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.

healthcareNew

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.

False Equivalence Right

Albrecht Durer, Weeping Angel Boy

Albrecht Durer, Weeping Angel Boy

I cannot begin to tell you all how tired I am of hearing about Healthcare.gov and all of the glitches. Yes, I get it, really I do. It is hinky, the roll out was not seamless and smooth, it is well let’s just say it is imperfect.

It is in fact an ugly baby.

What Healthcare.gov is not; it is not the Patient Protection and Affordable Care Act (ACA). Healthcare.gov is simply a delivery vehicle, one of many and one that is currently not performing as it should but it is not the law itself. Democrats on the Hell  Hill, pundits in the media and all of us truly need to separate the two and discuss them as distinct and not at all equal. It is contingent upon those of us who support the idea of access to affordable Health Insurance for all citizens that we not confuse or confabulate the issues surrounding the ACA (aka: Obamacare) and the rollout of one hinky delivery system, Healthcare.gov.

All this being said, let’s first talk about some of the idiotic conspiracy theories first. Don’t think they exist? You don’t read the Right Wing My Head is Exploding with all my f’ng insider knowledge, do you? So, here are a few of my recent favorites, those Right Wing walks resulting in False Equivalency that eventually makes their way into the mainstream because everyone is afraid to call Bullshit:

  • No bid contract awarded to CGI, the Canadian corporation, prime contractor.
    • Since 2007 CGI has had an ID/IQ designation with the Department of Health and Human Services (DHHS). The designation means Indefinite Delivery, Indefinite Quantity and covers contracts from $1K to $4B. CGI is one of 16 companies granted this designation prior to President Obama’s first term. These designations are consistent throughout the government, whether they are appropriate or not is a different issue. (sourced from various sites including DHHS). It is possible, though not probable some work orders for Healthcare.gov were awarded under this designation. It should be noted however, CGI was not the only vendor working on the Healthcare.gov integrated solution.
    • Further, on various sites (no confirmation yet) the RFP (Request for Proposal) was sent to several qualified vendors. DHHS received four (4) responses and of these, only CGI’s response was reviewed and accepted (again no confirmation of the veracity of this statement). There is only one reason why other responses would have been rejected without review; the response did not meet the stated requirements of the RFP.
  • Senior Vice President of CGI Federal, Toni Towne-Whitley was a Princeton classmate, class of ’85 of First Lady Michelle Obama and is a member of the Princeton Black Alumni.
    • Yes, both of these statements are true on their surface. Careful examination of some facts would find though, it is unlikely they are friends or ever met each other at school. They traveled in different circles, attended different schools at Princeton with different educational goals and attainments. Simply attending the same very large school does not instantly mean you know each other. By the way, Daily Caller, not every Black Person in the country knows every other Black Person in the country.
  • Upon award of the contract to CGI the President of CGI Group, George Schindler donated to the President’s reelection campaign.
    • Yes, in fact he did, $1,000; big money there. Mr. Schindler also donated to Mitt Romney and previously he had donated the max of $2,300 to John McCain. To make this easier though, let’s just debunk all of this and go ahead on to Open Secrets if you are interested. Follow the money, use the following criteria;
      • CGI
      • George Schindler
      • CGI Technologies and Solutions, Inc. PAC
      • Toni Townes-Whitley
  • The cost of Healthcare.gov was somewhere in the neighborhood of $693M.
    • No, no it was not anywhere close to this. In fact, the awarded contract was approximately $70M originally, when you factor in all the changes required due to recalcitrant GOP Governors who refused to implement their own state marketplaces, the final cost might be closer to $115M. The final costs are not in, however Daily Kos have done an excellent job of pulling apart the Right’s argument with facts here, including a great spreadsheet here.  I love facts!

Now, those are my favorites of the weekend. Really, how hard is it to stick with facts and stop making shite up?

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Can we talk for a minute about what Healthcare.gov is and what it is not? I don’t want to bore you with tech-speak; I do some of this for a living and even my eyes glaze over. I do want to talk about what Healthcare.gov is and why the idiots on the Hill should not be holding hearings over which they have not a clue.

  1. Healthcare.gov is not a simple website. The website is a frontend; it is how you and I access the system behind it.
  2. Healthcare.gov is an integrated system. This system requires tens of thousands, if not millions of lines of custom code to parse information you and I enter, including our names, address, financial status, this determines what products to show us. This is essentially “If, Then, What” lines of code based on multiple options. Then, once the products we qualify for are delivered to our screen and we have the opportunity to review and decide this same solution must send our choice(s) to external private vendors, outside of the Healthcare.gov system.
  3. Integration is not simple and it is not a one-to-one process at the federal level. For every single state that did not create their own marketplace the integration had to be created for that state. What this means, for example in Texas every single district, county, city, zip code combination had to be entered. All of the private insurance companies willing to offer plans for Texas citizens had to offer those plans to the marketplace. The State of Texas vetted those plans and made their own rules that had to be incorporated into the system.
    1. This was true of every single state. Every Red State that did not create their own Marketplace made up their own rules; rules in many cases with the sole intention to case the ACA to fail in their state, to prevent their citizens from accessing Affordable Insurance and ultimately affordable healthcare.
    2. Finally, nothing in Healthcare.gov stores your medical information, thus nothing in Healthcare.gov is in non-compliance with HIPPA. Keep in mind, one of key provisions of the ACA is the elimination of ‘pre-existing conditions’. With this provision, you and I no longer fill out extensive medical histories when applying for Health Insurance, in fact the only information we are asked is if we smoke.

If you are a Democrat, Liberal, Progressive or Left Leaning Independent please stop referring to Healthcare.gov as Obamacare or the ACA, or even a Website. It is none of these. It is just one of several delivery systems for the Patient Protection and Affordable Care Act, it isn’t the entirety of it. Could it have been done better? Yes, certainly, it could have been and I suspect all that is wrong with this particular delivery system will be corrected fairly quickly but let’s not fall into the trap the Right is laying for us, let’s not repeat their idiotic talking points as if they were gospel.

The truth is we are now going to have to watch as the GOP members on the Hill waste valuable time and money following their boogiemen down every conspiracy hole. Their insatiable appetite to find this President at fault for something, anything is horrifying, wasteful and frankly boring. The propagandizing by the Right is tiresome; that we fall into their trap repeatedly is shameful. They throw the Red Herring and we run with it.

Red Herring

Next up, what likely went wrong in developing Healthcare.gov.

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