The Clock is Ticking [UPDATED]

Today is (currently) the last day of the initial Open Enrollment season. Ms Shecantbeserious has indicated that, if you've tried to sign up and met with no success, the actual final day is April 15th [ed: irony - how does it work?]. I have several clients in this boat right now, and am waiting with bated breath as to how it will play out.

Golden State readers are in a very different boat. Co-blogger Bill reminds us that:

"Under the latest deadline changes, an application has to be started on CoveredCA by MARCH 31. You have until APRIL 15 to complete it. Outside of a qualifying event, if you miss the March 31 date, you're out until next year. On the Federal Exchange, they allow you to check a box that says that you tried to enroll and couldn't and are then allowed until April 15 to start a new application. That's not the case in California!"

Best get crackin'!

UPDATED: Heh (from Bill H):

The latest (slightly edited) press release from CoveredCA:

"Record-setting numbers of people trying to sign up for Covered California™ health insurance plans overwhelmed the system on the final day of open enrollment. Because of the staggering demands on the system, Covered California announced the following policy this afternoon:

• Consumers who were unable to create an online account or start their online application because of technical difficulties can contact a Covered California Certified Insurance Agent to explain that they attempted to get through on March 31 and experienced difficulties. Those consumers will have until 11:59 p.m. April 15 to work with the Certified Insurance Agent to complete their application and choose a plan.
 

• Consumers who created an online account and completed the first page of the application by 11:59 p.m. March 31, 2014, will be able to complete their application for the open-enrollment period, either by themselves online or with the help of a Certified Insurance Agent. Consumers must complete the application and select a plan by 11:59 p.m. April 15, 2014. Those enrollees will receive coverage effective May 1, 2014."

Rumors that the entire system is running on two surplus Commodore 64 computers are unfounded. An Altair 8800 is also employed to dynamically balance the load.

Happy 9th Blogiversary to the HBB!

Congratulations to my friend David Williams' Health Business Blog, which recently hit the 9 year mark (just a few months after IB did).

Kudos, David, and many more years of successful bloggetry!

Does the ICD 10 have the Metric Curse?

Headlines on all the health care outlets yesterday (3/27/2014): 

BREAKING NEWS: House approves temporary SGR fix

Bill also delays ICD-10, two-midnight rule and RAC audits

According to the article: “The House of Representatives on Thursday approved a temporary fix to the sustainable growth rate (SGR) for one year in a bill that also delays ICD-10 implementation until at least October 2015 and postpones hospital compliance with the controversial "two-midnight rule" and recovery audits of medically unnecessary claims until March 2015.”

While several items were approved, the excitement was due to yet another delay for the ICD-10. In 1996, the new HIPAA law mandated the acceptance of the ICD 10, and much like the poor metric system, it has been delayed and delayed in its implementation.

Why has it been delayed? Cost and complexity:

There are significant differences between ICD-9, what is used now and ICD-10, what is currently used in 25 countries, which this table demonstrates:

ICD-9	ICD-10
3-5 characters in length	3-7 characters in length
Approximately 13,000 codes	Approximately 68,000 available codes
First digit may be alpha (E or V) or numeric; digits 2-5 are numeric	Digit 1 is alpha; digits 2 and 3 are numeric; digits 4-7 are alpha or numeric
Limited space for adding new codes	Flexible for adding new codes
Lacks detail	Very specific
Lacks laterality	Has laterality (i.e., codes identifying right vs. left)

What has the medical community so upset about adopting the ICD-10: moving from around 13,000 codes to 68,000 codes. Why such an increase? Because in the ICD-10 the code tells a story. Instead of a code that says “Fracture”, the new code says “Fracture, left foot, first incident, middle toe, while a passenger in a car in a car crash”. In fact, the codes are so complex, they are unintentionally funny. Here are a few real codes:

T63.442S Toxic effect of venom of bees, intentional self-harm, sequela

W56.22xA Struck by orca, initial encounter

Z73.4 Inadequate social skills, not elsewhere classified

V91.07xD Burn due to water-skis on fire, subsequent encounter

And then there is the cost. I have already had some webinars on the glory that is ICD-10, and it is recommended to the physicians that they obtain a line of credit to keep their businesses open during the transition, as the new codes will cause delay in payments. In fact, on the CMS Website, a handout for physicians states, “Budget for time and costs related to ICD-10 implementation, including expenses for system changes, resource materials, and training. Assess the costs of any necessary software updates, reprinting of superbills, trainings, and related expenses.” Great, a new unfunded federal mandate, but at least this time they are stating it will be costly to transition.

Needless to say, the medical community is doing cartwheels over a possible delay. (The first question on a CMS ICD-10 webinar I attended at the beginning of March “Is there going to be a delay?” The answer was "no"). Let’s all hope that the Curse of the Metric System continues to plague the ICD-10 or the next time you go to the doctor your code could be “Headache before sex, subsequent occurrence, would rather read “10 Shades of Gray”, or at the least take a long hot bath, sheesh…”

Cavalcade of Risk #205: Call for submissions

Nancy Germond hosts next week's Cav. Entries are due by Monday (the 31st).

To submit your risk-related post, just click here to email it.

You'll need to provide:

■ Your post's url and title
■ Your blog's url and name
■ Your name and email
■ A (brief) summary of the post

PLEASE remember: ONLY posts that relate to risk (not personal finance tips and the like). And please only submit if you are willing to link back to the carnival if your submission is accepted.

Yo Quiero Obamacare?

The Obama administration has been helping to facilitate a series of events nationwide at

Mexican Consulate offices to enroll people in Obamacare – and a key activist says the efforts are “our responsibility” regardless of citizenship.

“Whether they’re Mexican nationals or whether they’re United States citizens or whether they’re in transition-- and if they’re there it is our responsibility within all of America to educate on the Affordable Care Act,” Enroll America Field Organizer Jose Medrano told Breitbart News on Wednesday.

Breitbart

The 6 Million Person Question

So there's this:

"More than 6 million Americans have now signed up for private insurance under the [ObamaTax]"

But have they really bought insurance?

Consider that we already know that Ms Shecantbeserious counts plans left unpaid for as "sold." So one is left with the real question:

How many of these (alleged) new policyholders have actually paid for their new coverage?

And here's a couple more:

How many are young and healthy (and preferably male)?

How many are paying full freight, and how many are counting on the generosity of others taxpayers?

Inquiring minds want to know.

Health Wonk Review: March Madness edition

The bad news is that this week's HWR host Chris Fleming missed a total of (sweet) 16 posts by that much.

The good news is that there are plenty of great posts from which to choose, from HWR founder Joe Paduda on ideology and business decisions to David Williams ground-breaking interviews of all 9 candidates for governor of Massachusetts - pretty amazing. And our favorite health care economist, Jason Shafrin, offers some surprising insight into genetic testing and adoptions.

Do check it out.

Buyers Remorse

Did you ever have one of those moments when you realize a decision you made, or a choice, was a really, really, really stupid idea?  

Now you know how some of our Congress critters feel.

Like roaches that scatter when the light comes on, vulnerable Representatives and Senators are running away from Obamacare as fast as they can.

Several Democratic senators reportedly plan to introduce as soon as Thursday a set of principles and legislation aimed at fixing parts of ObamaCare amid concerns the law could cost Democrats House seats and possibly the Senate in November.

Fox News

They were for the law before they were against it.

Begich and Warner have called for allowing "copper" plans on the government-run health exchanges. The new insurance plans would offer lower premiums and higher out-of-pocket costs than the "bronze," "silver" and "gold" options currently offered.

Higher deductible plans?

Most people I talk to think the current deductibles are too high. Pushing them higher won't work. Just shows how out of touch Congress zombies are.

Warner, who faces a formidible midterm challenge from Republican National Committee Chairman Ed Gillespie, said on Fox News earlier this week that he supports allowing Americans to purchase health insurance across state lines.

Buying across state lines never made any sense. Even less so now with the pricing guidelines of Obamacare.

One Ringy Dingy

The latest excuse for not enrolling in #Obamacare? 

According to Dirty Harry . . .

Senate Majority Leader Harry Reid (D., Nev.) said the fault of struggling to sign up on the Obamacare exchanges didn’t lie with the faulty website, but with the people who weren’t “educated on how to use the Internet.”

Explaining the reasoning behind the latest Obamacare delay, Reid said too many people just didn’t know to use their computer properly and needed more time. 

Free Beacon

Guess they don't know how to use the telephone either.

Deadline? *What* deadline?!

Earlier this morning, Bob noted that the Obamastration itself has acknowledged that it has no "statutory authority to extend the open enrollment period in 2014."

But that was then, and this is now:

"Federal officials confirmed Tuesday evening that all consumers who have begun to apply for coverage on HealthCare.gov, but who do not finish by Monday, will have until about mid-April to ask for an extension."

Now, leaving aside the legal challenge that this poses (as if legalities were of any interest to this regime), one needs ponder a simple question:

Why?

That is, why would they extend the enrollment period, after so vehemently denying that they would do so?

I think a good part of the answer lies here:

"The results were bleak—just two-thirds of the overall respondents knew that they had to get health insurance this month or face a penalty .. Clearly some of those most likely to be affected by the ACA were ill-prepared to navigate the new health insurance environment"

We already know that the vast majority of those who have enrolled are either folks who have lost their previous insurance or who are being shunted to Medicaid.

And we know that the uninsured are staying away from ObamaPlans in droves.

Seems to me, this extension means one thing: the ObamaTax enrollment numbers must be truly, epically dreadful.

Still not convinced?

Then how 'bout this little nugget, buried inside the  WaPo story linked above:

"Under the new rules, people will be able to qualify for an extension by checking a blue box on HealthCare.gov to indicate that they tried to enroll before the deadline."

Seems harmless enough: simply show that you've made a good faith effort to enroll and ... wait ... What's this:

"This method will rely on an honor system; the government will not try to determine whether the person is telling the truth."

What could possibly go wrong?

Pants on Fire

The Obamacare open enrollment deadline is just around the corner. March 31, 2014 in case you are wondering.  

If you haven't applied by then you can't buy coverage until 11/15/14.

Unless you have a qualifying event that creates a special enrollment period.

Many wonder if the deadline will be extended.

Here is your answer.

"We have no plans to extend the open enrollment period," HHS official Julie Bataille said. "In fact, we don't actually have the statutory authority to extend the open enrollment period in 2014."

Weekly Standard

When has that stopped anyone?

This from an administration that said everyone must have coverage, and then granted over 1200 exemptions. Said you had until 12/15/13 to apply for a 1/1/14 effective date . . . and then changed it. Originally started the 2015 open enrollment in October, 2014 then delayed it until after the 2014 elections. Said the mandate applied to everyone and then modified it for business.

Good thing they lack the statutory authority to modify the law.

Oops!

A newly discovered glitch in the main ObamaCare website reportedly is

giving thousands of people the wrong information about whether they qualify for premium subsidies. 

Because of the glitch, some people may be initially told they qualify for subsidies when they don't. Others may be told they don't qualify when they do. 

Fox News

Can you say clawback?

Preview

Care to take a stab at where premiums will be on 2015 Obamacare plans? Here is a preview of things to come.   

Two months before health insurers must submit rate proposals for 2015 to government regulators, WellPoint Inc. fired a surprising shot across their bow by predicting it may ask for “double-digit-plus” increases.

BenefitsPro

Double digit.

As in 10% and higher.

My money is on higher.

Of course this rocket surgeon has his own thoughts.

“The double-digit increase surprised me,” said Stephen Zaharuk, a New York-based analyst at Moody’s Investors Service, in a telephone interview. “If everything’s working according to plan, then the increases should be where the medical trend is, which should not be double-digit.”

Seriously?

Obviously Mr. Zaharuk has no clue how health insurance rates are determined. Maybe he should stick to predicting grocery prices.

“The rules of the road keep changing,” said Dan Mendelson, chief executive officer of Washington-based consulting firm Avalere Health. “These companies have to hedge their bets.”

Rule changes?

No kidding.

Expect DC to call for broader networks and expanded formularies, just to name a few.

About that *Other* Big ObamaTax case

Cato's Michael Cannon has been following the Halbig case for quite some time. Last we checked, it looked like a US District judge had shot down this case, which argues that IRS enforcement of the (Evil) Mandate was illegal in 34 of the 58 states.

Reports of the case's death, however, are greatly exaggerated. As Michael reports today:

"[A]ppellate Judge Thomas B. Griffith clarified that an Exchange established by the federal government is not “established by the State.” When the government’s lawyer argued that federally established Exchanges meet that requirement, Judge A. Raymond Randolph cut him off: “That is a leap. That is not statutory interpretation.”

Interesting development.