UPDATE: More News.
This is supposed to be reassuring.
Obamacare contains a $25 billion federal risk fund set up to benefit health insurance companies selling coverage on the state and federal health insurance exchanges as well as in the small group (less than 50 workers) market. The fund lasts only three years: 2014, 2015, and 2016.
The government’s risk management program for the insurers has three parts (the “3Rs”):
A revenue neutral Risk Adjustment System designed to level adverse claim costs between health plans.
A Reinsurance Program that caps big claim costs for insurers (individual plans only).
A Risk Corridor Program that limits overall losses for insurers.
Of the $25 billion, $20 billion is earmarked for the Reinsurance Program and $5 billion goes to the U.S. treasury.
First, the Reinsurance Program caps big individual claim costs for insurers––in 2014, 80% of individual costs between $45,000 and $250,000 are paid by the government, for example.
Then comes the Risk Corridor program. Participating health plans will receive payments from the federal government in any of the following circumstances:
The plan’s costs for any benefit year are more than 103% but not more than 108% of the health plan’s targeted amount. The feds will reimburse 50% of all costs in excess of 103% of the medical cost target.
If the plan’s costs are more than 108% of the annual target, the feds will first pay the health plan a flat 2.5% of the target and then reimburse the plan for 80% of their claim costs above the targeted amount––with no upside limit.
Target cost is simply defined in the new law as a health plan’s “total premiums (including any subsidies) reduced by the administrative costs of the plan.” It is whatever the health plan projected its premium needed to be to pay medical costs.
The CMS has a new contractor for Obamacare, not just the web site. The previous contractor, CGI Federal, has been replaced rather suddenly.
“Accenture, one of the world’s largest consulting firms, has extensive experience with computer systems on the state level and built California’s large new health-insurance exchange. But it has not done substantial work on any Health and Human Services Department program.
“The administration’s decision to end the contract with CGI reflects lingering unease over the performance of HealthCare.gov even as officials have touted recent improvements and the rising numbers of Americans who have used the marketplace to sign up for health coverage that took effect Jan. 1.”
CGI Federal is the company connected with Michelle Obama through her classmate, a fellow Princeton alumna.
It’s true that Townes-Whitley works for CGI Federal. She joined the company in May 2010, and is senior vice president of the Civilian Agency Programs Business Unit, according to the CGI website. In her current role, she oversees services to 22 U.S. federal civilian agencies and is “responsible for sales, client relationships, P&L and member management for CAP’s 1,850+ members across the U.S. and 34 countries internationally.”
Her job sounds similar to the job Michelle held briefly with the University of Chicago Hospitals, where she was in charge of “urban outreach.”
The American College of Emergency Physicians (ACEP) blasted MichelleObamacare, expressing “grave concerns that the University of Chicago’s policy toward emergency patients is dangerously close to ‘patient dumping.'” The group concluded that the Urban Health Initiative “reflected an effort to ‘cherry pick’ wealthy patients over poor.” That practice was made illegal by the Emergency Medical Treatment and Active Labor Act (EMTALA) signed by President Ronald Reagan.
Bipartisan complaints about impoverished South Side Chicago patients getting the shaft led GOP Sen. Charles Grassley of Iowa and Democratic Rep. Bobby Rush of Chicago to challenge the crony hospital’s abuse of its nonprofit status and lucrative tax breaks. But the probe went nowhere.”
Of course, the job ended when Barack was elected President and the position was never filled again. It will be interesting to see if Townes-Whitley stays with CGI Federal after this.
Anyway, the move was deemed “urgent” because the Obamacare program is in big trouble, not just the web site.
If the ObamaCare contractor brought on last week to fix the back-end of the HealthCare.gov portal doesn’t finish the build-out by mid-March the healthcare law will be jeopardized, according to a procurement document posted on a federal website.
It said insurers could be bankrupted and the entire healthcare industry threatened if the build out is not completed.
The procurement document signed by healthcare officials in late December says that the government determined in mid-December that CGI Federal, the contractor originally tasked with connecting the online healthcare portal to insurers, was not up to the task.
The Centers for Medicaid and Medicare Services (CMS) announced last week it was firing CGI Federal, and bringing on Accenture to finish the website.
It’s not just the web site, as I keep repeating.
“If this functionality is not complete by mid-March 2014, the government could make erroneous payments to providers and insurers,” it continues. “Additionally, without a Financial Management platform that accounts for enrollments and associated program costs that integrates with the existing CMS Accounting platform, the entire healthcare reform program is jeopardized.”
The “back end” was never designed or written prior to the October 1 rollout. I pointed this out two months ago. They didn’t even have the payment mechanism built. If anyone still wonders why they don’t know if people paid their premium for coverage, this is why.
“Well, how much do we have to build today, still? What do we need to build? 50 percent? 40 percent? 30 percent?” Chao replied, “I think it’s just an approximation—we’re probably sitting between 60 and 70 percent because we still have to build…”
Now, we have until March 14. What then ?
Cohen said that “because we don’t have full functionality” of the website that the government was using a workaround, and that the automated payment system would be ready “in the next months.” Notice he didn’t say how many months ?
While Cohen did not give a timetable for the project, he said that a stopgap system would pay insurers next week based on calculations of what they are owed.
However, the back-end problems extend beyond federal subsidy payments. According to the document, the system is vulnerable to “inaccurate forecasting” of the risk mitigation programs in place to pay insurers who enroll a higher-than-expected number of sick patients with expensive bills, “potentially putting the entire health insurance industry at risk.”
By mid-March, Accenture must build a financial management platform that tracks eligibility and enrollment transactions, accounts for subsidy payments to insurance plans, “provides stable and predictable financial accounting and outlook for the entire program,” and that integrates with existing CMS and IRS systems.
The plan to “pay insurers” is the notorious Reinsurance Program
insurance purchased through Obamacare’s government-run exchanges isn’t even full-fledged private insurance; rather, it’s a sort of private-public hybrid. Private insurance companies pay for costs below $45,000, then taxpayers generously pick up the tab—a tab that their president hasn’t ever bothered to tell them he has opened up on their behalf—for four-fifths of the next $200,000-plus worth of costs. In this way, and so many others, Obamacare takes a major step toward the government monopoly over American medicine (“single payer”) that liberals drool about in their sleep.
See, that wasn’t that painful, was it ?
Obamacare also contains a “Risk Corridor Program that limits overall losses for insurers.” So insurers not only don’t have to pay out all of their costs; they also don’t have to swallow all of their losses.
There are all kinds of surprises to come. I can hardly wait.
Tags: health care, medicine, politics