Stanley Feld M.D.,FACP,MACE

President Obama and CMS have been extremely quiet about Health Insurance Exchange enrollment since enrollment opened November 15,2014

President Obama reported that on  opening day the health insurance marketplace performed much better than last year. However, some consumers reported long, frustrating delays trying to buy insurance and gain access to their own accounts at HealthCare.gov.

Consumers there were having a hard time logging into their accounts, retrieving old passwords and proving they were who they said they were — a process known as identity proofing, which also vexed many people last fall.

Some people did complete their applications, but it often took them 90 minutes. Some people were unable to finish what they started, so they left the clinic with plans to return at another time.

The insurance exchanges are supposed to be the centerpiece of Obamacare.

 Ms.Sylvia Burwell, the Secretary of the Department of Health and Human Services said, “23,000 people had completed online applications in the first eight hours after HealthCare.gov, the federal website, opened on Saturday morning.”

Twenty three thousand is a low number for a 45-day enrollment period with four days each at Thanksgiving and Christmas.  It is only 1,035,000 enrollees (45 x 23,000). We do not know if they are new or old enrollees. 

Ms. Sylvia Burwell has given us signals previously that all is not well with Obamacare.

The estimate of total enrollees (old and new) for the end of the 2015 enrollment period was lowered from 13 million to 9 million. If 8 million were enrolled in 2014 this is only an increase of 1 million new enrollees.

There were clearly not 8 million valid enrollees when President Obama did his victory lap at the end of the extended enrollment period on March 31,2014.

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It was later announced that 85% of enrollees were to receive subsidies (tax credit). The tax credits were to make the insurance premiums affordable to enrollees earning less than $50,000 a year.

It turned out that 65% of those approved for subsidies originally had the subsidy reduced when they could not verify their claimed income.

The American taxpayers, who are responsible for the subsidy (tax credit), were never told how the government was going to collect the government over payment. Taxpayers were never told the amount of  payment due from people who received the invalid subsidies.

 How many of those over subsidized people dropped out of Obamacare because they could not afford the premium or the deductible.

How many enrollees remained from the 8 million claimed to have enrolled?

 Somehow the published number of enrollees dropped to 7.3 million. Did the decrease from 8 million to 7.3 million include the over subsidized dropouts?  

I should think an inspector general or someone in congress would start connecting the dots.

I would think the CBO would recalculate their estimates.

I should think someone in the press would sense there was something fishy and start investigating.

Last week it was discovered that 400,000 people were counted in the total enrollment number that did not buy healthcare insurance. The 400,000 enrolled for low cost dental insurance.

 This new revelation lowered the total number of claimed enrollees to 6.9 million from the 7.3 million claimed enrollees.

Kathleen Sibelius declared over a year ago that Obamacare would have to have over seven million enrollees to be viable and declared successful.

In a previous blog my estimate of valid enrollees for 2014 was 3 million. I have also pointed out that the healthcare insurance industry is not worried about the number of enrollees because if they lose money the government would bale them out and subsidized the difference.

The loser is the taxpayer. We have been paying a tax increase of more than 10% for Obamacare since 2010.

The public has not yet seen any numbers proving Obamacare’ s viability or it’s bending of the cost curve.

 We have seen patients complaining that they cannot afford the 6-10 thousand dollar deductibles of the health insurance policies. People have realized that they are not covered by insurance until they reach their deductibles. People have been hesitant to get necessary medical care in order to avoid paying the deductibles.

The Obama administration claims to have reduced healthcare costs. The administration does not count the patient’s deductible costs (out of pocket costs) in their bogus calculation of costs to the healthcare system.

The avoidance of follow-up care by patients with pre-existing illnesses (chronic diseases) is only going to lead to complications of those chronic disease and higher societal healthcare costs.

Lowering the goal for the number of enrollees to 9 million if only there are only 3 million valid enrollees that stayed in the system is going to be a very difficult task.

The changing of the date to begin open enrollment from October 1 to November 15 for political reasons is not going to help achieve the goal.

President Obama will probably extend the enrollment period from December 15,2014.

The Obama administration already announced the 2016 open enrollment period. It starts October 1 2015 and ends December 15, 2015.

There is a great website that calculates the estimated weekly enrollment and actual enrollment. Enrollment is not going very well. President Obama and his administration are very quiet about the enrollment. The mainstream traditional media is also ignoring enrollment.    

The website is, http://acasignups.net

As of 11/21/2014 the website reports confirmed enrollees for 2015 QHPs: at least 39,215 have enrolled as of 11/21/14 as opposed to the government estimated enrollees for 2015 QHPs of at least 410,000 as of 11/21/14.

No one is paying attention to the website. The Obama administration is not providing the information necessary for consumers to judge how well Obamacare enrollment is doing.

Ms. Burwell said,

Ms. Burwell said that attention should be on all of the people who now have health insurance, rather than the miscalculation.

“While we understand some will be skeptical, our clarity that this is mistake and the fact that we have quickly corrected the numbers should give people confidence,” she said. “It is important to continue to focus on the fact that millions of Americans are getting affordable health care.”

The Obama administration persists in trying to distract the American public.

I think the Obama administration continues to believe, as Jonathan Gruber believes, that Americans are too stupid to understand what the administration is doing.

The administration wants to prove that the free market and private insurance cannot provide healthcare coverage for all that only total government control of the healthcare system can work.

  The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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 Stanley Feld M.D.,FACP,MACE

Open Enrollment for Obamacare started November 15th rather than October 1^st. Open Enrollment for Health Insurance Exchanges was originally going start October 1,2014 to run until December 15,2014 for enrollees to have insurance on January 1,2015.

It think the open enrollment dates were delayed to prevent negative publicity for Democrats in the midterm elections. The date to close open enrollment has been moved to March 15^th or March 31^st2015 instead of December 31,2014.

President Obama is changing dates at will without congressional approval. It is creating confusion. Americans are giving up on following changes in the law.

President Obama probably believes, as Jonathon Gruber, that the American public is too stupid to follow all of his maneuvers.

It is impossible to know when open enrollment ends by following the mainstream media. I think it will end when the Obama administration has something to brag about despite what the law demands.

Early in 2014 it became clear to health insurance consultants that the healthcare insurance industry would raise Obamacare 2015 premiums by double digits (15-30%). The demographic of 2014 enrollees was actuarially unsound according to the healthcare insurance industry.

The Obama administration expressed fear that the healthcare insurance industry would not participate in the health insurance exchanges because they were destined to loss money.

The Obama administration is presently boasting that the average premiums are going to rise only slightly in 2015.  

Healthcare insurance companies are flocking to sell insurance in more markets rather than quitting the health insurance exchanges.

The Obama administration claims that Obamacare has created a competitive atmosphere for the healthcare insurance industry.

You bet it has. It has done the by creating subsidies for the healthcare insurance industry so it takes on no risk along with increased profit. This is the reason all the companies are fighting to get into the health insurance exchange market.

President Obama has offered to bail out the healthcare insurance companies if they do not make an adequate profit in the health insurance exchange.

The mainstream traditional media has not reported that Obamacare provided insurance company subsidies, nor have the subsidies been connected to the dampening of extreme increases predicted for premiums in 2015.

However, the decreases that are being reported by the Obama administration are deceptive.

Below is a CMS provided map of states and counties with either increases or decreases in premiums.

In about a fifth of the counties in states using the federal insurance exchange, premiums for the lowest-priced silver plans will increase by 10 percent or more. But rates for the same plans will decrease in all of Maine, Montana and New Hampshire, and most parts of Mississippi and South Dakota. NOV. 14, 2014

Largest decrease: -28.0%

Greatest increase: +29.5%

Minneapolis, Honolulu, Seattle, Phoenix, San Diego, St. Louis,  New Orleans , Dallas, Boston, Tampa, Philadelphia Detroit, Anchorage, San Francisco, Denver, Houston, Miami, Atlanta, Chicago, Los Angeles, Washington, D.C. New York all are experiencing increases in premiums.

 Source: Centers for Medicare and Medicaid Services

A PricewaterhouseCoopers report on all individual market premiums — on and off Obamacare exchanges — found a large range of rate changes, from a drastic 35 percent hike in Colorado to a 22 percent cut, also in Colorado (the state’s Obamacare exchange changed the geographic rating areas this year to cut costs for ski resort towns). Overall, the average rate hike nationwide is 5.6 percent, according to PWC.

The published map belies the Obama administration’s claim that premiums have been, on the average, lowered. It does not take into account population density in counties where premiums are lowered or raised.

Eight states are facing double-digit premium hikes in 2015 while just four states have reported decreases according to the Daily Caller.

 The premiums in some states could be lowered. However, the high deductibles included in these health insurance plans have not been lowered. The high deductibles are out of pocket expenses. The high deductibles continue to be unaffordable to many even thought these enrollees might receive sizable “tax credits? subsidies?” to help them pay for the premiums.

In January 2014, I described the subsidies provided by the Obama administration to the healthcare insurance industry. The Obama administration guaranteed a profit for participating in the health insurance exchange at no risk through the Reinsurance program and the Risk Corridor program that is buried in Obamacare.

(Nancy Pelosi: “We will not know what is in the bill until we pass the bill.”)

 “This was one of President Obama’s deceptions.

It is similar to the deception “If you like your insurance you can keep it. If you like you doctor you can keep him/her.”

Last week we learned that the insurance company bailout was built into the original bill passed in 2010. The President knew about this bailout before Obamacare was passed.

Did the congressional members who passed the bill know about the built in bailout?

If they did they should all be voted out of office. If the Democrats needed to pass Obamacare did not know about the bailout they should have and they should all be voted out.

It should be recalled that this was a Democrat controlled House and Senate. There was not a single Republican vote included in the passage of Obamacare.

The American people did not know about the built in bailout at taxpayers’ expense.

Obamacare contains a "Reinsurance Program that caps big claim costs for insurers (individual plans only)." Robert Laszewski, a prominent consultant to health insurance companies, writes that in 2014, 80% of individual costs between $45,000 and $250,000 are paid by the government [read: by taxpayers], for example." 

Private insurance plans bought through the health insurance exchanges are not private health insurance plans. They are plans that are subsidized by the government if the insurance bill goes over $45,000.

Who pays this government subsidy?

The taxpayers, by having their taxes increased.

 Who makes the profit from this subsidy?

 The healthcare insurance industry makes the profit because the insurance policies have been priced at high risk (Increased deductibles, and increased premiums for consumers not eligible for government subsidies).

 "The reinsurance program has done and will continue to do what it was intended to do; help attract and keep more carriers in Obamacare than might have otherwise come."  Thus, Obamacare is being aided by having taxpayers subsidize big insurance companies' business expenses.”

Obamacare also provides the healthcare industry a greater subsidy. It is called the “Risk Corridor Program”. The “Risk Corridor Program” limits the overall losses of the healthcare insurance industry to 2.4%.

This is the way the “Risk Corridor Program” works. The healthcare insurance company submits its expected costs to the government for a particular year.

If the expected costs of the insurance exceed 102%, the government will pay the healthcare insurance company 80% of the difference above 102% at taxpayers’ expense.

 “Taxpayers' are unwitting generosity toward these "participating health plans" (plans sold through Obamacare's government-run exchanges):

 "If the health plan has costs at 110% of the medical cost target [the costs that the insurer expects to accrue], it will be responsible for only 102.4% of the target (a 2.4% shortfall)-only about a quarter of its losses.”

There is little risk to the healthcare insurance company for being involved in the healthcare insurance exchanges.

The key point is President Obama had this written into Obamacare without telling taxpayers about it. I wonder if the CBO knew about it and calculated it into the original cost estimates of Obamacare.

“In this way, and so many others, Obamacare takes a major step toward the government monopoly over American medicine ("single payer") that liberals drool about in their sleep.”

 There are many other deceptions that lie ahead. Now that the Jonathan Gruber controversy has increased the American public’s awareness of Obamacare deceptions Americans will begin to shout about the costs and rationing of care.

  The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.