Six Months to Go –– Will the Health Insurance Exchanges Be Ready on Time? Survey: Health Plan Execs Don't Think So

As the Obama administration continues its top secret effort to build federal insurance exchanges in about 34 states while 16 states are doing it on their own, that continues to be the big question.

HHS is using IT consulting firm CGI for much of the work on the exchanges and the federal data hub. CGI has their plate full since they are not only working on the federal exchange but also doing work for the state exchanges in at least Colorado, Vermont, and Hawaii.

Earlier this month, the Senate Finance Committee held an oversight hearing. The Obama guy in charge of exchange development testified before them. I thought it was notable that it was the Democrats who expressed the greatest concern, and frustration, over senators not getting a clear idea for just where the administration is toward the goal of launching the new health insurance exchanges on October 1.

I thought the following Reuters quote was telling;

I am absolutely confident that every state will have an exchange that will be functioning and ready, said Gary Cohen [HHS executive in charge of the effort], who declined to elaborate on the number and identity of states that could be in for difficulties."

He wouldn't elaborate on just where there might be problems? Why? Why does the administration have to be so secretive?

This lack of transparency has the health insurance industry––the people the feds are going to have to connect with––very worried.

In early February, information technology consultant Edifecs, which provides health care software services to health plans, hospitals, and other organizations, held a "Compliance Summit" for 125 executives from hospitals, clearing houses, state health insurance exchanges, and health plans. The audience included executives from 34 different health plans. I gave the conference's opening keynote speech.

These are the industry executives that the state and federal exchanges are working with day-to-day. So, if you want to get the perspective from those in the trenches with the state and federal health insurance exchanges (HIXs) on whether they'll be ready, this is a pretty good group to ask.

Edifecs did just that using interactive software in the room to get the audience's response to a number of questions.

The input from the marketplace doesn't inspire confidence:
The vast majority of those who attended are planning to participate in the new health insurance exchanges. They are worried that, with the feds and states getting such a late start in detailing requirements and with so little time left, that their own organizations can be ready. They are also worried because the information they are getting from the health insurance exchanges in order to do their share of the work is poor, to very poor. They are not optimistic that the government-run exchanges will be ready on time. Almost all of those surveyed are concerned that the exchanges have not involved them as users in gaining input from the industry––traditionally a very bad sign in system development. And, the executives are very concerned about being able to reconcile billing and eligibility information from the exchanges.From the Edifecs survey:

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Judge Bars Man From Saying ‘Bingo’ For Six Months After False Call Causes Chaos

In the Ohio Valley, where bingo night is serious business, false “bingo” calls can get you 90 days in the pokey.

Austin Whaley, an 18-year-old from Covington, Kentucky, learned this the hard way when he and several friends entered a local bingo hall and yelled “bingo” for comic effect. According to the Cincinnati Enquirer, “the crowd of mostly elderly women did not take kindly to Whaley’s bingo call.” The room filled with groans from those who’d thought they lost; upon realizing they’d been duped, “they started hooting and hollering and yelling and cussing.”

Park Hills Police Sgt. Richard Webster reported that Whaley’s antics “delayed the game by several minutes” and “caused alarm to patrons.” When Whaley refused to apologize after being caught, Whaley cited him for second-degree disorderly conduct.

“Just like you can’t run into a theater and yell ‘fire’ when it’s not on fire, you can’t run into a crowded bingo hall and yell ‘bingo’ when there isn’t one,” said Park Hills Police Sgt. Richard Webster, the officer who cited Whaley. [...]

“He seemed to think he could say whatever he wanted because it was a public building. I tried to explain that that’s not the case. Just because it’s a public building doesn’t give you the right to run into a theater and yell ‘fire.’ You can’t go into a ballpark and yell ‘out,’ because people could stop the game.”

When Whaley appeared in Kenton District Court last week, the judge ordered Whaley: “Do not say the word ‘bingo’ for six months.”

As comical as it may be, sentencing someone to not utter the word “bingo” is likely a violation of the First Amendment.

The 1919 Supreme Court case Schenck v. U.S. introduced the “clear and present danger” test, which allows punishment for speech that would knowingly cause a panic, such as shouting “fire” in a crowded theater (this test has also been largely superseded by more speech-protective decisions). But yelling “bingo” in a bingo hall hardly lives up to the standard. Nobody flees for their life when they think they’ve lost the whimsical game of chance.

Bingo players may consider Whaley a jerk, but even jerks have constitutional rights.

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Dust Bowl Days: Historic U.S. Drought Projected To Persist For Months, Worsened By Thin Western Snowpack

NOAA's latest seasonal drought outlook projects historic drought will persist.

By Lauren Morello and Andrew Freedman via Climate Central. See also the NY Times piece, “Thin Snowpack in West Signals Summer of Drought”

Time is running out to avert a third summer of drought in much of the High Plains, West and Southwest, federal officials warned Thursday.

Without repeated, significant bouts of heavy snow and rain in the remaining days of winter, a large part of the country will face serious water supply shortages this spring and summer, when temperatures are hotter and average precipitation is normally low.

The drought already ranks as the worst, in terms of severity and geographic extent, since the 1950s. Though it’s not over yet, its economic impact appears to be severe, said Brad Rippey, a meteorologist at the Agriculture Department’s Office of the Chief Economist.

It “will probably end up being a top-five disaster event” on the government’s ranking of the costliest weather events of the past three decades, he said at a Capitol Hill briefing Thursday.

There is little relief predicted in the National Oceanic and Atmospheric Administration’s (NOAA) latest three-month drought outlook, which the agency released Thursday. Federal forecasters predict that drought will persist in the Rocky Mountain and Plains states, expand throughout northern and southern California and return to most of Texas, a state that has been mired in drought since 2011.

NOAA does forecast improvements in drought conditions in the Upper Midwest and Southeast, areas that have received beneficial precipitation in recent weeks.

“The next couple of months will kind of determine how the spring and summer plays out in that part of the country,” said Jake Crouch, a climate scientist at NOAA’s National Climatic Data Center in Asheville, N.C. Crouch said that continued drought conditions could threaten water supplies in many areas, particularly in the Southwest.

Dwindling Water Supplies

With drought extending into its second or even third year in some areas, the main concerns are shifting from agriculture and recreation to water supplies as rivers run dry and reservoirs shrink.

Speaking at the annual meeting of the American Association for the Advancement of Science in Boston on Feb. 15, Texas state climatologist John Nielsen-Gammon said water managers are especially concerned about the situation in West Texas, where emergency conservation plans have gone into effect as water supplies dwindle.

In the western U.S., low mountain snowpack is once again a concern, especially in portions of Colorado, New Mexico and Wyoming that feed the Platte and Arkansas rivers, said Mike Strobel of USDA’s National Resources Conservation Service.

Western mountain snowpack compared to average. (Credit: USDA)

“We’ve got the same trend we had last year,” Strobel said. “But prior to last year, we had very good snowpack, so there was a lot of moisture in reservoirs and soil” when drought conditions hit. This year, reservoirs are running low and soils are dry, which could magnify the impact of a winter without much snow buildup.

In Colorado, where 100 percent of the state is experiencing some level of drought, snowpack is at 70 percent of the long-term average and just 91 percent of last year’s total, Strobel said. Streamflow forecasts are poor and reservoir levels are low.

“We just don’t have the water in storage right now as we’re heading into the spring and summer, periods that are essential for agriculture and water management,” he said.

Those dry conditions and poor snowpack have also raised the risk that water levels could drop on the Mississippi River later this year, in a repeat of factors that reduced barge traffic last fall.

“We need rain in spring and fall so that we don’t have a crisis like we had this year on the Mississippi,” said Steve Buan from NOAA’s North Central River Forecast Center.

The portions of Minnesota, Wisconsin and Iowa that funnel water into the Mississippi are “bone dry,” Buan said. NOAA estimates there is a 40 percent chance that come fall of 2013, the Mississippi River will dip as low, or lower, than during the record-breaking autumn last year.

The drought was most likely initially set into motion by the cooler-than-average water temperatures in the tropical Pacific Ocean, combined with the effects of warmer-than-average waters in the Atlantic Ocean. Studies have shown that this combination tends to favor major drought events in the U.S.

But some scientists, such as Nielsen-Gammon, suggest that the overall warmer climate created by manmade global warming may have amplified this already devastating drought, particularly by triggering more intense heat during the spring and summer of 2012.

A recently released draft of a new federal climate change assessment shows that as the climate continues to warm in the next few decades, drought events are likely to become more frequent and severe, leading to more significant water supply and agricultural impacts in much of the U.S

Escalating Costs

The continuing drought has already taken a toll on the nation’s farmers, said the USDA’s Rippey.

Drought during last year’s growing season took “major hits on row crops,” especially corn and sorghum, he said. Parched conditions reduced the nation’s production potential for those two crops by about one-quarter. Drought cut corn yields by 4 billion bushels and sorghum yields by 100 million bushels.

According to Climate Central research released on Feb. 18, the states of Missouri, Illinois and Indiana were among the hardest hit “Corn Belt” states, with yields at nearly 30-year lows.

The U.S. soybean crop rebounded slightly during a cooler, wetter August last year, though the overall yield still dropped by 200 million bushels, USDA found.

But heading into spring, it’s winter wheat that is the most immediate concern, Rippey said. In Oklahoma and South Dakota, roughly two-thirds of the current winter wheat crop is rated “poor” or “very poor,” while more than half of Texas’ crop falls into the same categories despite some rainfall this winter.

“We are at high risk for abandonment this year,” Rippey said, predicting that farmers could walk away from 25 percent or more of the nation’s winter wheat this year, the worst since 2002, unless their crops begin receiving steady, regular rains.

USDA won’t release its official estimates of crop production for 2013 until mid-May. But the agency is optimistic that U.S. corn will do well this year, yielding 163.5 bushels per acre. July weather will tell the tale, Rippey said, but encouraging signs include ebbing drought in the eastern half of the Corn Belt.

Another Destructive Wildfire Season Ahead?

It’s still too early to tell whether poor snowpack and persistent drought will yield another severe fire season in the western U.S., experts said.

Last year’s fires consumed many of the dead and damaged trees and underbrush that fuel wildfires, said Jim Douglas, a senior advisor at the Interior Department.

“If that fuel doesn’t regrow, it’s not there,” he said. “So we could have drought conditions with nothing to burn yet. And we could have a spring with early moisture, with a lot of grass growing good and tall. If it dries out in late summer, we could have very bad fire conditions.”

The National Interagency Fire Center projects an immediate above-average fire risk in regions hardest hit by drought in its Feb. 1 outlook, including portions of the Oklahoma Panhandle and eastern Colorado. But in the drought-stricken Rocky Mountains and Southwest, fire season normally doesn’t begin until April, the center said, and what it will look like isn’t yet clear.

– By Lauren Morello and Andrew Freedman

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