Foot Dragging on Implementing HealtchCare Exchanges

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**Easy E**

With the Health Exchanges going into effect in some states on Tuesday, the ACA (Obamacare) has been big news lately. NPR especially seems to be all over it. At least locally. This was one report I listened to and thought I would share.

http://www.npr.org/blogs/itsallpolitics/2013/09/26/226498730/republican-tactics-slow-down-obamacare-prep

As Republicans try to figure out how to defund President Obama's health care law, some members of the party are attacking Obamacare on other fronts, too.

One House committee is investigating groups that were contracted to educate people about how to enroll, and the tactics are slowing down preparation for the rollout of the health care exchanges scheduled next Tuesday.
Investigating The "Navigators"

Lisa Hamler-Fugitt was staring at her computer at work right before taking off for the long Labor Day weekend when a nondescript email from the House Energy and Commerce Committee landed in her inbox. At first, she thought nothing of it.

"In fact, I thought that it was probably just a sign-on letter, a 'Dear Colleague' letter," she says.

Instead, it was a four-page statement from House Republicans, insisting that she turn over reams of information to Congress. Why? Because her organization — the Ohio Association of Food Banks — had recently won a $2 million grant from the federal government to help educate poor, uninsured Americans about how to enroll in the Affordable Care Act. These grants are called "navigator grants."

Congressional Republicans demanded a detailed description of how Hamler-Fugitt's group would spend the money, what kind of training her so-called navigators were getting and how they planned to protect private information during outreach efforts.

"I was pretty outraged," Hamler-Fugitt says. "Our written response to the committee's questions were 118 pages. And the documentation that we provided included 4,684 pages, primarily of emails."

A "Crusade"?

The committee gave her only two weeks to respond. So her small staff had to stop all navigator work for a while. Now, days before Obamacare enrollment begins on Oct. 1, Hamler-Fugitt says her navigators haven't even finished training.

To some House Democrats, that was exactly the goal of this congressional probe.

"The Republicans are on a crusade to stop the Affordable Care Act," says Rep. Henry Waxman of California, the top Democrat on the House Energy and Commerce Committee. "There's been no wrongdoing that anybody can show. It's as if you took a whole bunch of people and said, 'We think you may do something wrong, and now we want to ask you a lot of questions about your organization.' "

Earlier this year, Republicans were furious after learning the IRS may have targeted conservative groups for lengthy review. Now, House Republicans have singled out about 50 of the more than 100 navigator groups to scrutinize.

To be sure, navigators have to be ready for a challenging task. They will help people figure out exactly what plans they can afford, their eligibility for Medicaid, whether they qualify for tax breaks. All of this requires understanding intricate rules.

And Republican Rep. Tim Murphy of Pennsylvania doesn't think the navigators will be ready.

"It's like that old Hans Christian Andersen tale, 'The Emperor's New Clothes.' I'm not going to pretend that everything's OK if it's not," Murphy says.
Murphy, who oversees the navigator investigation, says this is no political game he's playing. He says many of the navigators have little experience with health insurance, the time frame for training is too tight, and navigators will have access to very private data about people.

"It's worth asking what will be done with navigators when they obtain personally identifiable information or health records — names, Social Security numbers, birthday, other information that can be used, and even in some cases, what if people reveal health problems?" Murphy says.
Dropping Out

For some groups, this congressional inquiry — combined with the strict regulations some states are imposing on navigators — was just too much.
That was the case for Cardon Outreach, an organization that helps people enroll in Medicaid. Chuck Kable, Cardon's lawyer, says it simply decided to give back the $833,000 navigator grant after receiving the House committee's letter.

"You know, we're relatively small," Kable says. "And the people that would be involved in that response are high-level executives whose time is extremely valuable. Because we're a small organization, we have a lot on our plates."

And with some navigators dropping out, Republicans like Rep. Tim Huelskamp of Kansas say it won't be their job to answer questions about how to enroll in Obamacare.

Congressional offices usually help people solve problems with federal programs, like Social Security or Medicare. But when it comes to Obamacare, Huelskamp says he doesn't have enough information to help.

"Our position is, if you want to sign up, you got to call HHS," says Huelskamp, referring to the Department of Health and Human Services. "So we will say, 'Call [HHS Secretary] Kathleen Sebelius' office if you want to figure that out.' "

Anyway, Huelskamp says, his office has received only one phone call this entire time about how to enroll in Obamacare. And he says he's pretty sure it was from a Democratic Party operative.

So, the article mentions the IRS Scandal. How does this compare?

I have also heard some stories about Republican run states not doing much to support the new law. Can anyone from these states share some insight?

**Goliath**

"I don't think they'll have enough time to get fully trained, so I'm gonna send them a demand for a detailed report that'll use up what little time they did have to get trained! That way they won't be finished in time, and Obamacare will come crashing to the ground! Muhahahahahaha!"

Above: What Goliath imagines Tim Murphy might have said to himself prior to launching these investigations.

**Dreadclaw69**

Easy E wrote:
So, the article mentions the IRS Scandal. How does this compare?

Maybe because;
A) the IRS will have a not insignificant role in the implementation of the ACA
B) when people get targeted by a government body that is regulated by privacy laws, and then have their financial information passed to political opponents they may have a justifiable reason to be nervous about their medical history being handled by community organisations that has less regulation.

**MrMoustaffa**

Is there a relatively nonbiased place I can read up on what exactly Obamacare does? I've been hearing so much spin on it lately I really don't know what to believe anymore.

**-Shrike-**

MrMoustaffa wrote:
Is there a relatively nonbiased place I can read up on what exactly Obamacare does? I've been hearing so much spin on it lately I really don't know what to believe anymore.

It's quite simple. When you sign up to Obamacare, Obama himself will hold you at gunpoint and force you to sacrifice kittens to the Ruinous Powers.

**Jihadin**

Congressional Republicans demanded a detailed description of how Hamler-Fugitt's group would spend the money, what kind of training her so-called navigators were getting and how they planned to protect private information during outreach efforts.

"I was pretty outraged," Hamler-Fugitt says. "Our written response to the committee's questions were 118 pages. And the documentation that we provided included 4,684 pages, primarily of emails."

A "Crusade"?

The committee gave her only two weeks to respond. So her small staff had to stop all navigator work for a while. Now, days before Obamacare enrollment begins on Oct. 1, Hamler-Fugitt says her navigators haven't even finished training.

Two million wasted right there.

**whembly**

MrMoustaffa wrote:
Is there a relatively nonbiased place I can read up on what exactly Obamacare does? I've been hearing so much spin on it lately I really don't know what to believe anymore.

Well... here's the bill itself:
http://www.gpo.gov/fdsys/pkg/BILLS-111hr3590enr/pdf/BILLS-111hr3590enr.pdf

Here's a high level pros and cons:
http://useconomy.about.com/od/healthcarereform/a/Obamacare-Pros-And-Cons.htm

**MrMoustaffa**

whembly wrote:
MrMoustaffa wrote:
Is there a relatively nonbiased place I can read up on what exactly Obamacare does? I've been hearing so much spin on it lately I really don't know what to believe anymore.

Well... here's the bill itself:
http://www.gpo.gov/fdsys/pkg/BILLS-111hr3590enr/pdf/BILLS-111hr3590enr.pdf

Here's a high level pros and cons:
http://useconomy.about.com/od/healthcarereform/a/Obamacare-Pros-And-Cons.htm

906 pages... This could take a while...

**Alfndrate**

MrMoustaffa wrote:
whembly wrote:
MrMoustaffa wrote:
Is there a relatively nonbiased place I can read up on what exactly Obamacare does? I've been hearing so much spin on it lately I really don't know what to believe anymore.

Well... here's the bill itself:
http://www.gpo.gov/fdsys/pkg/BILLS-111hr3590enr/pdf/BILLS-111hr3590enr.pdf

Here's a high level pros and cons:
http://useconomy.about.com/od/healthcarereform/a/Obamacare-Pros-And-Cons.htm

906 pages... This could take a while...

I suggest reading it while dropping the Browns off at the Super Bowl, it makes a quality roll of toilet paper...

**Seaward**

MrMoustaffa wrote:
906 pages... This could take a while...

On the bright side, you'll be the first to have read the whole thing.

**Maddermax**

MrMoustaffa wrote:
Is there a relatively nonbiased place I can read up on what exactly Obamacare does? I've been hearing so much spin on it lately I really don't know what to believe anymore.

The thing about "Obamacare" is that it isn't a program like, say, Medicare or Social Security, or most other big government programs where you go to the government and the government gives you X, but is mostly a series of interlocking regulations that describe how the private insurance market does/will do things. Basically, it's mostly the same system as pre-obamacare, but with a bunch of regulations to try an make it work better overall and to open up competition, though your political bent will probably determine if you think they will work or not. Part of the law also expands Medicaid and provides subsidies to help low income people afford insurance.

The major parts of the act:

1) The individual mandate - if you don't have insurance, whether employer provided or personally bought, you'll incur a fine, unless you're too poor (and if you're that poor, you'll likely also be eligible for the expanded Medicaid, unless you're in a republican state that blocked it). The fine is $95 next year OR 1% of your income, whichever is higher, but it will expand to $600 OR 2.5% of your income in a few years time. This is the Stick that's used to convince those who can afford health care, but can't be bothered getting it to buy into the system. It's most contentious bit of the law, but is necessary to allow some of the other parts, especially the changes to Pre-Existing Conditions being covered (without this mandate, many would opt out of insurance until they got something serious, and then buy in, crashing the system).

2) Making it easier for people to get coverage - There are several things done to make it much easier for people to get coverage. FIrstly, there's the expansion of Medicaid, which will allow more people to use that program to get healthcare (except, once again, in Red States that blocked the expansion). Secondly, there's significant government subsidies for those who are buying healthcare on the exchanges, which will help individuals who make up to $25k a year (Couples to about $50, and families a bit more). You can get an estimate on your subsidy here: http://kff.org/interactive/subsidy-calculator/. They also have things like letting Kids stay on your family plan until they're 26. These are the carrots to attract people into getting insurance.

3) Pre-existing conditions - people with pre-existing conditions will be able to get coverage, and you won't be able to be kicked out of coverage because of them (as some insurance companies used to do when they would have to pay for unrelated conditions).

4) Insurance Regulations - There are some minimums for coverage put in place, and insurers have to spend at least 85% of your premium on actual health care (rather than overheads/profits), and if they spend less than that, they have to refund you some money. That at least means you can't be fleeced as badly as some insurance companies out there have done.

5) The Exchanges - The most obvious part of the law, these are actually basically just going to be websites where you can compare and shop for health insurance. You won't need to use them if you have Employer provided health care, but if you shop for insurance yourself, these are where you'll go. Each state has it's own (though some are Federally operated, because the states refused) and it's basically just a shop front that helps you compare and buy insurance (with any subsidies you might get) from private insurance agencies. It should help make the market more competitive.

_________________________________________________________________________________________________________________________________________________

What changes will you see?

1) If your employer is going to be providing your coverage, very little. Pretty much all employer plans out there are already Obamacare compliant. Keep on keeping on.

2) If you're on Medicare or Medicaid already, no changes. Keep on keeping on.

3) If you're poor, you might be eligible for the expanded medicaid.

4) If you're not quite poor enough for Medicaid, but still not making a lot, you'll probably get a fair bit of your insurance paid with subsidies through the exchanges.

5) If you're doing well but don't have insurance, you'll have to get some on the exchanges or pay the fine.

6) If you're doing well and already have insurance purchased privately, your insurer might have to change the plan a bit (if it doesn't comply with the minimums and outlines set in the law), but you'll be able to shop on the exchanges to get a better deal if need be. Hell, if you have a family you might even get a little bit of subsidy for your plan too - best double check.

Because there might be many factors changing, it can be hard to compare a pre-Obamacare plan to a post-Obamacare plan exactly, so don't compare them on cost alone. You'll hear a lot of gak about "Way cheaper!" or "Hugely Expensive!" being thrown around using bad comparisons to try to spin it one way or the other, and it varies a lot by state (Blue states are seeing more savings, apparently), so pretty much ignore the pundits and derpers until you see the prices which will apply to you personally, and keep in mind the changes in coverage AND subsidies that you might receive.

**Ouze**

I'm also intrigued to find out what will happen when people who are subject to the tax simply refuse to pay it.

The IRS is tasked with enforcing the collection of it, which is proper, but the legislation also removes all the usual tools the IRS would normally use to force compliance: no liens, no levys, no seizures, no criminal proceedings. I don't know what that really leaves them - withholding returns if eligible, I suppose, but what if people aren't eligible for a return anyway?

**Jihadin**

It takes about a year of a "filing" of non compliance for your Federal Tax returns are held. So about two to three years down the road from now There be quite a few people madder then Hell about this. I can see the Federal Tax Refund being kept by the government. I do not see the IRS garnishing the wages. People are not effected by it now but when $$ comes involve people will go off the chain

**Easy E**

Tuesday the Healtchcare exchanges are suppose to open. Will the one in your state be ready?