You Can Keep It

WideModern_Obama_130621620x413“You can keep the plan you have.”

Everyone weights in, including Bill Clinton. Everyone has an opinion, on both sides of the aisle; Democrats and Republicans, the Tea Party is running with the idea of the Train Wreak.

The website doesn’t work as well as it should. It is certainly a problem; I think we can all agree.

Sign-up in the federal marketplace for private insurance are far below projections or what is necessary to claim success. The slow sign-up is consistent with the Massachusetts experience and reflective of the gross problems of Healthcare.gov. There are so many different issues, more than are being addressed by the media, the talking heads or by the clamoring politicians afraid of their re-election prospects.

What should we be thinking right now? Who is to blame for the failures? What are the answers?

Without pointing fingers at any single person or entity, is it possible to answer these questions? Probably not, so let’s point some fingers and remind ourselves of what the ACA was supposed to be and who is behind some of the failures and who is not.

Healthcare.gov is a website with a complex integrated system underlying it. It was underfunded, poorly managed from its onset and deployed without appropriate testing. Further to this, thanks to the many obstructionist Republican Governors who refused to establish state exchanges, the Federal exchange is far bigger than originally expected. What does this sizing mean? It means greater complexity, more integration to individual private insurance companies in individual states. Add to this the entrance barriers set up by those states that chose to ‘opt-out’.

Can we blame this entirely, no we can’t. We can point to this as part of the problem though.

We also have to blame the contractors, all of them, responsible for the design and deployment of the Healthcare.gov solution. No, not just the website the entire system; it does not work and this is a clear design flaw. The flaw isn’t just in the front-end, what you or I might see, but in the back-end everything from how it was sized to how it is integrated to the all the other systems it must integrate with to provide the services it was intended for. The contractors hired to provide this system were given a Statement of Work (SOW) to develop this system with what I am certain were clear milestones and requirements, they failed to meet the most critical of these. None of us can know for certain how oversight was provided over the various stages of the contract, how milestones were validated or whether there were periodic quality gates to insure requirements were being met. We do know though taxpayer money was paid to private contractors to deliver a system that does not work and that is doing great harm to citizens and this administration.

Does part of the blame for the system failure fall on the government agency in charge of the development? Yes, it does. They were responsible for oversight. Who within that agency is responsible? Ultimately, it is the head of the agency; however, knowing what I do about this process it is unlikely the top of the line was sitting in status report meetings, performing tests or otherwise involved in the daily activities of this project. There was an accountable deputy.

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Here is what I do know, The President of the United States is not responsible for the failure of Healthcare.gov as a computer system or website frontend and we truly need to stop beating him about the head and shoulders for this specific failure.

Finally, ‘You can keep your plan if you like it’. Yes, the President said this repeatedly. I think he believed it. In fact, within ACA all the policies now being cancelled by the Private insurance carriers were grandfathered for at least two years. This means Americans should have been able to keep their policies through 2015. Let’s talk about both the junk and what else the Private market is doing shall we?

  • High deductibles
  • High co-pay
  • Annual spending limits
  • No catastrophic coverage

These were primarily Defective products, not grandfathered and in many cases, states had thrown the companies out years ago. On the other hand, there were policies that did meet the standard for being grandfathered, even if they did not meet the ‘Basic Coverage’ standard of the ACA. What is happening with these? Why are policyholders receiving letters of cancellation of policies they like, that the President of the United States promised they could keep. There is a simple answer.

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The Private Insurance Carrier decided to re-price their product to ensure they were making a PROFIT.

When the ACA was designed and passed, it was a gimme to the Private Marketplace. It kept Private Insurers in the game, offering them a broader market even if they had to meet some new restrictions and regulations. Although the law was designed in favor of citizens, allowing them to keep their current policies, it cannot force the private insurer to continue offering that policy to the market.

Blaming the President for the greed of the Private Insurer is idiotic, truly stupid. For those making the most noise, I offer this tidbit to chew on. The acts of the Private Market are consistent with Capitalism at its finest.

This is what everyone wants, right? Free Market Capitalism and Competition

Well this is what you got, so stop bitching. The Private Insurance marketplace is doing exactly what they choose; they are evaluating their products, cancelling those that no longer meet their profitability standards and offering alternatives. They are using marketing techniques, while you and I might find them slightly shady; there is nothing illegal about what they are doing. If those receiving the cancellation letters are too lazy, stupid or stubborn to look for alternatives; shame on them.

I am tired of hearing the ACA is a failure. We have only gotten started and even today, with what has already been implemented it has helped Americans. Do we need to look at the ACA and potentially tweak the law? Yes, we do and we should. But this trash talk in Congress, on the street and in the media is ignorant and without merit.

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