This year was supposed to be the first wherein Obamacare’s state-based insurance exchanges would be self-sufficient. By now, the law’s architects assured, the exchanges would be thriving, competitive marketplaces, where all Americans could secure affordable coverage.
It hasn’t worked out that way.
Two of the original 17 state exchanges have failed. Half of those that remain are struggling financially.
After getting $5 billion in federal grants, most of the state exchanges have turned out to be a disastrous mix of runaway spending on technology, lower-than-expected enrollment, huge overhead costs, and looming bankruptcy.
If nothing else, the collapse of multi-million dollar state-based exchanges has created a PR problem for health reform, but that’s only part of the issue.
In Massachusetts, there is a stew of simmering revelations about apparent mismanagement of the Health Connector, a once working exchange created in 2006 that upon an update for the Affordable Care Act ceased functioning while consuming $1 billion.
Massachusetts health officials knew the Connector was in trouble for a year before its Oct. 1, 2013, launch date, according to an investigation by the Pioneer Institute, a public policy research organization.
“Instead of raising concerns about the project,” a team of University of Massachusetts Medical School contractors and MassHealth “misled the public by minimizing the shortcomings of the contractor hired to build the website, asked state workers to approve shoddy work and appear to have covered up the project’s abysmal progress in a presentation to federal officials,” said Josh Archambault, a senior fellow at Pioneer Institute and author of the report.
Despite over $205 million in federal taxpayer funding, Hawaii’s Obamacare exchange website will soon shut down. Since its implementation, the exchange has somehow failed to become financially viable because of lower than expected Obamacare enrollment figures. With the state legislature rejecting a $28 million bailout, the website will now be unable to operate past this year.
According to the Honolulu Star-Advertiser the Hawaii Health Connector will stop taking new enrollees on Friday and plans to begin migrating to the federally run Healthcare.gov. Outreach services will end by May 31, all technology will be transferred to the state by September 30, and its workforce will be eliminated by February 28.
While the exchange has struggled since its creation, it is not for lack of funding. Since 2011 Hawaii has received a total of $205,342,270 in federal grant money from the Department of Health and Human Services (HHS). In total, HHS provided nearly $4.5 billion to Hawaii and other state exchanges, with little federal oversight and virtually no strings attached.
Trying to force Obamacare expansion onto Florida by cutting funding for an existing Medicaid program has backfired on President Obama.
Florida Gov. Rick Scott, a Republican, is suing Obama’s Department of Health and Human Services over plans to stop funding the state’s Low Income Pool program, which compensates hospitals for seeing uninsured patients.
Almost immediately, Republican Texas Gov. Greg Abbott and Republican Kansas Gov. Sam Brownback announced they would join the suit against HHS.
Christie Herrera, senior fellow at Florida’s free-market Foundation for Government Accountability, told Watchdog.org the Obama administration has “awakened a sleeping giant.”
“They’ve raised the ire of all these other states that are in Florida’s exact position, and that’s why you’ve seen Kansas and Texas filing amicus briefs in the lawsuit,” Herrera said during a phone interview.
If ObamaCare were working as well as supporters claim, would New York state have just decided to steer more than half of its subsidized exchange enrollees to a public managed-care plan? New York is the second state after Minnesota to adopt a Basic Health Program for households up to 200% of the poverty level. It’s a government-managed health care option included in the 2010 reform law.
Following Minnesota is a curious move. Minnesota has signed up just 22% of those eligible for exchange coverage, 48th among all states and barely half the U.S. average of 42%, according to the Kaiser Family Foundation.
The MNsure exchange also ranks near the bottom in its share of young-adult enrollees (24.2%) and near the top in its share of adults age 55 and up (33%).
To top it off, PreferredOne quit the Minnesota exchange despite being its dominant insurer in 2014, hardly a vote of confidence.
In the 34 states that did not establish Obamacare exchanges, Governors nervously await a Supreme Court ruling that could throw their health insurance markets into chaos. Meanwhile, many of the Governors who did establish exchanges are regretting their decision.
More than five years after its enactment, Obamacare has proven a bitter brew for many states. Nowhere is this more evident than in health care exchanges.
Exchanges began as a figment of Washington’s imagination. The fertile minds of health policy analysts had conjured a bewildering system of cross-subsidies that involved charging young people unfairly high premiums to reduce premiums for older workers, overcharging healthy people to subsidize unhealthy ones, taxing middle income people to subsidize lower-income people (what the President likes to call “middle class economics”), cutting Medicare to enlarge Medicaid, taxing the uninsured for being uninsured, taxing employer-sponsored health plans and taxing employers for not sponsoring health plans, all garnished with tens of billions in new taxes on medicines, medical “devices” (everything from tongue depressors to defibrillators) and, of course, on health insurance itself.
The Foundation for Government Accountability has just published a report on state enrollments under the Obamacare Medicaid expansion. Here’s what the authors say about Michigan:
When Republican Governor Rick Snyder lobbied the Michigan legislature to adopt his Obamacare Medicaid expansion plan, he too sold it on the promise of low and predictable enrollment. His office predicted no more than 477,000 able-bodied adults would ever sign up, with 323,000 signing up in the first year.
But more able-bodied adults enrolled in ObamaCare expansion in the first three months than the state thought would sign up during the entire year. Despite the fact that Michigan did not expand Medicaid eligibility until April, nearly 508,000 adults signed up by the end of 2014, far more than the state thought would ever enroll. Enrollment continues to climb, with nearly 582,000 able-bodied adults signing up by April 2015.
Americans’ tax burden is already $3 billion heavier because of Ohio Gov. John Kasich’s expansion of Medicaid under Obamacare.
By putting more able-bodied, working-age childless adults on Medicaid than Kasich projected, Obamacare expansion is reducing incentives to work and threatening traditional Medicaid recipients’ access to care faster and at greater cost than anticipated.
After Kasich expanded Medicaid unilaterally, a state panel approved $2.56 billion in Obamacare spending for the expansion’s first 18 months. The money was meant to last until July, but it ran out in February.
Kasich’s Obamacare expansion cost $323 million in March — 84 percent greater than estimates revised just six months earlier.
Nearly half of the 17 insurance marketplaces set up by the states and the District under President Obama’s health law are struggling financially, presenting state officials with an unexpected and serious challenge five years after the passage of the landmark Affordable Care Act.
Many of the online exchanges are wrestling with surging costs, especially for balky technology and expensive customer-call centers — and tepid enrollment numbers. To ease the fiscal distress, officials are considering raising fees on insurers, sharing costs with other states and pressing state lawmakers for cash infusions. Some are weighing turning over part or all of their troubled marketplaces to the federal exchange, HealthCare.gov, which is now working smoothly.
Oregon and Washington state strongly embraced Obamacare and opened their own health insurance exchanges. The states are similar, not just geographically but politically, economically and demographically. As the first enrollment season winds down, Washington has some of the best results in the country. Next door, Oregon’s exchange website is still broken.
SALEM, Ore. — Oregon had all the right ingredients for a sparkling Obamacare success story: a Democratic doctor as governor, an eager Legislature and a history of health care innovation.