qotd: Why haven’t the exchanges done more for us?

Associated Press
February 15, 2016
Cancer Patients Snagged in Health Law's Tangled Paperwork
By Ricardo Alonso-Zaldivar

Hundreds of thousands of people lose subsidies under the health law, or
even their policies, when they get tangled in a web of paperwork
problems involving income, citizenship and taxes. Some are dealing with
serious illnesses like cancer. Advocates fear the problems, if left
unresolved, could undermine the nation's historic gains in health insurance.

The government says about 470,000 people had coverage terminated through
Sept. 30 last year because of unresolved documentation issues involving
citizenship and immigration. During the same time, more than 1 million
households had their financial assistance "adjusted" because of income
discrepancies. Advocates say "adjusted" usually means the subsidies get
eliminated.

"When people get that bill for a full-price plan, they panic and they
cancel the insurance," said Elizabeth Colvin of Foundation Communities,
an Austin nonprofit that serves low-income people. Some worry the
problem could undermine the law's insurance markets, now in their third
year.

"These problems can grow, and they can contribute to undermining
consumer faith in the system, and that could lead to attrition," said
Rachel Klein of Families USA, an advocacy group that supports the health
law.

Pressured by a Republican-led Congress hostile to Obama's overhaul, the
administration is highly sensitive to criticism that some people may be
getting benefits they're not legally entitled to. But Health and Human
Services Secretary Sylvia M. Burwell recently acknowledged the paperwork
tangle is more likely to trap the innocent than fraudsters.

http://hosted.ap.org/dynamic/stories/U/US_HEALTH_OVERHAUL_PAPERWORK_TRAP

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USA TODAY
February 16, 2016
Costs, changes led Obamacare enrollment to fall short of earlier estimates
By Jayne O'Donnell

The number of people who signed up for health insurance for 2016 on the
state and federal exchanges was up to 40% lower than earlier government
and private estimates, which some say is evidence that the plans are too
expensive and that people would rather pay a penalty than buy them.

In 2010, the non-partisan Rand Corporation estimated 27 million people
would have exchange policies this year and the Congressional Budget
Office at that time was estimating 21 million for 2016. CBO even said
last June that 20 million people would have plans purchased on the
exchanges this year. Just 12.7 million signed up for plans, however, by
the end of open enrollment Jan. 31 and about 1 million people are
expected to drop their plans — or be dropped when they don't pay their
premiums.

http://www.usatoday.com/story/news/nation/2016/02/15/costs-changes-led-obamacare-enrollment-fall-far-short-estimates/80061050/

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Comment by Don McCanne

Participation in the ACA exchanges is coming in at a much lower level
than were the original predictions. Furthermore, significant numbers
drop out each year, and many find that they receive significantly less
financial assistance than they expected at enrollment.

Since the exchanges are not working as hoped, perhaps we need
incremental innovations that would improve their functioning - you know,
those incremental improvements some politicians and policy wonks keep
telling us is all that we need to make ACA a universal, affordable system.

But what incremental change would expand coverage to absolutely
everyone? What incremental change would make the plans affordable for
everyone? What incremental change would ensure that access to care is
affordable when facing very high deductibles? What incremental change
would ensure that everyone would remain covered by their plans
throughout the year, especially when there are so many different reasons
that individuals lose their plans?

As mentioned many times before, the flawed health care financing
infrastructure is not amenable to simple incremental patches. Keeping
the same infrastructure will only perpetuate the severe deficiencies of
our dysfunctional financing model. Many will remain uninsured. Many will
not be able to afford health care, even if insured. And, worst of all,
many will suffer and die.

Maybe we should start tallying the financial hardship, suffering and
death in increments so that we can gradually feed that information to
the incrementalists who insist this is a small price to pay for keeping
intact the model that protects so well our private insurance industry.
Maybe then they will understand the evil of defaulting to incrementalism.

Single payer would fix it.