Sorry for the unpleasant imagery.
And anyway, it’s early yet:
Robert Laszewski is president of Health Policy and Strategy Associates, a policy and marketplace consulting firm where he works closely with many in the heath industry as they try to navigate the Affordable Care Act. He’s also the author of the excellent Health Care Policy and Marketplace Review blog, as well as Wonkblog’s 2013 “Pundit of the Year”. We spoke on Wednesday. A lightly edited transcript of our conversation follows.
EK: You mentioned the continued problems with error-ridden files. What are insurers doing for these people?
RL: There are two things. There are some obvious errors you get and the insurer can go back to the customer and straighten them out. That’s a very laborious task. The other thing that the administration is doing is a manual reconciliation. There’s unfortunately no computerized check between who HealthCare.Gov thinks is enrolled and who the insurance industry’s computer systems think is enrolled. So it’s being done manually. That’s a big problem.
The other challenge now is getting people to pay for coverage. I was surprised today calling around to people to find only about 50 percent have paid. That’s not a reason to panic yet. The due dates for payment have been sliding all around, so people can be confused. But it can be a mess. Some insurers are doing autocalls like politicians do the night before the election asking people to pay.
EK: I recognize that we won’t really know what the mix of healthy and sick people is until at least April, once we see the surge from the individual mandate. But what are insurers seeing in the mix so far?
RL: It’s not positive. I don’t want to say people have given up on the notion they’ll get a good mix. They know the administration will make a big push. The insurance companies will spend big on advertising and outreach. So no one has given up. But it doesn’t look good right now.
There’s a big misconception that this is about young people. That’s baloney. It’s about healthy people. A healthy 20-year-old might only pay a $100 premium. You want healthy 40 and 50-year-olds. The big problem right now is really total enrollment. We only have about 10 percent of the uninsured in here. Insurers think you need more like 70 percent of a pool of people to sign up.
EK: When you say “a pool,” what do you mean by that here?
RL: The people who are uninsured and eligible for the exchanges and the people coming over from the individual market. That’s the new pool. It’s hard to estimate exactly how many of them there are. But I think we’re going to ultimately need about 20 million people for a sustainable pool. It doesn’t need to be this year. That’s what the transitional risk corridors are all about. But it needs to happen in the first few years. So when I hear people talk about the goal being seven million, I think, “time out.” This needs to be 20 million people within three years.
The problem with the enrollments today is that they’re so small, it’s less than 10 percent of the uninsured coming in, it really can’t be anything but sick people.
He called it:
Humana Inc. (HUM) said it expects new Obamacare customers to be sicker and costlier than anticipated, after the U.S. government’s decision to let healthier people keep their existing plans.
Enrollees through the Patient Protection and Affordable Care Act’s insurance exchanges will be “more adverse than previously expected,” Humana said in a regulatory filing yesterday. While affirming its 2014 profit forecast, the Louisville, Kentucky-based health insurer said it was evaluating expectations for the new year.
Facing a wave of policy cancellations triggered by the higher standards of the Affordable Care Act, President Barack Obama said in November he would let people keep their existing health plans for an extra year. Analysts and insurers said the move might upset the financial stability of the exchanges by allowing younger, healthier customers to opt out of Obamacare.
“Humana was already assuming the exchange business would be unprofitable,” Carl McDonald, a Citigroup analyst, said in a note to clients today. “It now appears Humana believes it could lose even more money because the mix of exchange enrollment is less favorable than anticipated.”
Now are you convinced that Obamacare is an intentional failure? Private insurance has to be broken, the whole system a shambles, and then Obama can introduce the single-payer system he’s wanted all along.
Speaking of which:
The elderly could be denied vital medicines under plans to change licensing of NHS drugs, experts have warned.
Guidelines on how funding for new drugs is allocated are due to be changed – meaning ‘wider societal benefits’ will have to be considered before the NHS is allowed to prescribe a medicine.
The changes could mean that drugs aimed at older people might not be approved by the health watchdog NICE, the National Institute for Health and Care Excellence (NICE), pharmaceutical firms have claimed.
I don’t want to say what that sounds like to me, but it rhymes with “breath flannel”.
PS: Again, apologies for the post title, but sometimes nothing but graphic descriptions will do. I’m sure you see my point now.