“One year ago, every network, every member of Congress and certainly HHS and CMS watched or tried to log into HealthCare.gov. It proved to be a long, long wait. The collective frustration at the end of the day was the site did not work.
Despite repeatedly assuring both Congressional committees and the American public that the new marketplace and this bold new experiment on shopping for government controlled health insurance was to be smooth as silk and easy as pie, the rollout was a colossal failure for the HHS Secretary and her team. Ultimately, she admitted being responsible for the ‘debacle’ but not much has been done to eliminate the problems and clean up the process. HealthCare.gov is still broken.
The rollout was a failure, but my hope is the bureaucracy has learned some lessons. Here are five things I hope we can file away as lessons learned.”

“During the Patient Protection and Affordable Care Act’s first period of open enrollment October 2013 – March 2014, an estimated fourteen million people enrolled for health coverage through the new private insurance Marketplaces (8 million) and through Medicaid (6 million). To facilitate this substantial volume of enrollment and enrollment-related activities, approximately 4,400 Marketplace Assister Programs employing more than 28,000 full time-equivalent staff and volunteers served consumers nationwide. All Assister Programs were expected to help consumers understand their coverage options, apply for financial assistance, and enroll (see Appendix 1). Additional functions undertaken by many assisters included outreach and education; help with post-enrollment questions and problems; assistance with appeals of eligibility determinations; and help applying for other public benefits and services.
The emergence of Marketplace Assister Programs around the country is a significant health policy innovation. The majority of programs that were operational in 2013-14 needed to organize, launch and scale up quickly to be ready for the ACA’s first open enrollment period. Because so many programs were new or substantially expanded their scope during this first year, this period was also characterized by both the need and opportunity for widespread “learning by doing.” Several surveys conducted during or just at the close of 2013-14 Open Enrollment have already begun to assemble valuable data about: consumers’ experiences with assisters; assisters’ self-reported experiences; and best practices and lessons emerging from specific states or assister-related initiatives.1”

“Legal challenges to various aspects of Obamacare (aka the Affordable Care Act) keep traveling on a rollercoaster. Today’s episode of the law’s continuing courtroom soap opera involves a ruling by a federal district court in Oklahoma, which overturned a 2012 IRS rule authorizing premium assistance tax credits in federal exchanges (since rebranded as “federally facilitated marketplaces”). The decision improves the likelihood that the Supreme Court ultimately will consider this issue on appeal; either in the spring of 2015 or during its next 2015-2016 term.
Judge Ronald White ruled in State of Oklahoma v. Burwell that the IRS rule is “arbitrary, capricious, an abuse of discretion not in accordance with law, pursuant to 5 U.S.C. section 706(2)(A), in excess of statutory jurisdiction, authority, or limitations, or short of statutory right, pursuant to 5 U.S.C. section 706(2)(C), or otherwise is an invalid implementation of the ACA, and is hereby vacated.”
In other words, it was not just a “bad idea,” but an illegal one, too.”

“As we start the final stretch before the midterm elections, many analysts are convinced that Obamacare isn’t the hot political issue it once was. While the flood of negative publicity about the law has subsided of late, a majority of people still oppose it, according to a Real Clear Politics average of polls taken from Sept. 2-15. And I’ve always believed the voters’ negative impressions of the law were “baked” into their assessments of Democratic incumbents.
That’s partly why Democratic Senators such as Kay Hagan of North Carolina, Mark Pryor of Arkansas and Mark Begich of Alaska find themselves barely breaking 40 percent in recent public polls.
But a new study out this week from Bloomberg Government threatens to bring the Affordable Care Act back to center stage — and in a way that will likely hurt the electoral chances of incumbent Democrats, all of whom voted for the law.”

“The federal exchange is set to cut thousands of individuals from its coverage rolls this week because of unresolved inconsistencies related to immigration status, with HHS saying 115,000 will lose coverage as of Tuesday (Sept. 30). Tuesday is also the deadline for about 279,000 households to submit current income information to the exchange or risk seeing changes in their tax credits and cost-sharing subsidies that could result in higher costs for enrollees.
Furthering the saga on coverage data matching issues, the National Immigration Law Center has filed an administrative complaint under the ACA’s anti-discrimination section due to HHS’ failure to communicate with consumers in languages other than English and Spanish. The center also filed a Freedom of Information Act request in order to glean more insight into why that decision was made.”

“When it comes to health insurance exchanges, there’s nothing like the first time to grab voters’ attention and enthusiasm.
Morning Consult polling found 47 percent of voters say they are not at all likely to purchase health insurance through an online exchange this year. In the weeks before the start of open enrollment in 2013, that figure was 19 percentage points lower, with only 28 percent saying they were not at all likely to purchase insurance on the exchange. Voters’ stated likelihood of buying insurance decreased across all categories from 2013 to 2014.”

“After a long list of Obamacare failures in Alaska, one physician is shutting down his decades-old practice, charging that the health-care law and other federal programs are “unsustainable” for practicing doctors.
Dr. William Wennen, a plastic surgeon, is closing his Fairbanks practice after 38 years of working in the state. Dr. Wennen blames federal health insurance programs, citing Obamacare, Medicaid and Medicare, for shutting down his practice.”

“A survey of American physicians released this week paints a restless picture of the nation’s doctors—especially when it comes to Obamacare.
“The system is broken and I am out of here as soon as I can,” one doctor wrote. “I am tired of being used, abused, and lied to. Has anyone here woken up to the fact that we are always the last ones to be considered in the equation of change?”
Roughly 20,000 of 650,000 doctors responded to the Physicians Foundation’s survey, and voluntary surveys are prone to finding those with strong opinions. But of those strong opinions, 46 percent of doctors gave the Affordable Care Act (ACA) a “D” or “F,” while only 25 percent gave it an “A” or “B.””

“With just one week left before the launch of the controversial Open Payments database – which will reveal how much money doctors receive from drug and device makers – three of the biggest industry trade groups are complaining they have not had an opportunity to review important background information about relationships with physicians.
And the trade groups – the Pharmaceutical Research and Manufacturers of America, BIO and AdvaMed – are reiterating concerns expressed last month that the Centers for Medicare and Medicaid Services has still not explained why one-third of the payment information submitted by drug and device makers, as well as group purchasing organizations, was removed from the database.”

“One of Barack Obama’s best-remembered promises was, “If you like your health insurance, you can keep it.” But at the very same time the president was making that promise, lawmakers on Capitol Hill were drafting legislation that would make sure that promise could never be kept.
We call it Obamacare.
Moreover, the problem is not only that millions of people were unable to keep the plan they had in 2010, when the health reform law was passed. They are not likely to be able to keep for long any plan they have selected this year on a health insurance exchange. As we go forward, all health plans will be subjected to restrictions that are likely to change every year. So a plan that meets the Obamacare restriction this year, may not meet the restriction next year or the year after that.”