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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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User:LashondaO

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Why Rich People Hate Talking About Inequality

Ed. note: This is the third and final post in a TP Ideas symposium on Branko Milanovic’s The Haves and the Have-Nots: A Brief and Idiosyncratic History of Global Inequality. The first installment is here here and the second is here.

The wealthy don’t like it when we talk about it inequality. Mitt Romney famously labeled President Obama’s critique of inequality “class warfare” motivated by “envy,” and proposed instead that debate about economic inequality be confined to “quiet rooms.” It’s fair to say he’s not alone among the super-wealthy in thinking this isn’t a “proper” subject for open, political debate.

At first blush, their motivation here is straightforward: it could cost them money. But given America’s one percent already has so much, and so little redistribution is on the table, they’d have to be exceptionally greedy to have such a strong reaction to even broaching the inequality discussion. Of course that’s possible, but the history of debates around inequality as surveyed in Branko Milanovic’s wonderfully readable book suggests another explanation. The rich don’t like inequality talk because, by its very nature, it involves making moral judgments about the way the rich live their lives into a topic for public discussion.

In the book’s first essay, “Unequal People,” Milanovic runs down the earliest modern economic theories about whether inequality is good for economic growth. The difference between early theories wasn’t, as we think today, whether or not you thought inequality was something that happened as a consequence of a roaring economy: it was whether, essentially, the rich are good people or not.

On the first view, defended to varying degrees by Max Weber and John Maynard Keynes, the rich were virtuous workers, dutiful, acquisitive folk who accumulated but spent no more on indulgences than the poor. Their massive savings were invested back in the marketplace, which, as Keynes put it, “made possible those vast accumulations of fixed wealth and of capital improvements” which redounded “to the advantage of the whole community.” The virtuous rich were uninterested in selfish consumption, serving principally as what Milanovic calls “saving machines” for the broader capitalist society.

Milanovic’s second view paints a dimmer picture of virtues of the rich. It assumes that the rich are selfish, greedy parasites who hold on to massive hoards and spend on themselves without investing in much of anything socially useful. In democracies, this leads the naturally-angry rest of society to impose punitive tax rates that slow economic growth. By being selfish misers, the rich end up taking money away from everyone.

What’s interesting about both sides of this debate is that they assume a public policy problem (“what grows the economy?”) needs to be discussed in terms of the moral character of the rich. This isn’t because economists have a yen for judging people; rather, it’s that when you have the amount of accumulated capital and power that rich do, the way in which one spend one’s money ends up having an extraordinary impact on everyone else in society. Invariably, assessing the desirability of rich people’s consumption choices will take on a moral cast, as what a person chooses to spend their money on says a lot about the person. Especially when they’re rich enough to spend it on anything.

It’s impossible to imagine that this point escapes wealthy people who follow the news. My guess (and I can’t prove this, but statements like Romney’s are certainly suggestive) is that when they hear that the one percent “should pay its fair share,” they hear the public calling the way they choose to live their lives unfair and unjust. No one likes being judged as a bad person, especially by the world’s most powerful politicians and in the pages of the world’s most-read newspapers. The wealthy, then, react negatively to public debates about inequality for the same reason many meat-eaters don’t like debating vegetarianism.

Uncomfortability, of course, isn’t a defense. The power wielded by America’s wealthy means that, like it or not, the rich can’t and shouldn’t be allowed to escape public scrutiny. Moreover, they often bring on themselves: see the pretty nasty things some wealthier folk say about poor and middle class Americans and the lengths to which others go to sing the praises of the “productive class.” But hypocrisy aside, the moral anxiety of the wealthy is both an interesting psychological fact and a neat window into the little, surprising ways in which the personal can’t be detached from the political.

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Presidential Proclamation -- National Donate Life Month, 2013

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For Immediate Release March 29, 2013 Presidential Proclamation -- National Donate Life Month, 2013 NATIONAL DONATE LIFE MONTH, 2013- - - - - - -BY THE PRESIDENT OF THE UNITED STATES OF AMERICAA PROCLAMATION Today, more than 115,000 men, women, and children are on the waiting list for an organ transplant. To help them get the care they need, millions of Americans choose to be organ and tissue donors -- a decision that reflects not only profound generosity, but also our commitment to one another. During National Donate Life Month, we renew the call for organ and tissue donation. Most people can be donors, and the need is great. I encourage Americans of every background to learn the facts about organ and tissue donation, consider signing up for their State's registry, and talk to family and friends about their decision. Information and resources about how to get involved are available at www.OrganDonor.gov. Together, we can respond to the donor shortage that keeps thousands of patients from getting life-saving care. Let us mark this month by rededicating ourselves to that task, standing with donors and their families, and igniting hope for those in need. NOW, THEREFORE, I, BARACK OBAMA, President of the United States of America, by virtue of the authority vested in me by the Constitution and the laws of the United States, do hereby proclaim April 2013 as National Donate Life Month. I call upon health care professionals, volunteers, educators, government agencies, faith-based and community groups, and private organizations to join forces to boost the number of organ and tissue donors throughout our Nation. IN WITNESS WHEREOF, I have hereunto set my hand this twenty-ninth day of March, in the year of our Lord two thousand thirteen, and of the Independence of the United States of America the two hundred and thirty-seventh.  BARACK OBAMA

 

Blog posts on this issue March 29, 2013 5:47 PM EDTWeekly Wrap Up: ‘The Promise of America”

Here’s a quick glimpse at what happened this week on WhiteHouse.gov.

March 29, 2013 4:11 PM EDTIn Miami, President Obama Talks About his Plan to Put People to Work Rebuilding America

Despite strong efforts to fix our broken national infrastructure over the past four years, much work needs to be done if we are to prove to the world that there is no better place to do business than in the United States.

March 29, 2013 3:02 PM EDTOpen Government: A Time for Self-Assessment

The Obama Administration has harnessed new technology to engage the public, worked to disclose information more quickly, and given citizens a greater voice in decision-making. There is more work to do, and we remain committed to continuing this in the second term.

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Group uses Reagan shooting to push tougher gun laws

A pro-gun-control group is using footage of the attempted assassination of President Reagan in a new ad. 

The ad from the United Network of Rational Americans uses the footage to argue expanded background checks might have prevented John Hinckley Jr. from shooting the president. It also says Reagan himself made that argument. 

"President Reagan believed something could have prevented the attack," the ad's narrator says. "Ten years later, he wrote the attack might never have happened if a bill requiring background checks had been law."

Hinckley shot Reagan 32 years ago this week despite the presence of armed Secret Service agents and police, the group notes. He was later found not guilty by reason of insanity in the shooting, which injured four. Reagan suffered a punctured lung and press secretary James Brady was left paralyzed.

The ad cites a 1991 op-ed by Reagan in support of the Brady Bill, named for his press secretary. That legislation requires a background check on individuals who purchase weapons from a federally licensed dealer. Next month, the Senate will consider legislation that would expand background checks to private and gun show sales.

The use of the Reagan footage could inflame an already divisive debate. United Network of Rational Americans was founded by Scott Crider, an activist who made headlines with the "Dogs Against Romney" group during the 2012 presidential campaign. That group staged events that mocked the Republican presidential nominee over an incident where the Romney family took a road trip with their Irish Setter placed in a carrier on top of their car.

"Thirty-two years ago this week, President Ronald Reagan was shot by a mentally disturbed man," Crider said in a statement posted to Facebook. "The best armed security in the world couldn't prevent it."

In an event Thursday at the White House, President Obama asked supporters to pressure their members of Congress to support an expansion of background checks.

“If they're not part of that 90 percent that agree that we should make it harder for a criminal or someone with a severe mental illness to get a gun, you should ask them why not," Obama said.

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