebelius first testified about the HealthCare.gov debacle. Also buzzworthy was the Nov. 13 hearing of the House Oversight and Government Reform Committee. The panel subpoenaed Todd Park, the U.S. chief technology officer, and it was unclear whether he would appear (he did.)

Here�s a look at highlights from the Hill:

Date: October 24, 2013
Committee: House Energy and Commerce

Title: PPACA Implementation Failures: Didn�t Know or Didn�t Disclose?

Witnesses: Cheryl Campbell, senior vice president, CGI Federal; Andrew Slavitt, group executive vice president, Optum/QSSI; Lynn Spellecy, corporate counsel, Equifax Workforce Solutions; John Lau, program director, Serco

Length: 4 hours, 24 minutes

Minority party response and transcript.

Highlight: �Federal officials did not fully test the online health insurance marketplace until two weeks before it opened to the public on Oct. 1, contractors told Congress on Thursday,� the New York Times reported. �While individual components of the system were tested earlier, they said, the government did not conduct �end-to-end-testing� of the system until late September.�

Memorable exchange: Continue reading at �.. http://www.propublica.org/article/a-cheat-sheet-for-the-obamacare-hearings?utm_source=et&utm_medium=email&utm_campaign=dailynewsletter

More coverage: Obamacare and You

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Health Policy Canceled? What We Know and Don't Know

by Charles Ornstein� ProPublica, Oct. 31, 2013

Every day, we�re seeing reports that consumers across the country will be dropped by their health insurance companies on Jan. 1 or another date in 2014. But two central questions remain:

First, just how many people will be affected?

Second, and more importantly, is this a good or bad thing?

We don�t yet know the answer to either question, although the answer to the first question is surely a big number. Here�s where things stand:

A minimum of several hundred thousand people with individual health insurance policies (those not provided by their employers) have received letters notifying them that their coverage will be terminated on Jan. 1 � or at some date after that � because their plans don�t meet the requirements of the Affordable Care Act.

The issue has been percolating for several weeks, initially being overshadowed by the rocky rollout of the Healthcare.gov federal health insurance marketplace. But this week, in part because of a prominent NBC News report, the issue has gained traction. Republican lawmakers and the act�s opponents have given it more attention than the website�s continuing woes.

The story is full of nuance, and that�s what makes it easy to misunderstand.

What is definitely true is that many people are receiving notices saying that they will have to find new insurance coverage on Jan. 1 or a later date. That directly contradicts what President Obama said repeatedly: that those who liked their plans could keep them. (The Washington Post has said Obama�s statements deserve four pinnochios because they were not true.)

How many people are affected?

According to the NBC News report:

Four sources deeply involved in the Affordable Care Act tell NBC News that 50 to 75 percent of the 14 million consumers who buy their insurance individually can expect to receive a "cancellation" letter or the equivalent over the next year because their existing policies don�t meet the standards mandated by the new health care law. One expert predicts that number could reach as high as 80 percent.

Sarah Kliff at the Washington Post writes:

It�s hard to put an exact number on this, given that insurance plans are the ones who decide whether or not to continue offering an insurance product. Experts have estimated that somewhere between half and three-quarters of those who currently buy their own policies will not have the option to renew coverage, which works out to around 7 to 12 million people.�� Continue reading at �. http://www.propublica.org/article/health-policy-canceled-what-we-know-and-dont-know?utm_source=et&utm_medium=email&utm_campaign=dailynewsletter

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Podcast: Why Is Healthcare.gov So Flawed?

by Minhee Cho� ProPublica, Oct. 29, 2013, 11:35 a.m

Healthcare.gov, the home of the federal insurance marketplace, has faced nothing but problems since it launched on Oct. 1. ProPublica�s Charlie Ornstein has chronicled the range of issues that have plagued the site, including duplicate enrollments and children reported as parents, as well as a wildly misleading price estimator tool.

How did we end up in this mess?

Ornstein joins ProPublica�s Editor-in-Chief Steve Engelberg on the podcast to discuss the many challenges Healthcare.gov has been up against since the Affordable Care Act was first passed in 2010; how, if the site�s glitches aren�t fixed soon, it could face a so-called �death spiral�; and the government�s decision to move forward with the site launch even though it knew there were problems:

�...the administration was out there loudly proclaiming, go to Healthcare.gov. It�s open for business. Sign up for coverage. Lady Gaga tweeted it...but the infrastructure to get covered wasn�t working,� Ornstein says. �They were directing millions of people to a website that was completely incapable of handling the traffic.� ��Continue reading at �. http://www.propublica.org/podcast/item/podcast-why-is-healthcare.gov-so-flawed/?utm_source=et&utm_medium=email&utm_campaign=dailynewsletter

You can listen to this podcast on iTunes and Stitcher. And for more on Healthcare.gov, read Ornstein�s latest reports:

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Today's Obamacare Hearing: What You Need To Know

by Charles Ornstein | @charlesornstein� ProPublica, Oct. 29, 2013

Last week, the House Energy and Commerce committee held the first of what is likely to be many hearings on how the rollout of Healthcare.gov went so wrong. Today, the House Ways and Means Committee takes its turn with scheduled testimony from Marilyn Tavenner, administrator of the Centers for Medicare and Medicaid Services, which runs Healthcare.gov.

Here�s what you need to know:

1 Watch the hearing here:

Continue reading at �..� http://www.propublica.org/article/todays-obamacare-hearing-what-you-need-to-know?utm_source=et&utm_medium=email&utm_campaign=dailynewsletter

The Affordable Care Act's Most Important Date: Not What You Think

More coverage: Healthcare.gov's Users Speak Out: 'Clean This Mess Up'

More coverage: Obamacare and You

Also read ��

Why Health Insurance Cancellations Shouldn't Be a Surprise �

Test Run No. 2: HealthCare.gov's Invisible Health Plans

50 Years After the Community Mental Health Act, the Best Reporting �

Can a Reprieve and a Lawsuit Reverse Health Insurance �

Health Policy Canceled? What We Know and Don't Know

Answered: Why Two Obama Loyalists Lost Their Health Policies �

Health Care Sign-Ups: This Is What Transparency Looks Like �

Health-Care Rollout: The View From Kansas

Is Healthcare.gov the Future? We Ask a Health Futurist

How the Feds Could Fix Their Glitchy Health Care Exchange �

How Low Will Health Care Enrollments Be? Here's What to Watch For

Podcast: What Happens to Those Losing Health Coverage Under �

Health Care Delays Squeeze Patients in State High-Risk Pools �

How (If at All) Has the Health Care System Failed You?

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