By Lambert Strether of Corrente
“Let’s just make sure it’s not a third-world experience.” –Henry Chao, HHS, of the ObamaCare Federal Exchange
UPDATE “Credit Reporting Agency Hired to Verify Incomes for Insurance Subsidies” — and lambert scooped the world at Naked Capitalism. The Times, 2013-07-17:
The Obama administration has hired a credit reporting agency to help verify the incomes of people who apply for federal subsidies to buy insurance under the new health care law.
The company, Equifax Workforce Solutions, a unit of Equifax Inc., will provide information that is more current than what is available on federal income tax returns.
So the other shoe drops: Income verification by the IRS got triaged on July 5; and Obama just privatized the function; yet another market state solution. You read it here first on 2013-05-12; the context is the change from the 21-page ObamaCare application form to the 3-page form, with new wording added to the 3-page form:
It looks like young Ezra (and, to be fair, everybody else) missed a major policy change in Obama’s shift to the new, shorter (for individuals*), final version of the basic application for ObamaCare.** [The form now reads:]
We’ll check your answers using information in our electronic databases and databases from the Internal Revenue Service (IRS), Social Security, the Department of Homeland Security, and/or a consumer reporting agency. If the information doesn’t match, we may ask you to send us proof.
[H]ere’s the bottom line: You fill out the ObamaCare form under penalty of perjury. And “if the information doesn’t match” “we may ask you to send us proof.” So, if you play “the match game” [with dirty data from Equifax] and lose, you could be facing a perjury charge driven by credit reporting data (or payday lending data, or utility data, or….). Data that you may not know about, that may well be false, that might even be about somebody else, and for which the burden is on you, personally, to correct, which is extremely difficult and costly to do.
Check out the post for lots of detail, and screen shots of the changed form.
I know gloating is so unattractive, but it’s nice to see that an English major’s old-fashioned close reading of the ObamaCare application form, plus a realistic dose of cynicism and paranoia assessment of the administration’s capabilities, can yield a good outcome, and well before the very well-paid access journalists, too.
Will the state Exchanges launch on time? Even if the Exchanges (now also called “marketplaces”) will only cover 7 million of the 56 million uninsured in 2014, this answer to this question is still important to some; and the political fortunes of the Democratic nomenklatura are not necessarily their first concern.
[T]his implementation issue is not a trivial thing. Many, many, many people are counting on it. They expect to have access to health insurance and for that health insurance to give them access to actual health care. I repeat: This is not trivial. It is not a game.
The answer given by administration officials is “Yes!” Just this week:
“The marketplaces [note plural; she includes all the states] will be ready,” Health and Human Services spokeswoman Joanne Peters said Thursday in a typical statement. “We are on schedule with the testing that began in October 2012. Any discussion to the contrary is pure speculation.”
In fact, there’s not even a Plan B. HHS Secretary Kathleen Sebelius, back on April 12:
“No,” Sebelius said when asked whether there’s a backup plan in case that deadline slips. “We are determined and on track to meet the Oct. 1 deadline.”
But then they can’t say anything else, can they? Given that Obama nailed his colors to the mast of the October 1 launch date in his April 30 presser: “We will implement it.” So, no matter what, we can expect — the ObamaCare rollout being, after all, an off-year employment opportunity for campaign operatives — a ribbon cutting ceremony, a public relations campaign, happy “consumers,” parades, ponies, rainbows, and so forth. Maybe even cute videos and some apps! Something’s going to go up at healthcare.gov, no matter what and come what may. But what? How, at this point, do we verify any of the claims the administration is making? I mean, some of us need to know whether we’re going to be mandated to spend thousands of dollars or not! Even if employers did catch a break and won’t have to.
If ObamaCare were a multibillion fighter plane I’d expect fly-bys, glamour shots of pilots and cockpits, YouTubes of aeronautical maneuvers, and plenty of breathless stenography in the fan press. Even if the aircraft was years late, over budget, and not up to spec! But from ObamaCare, none of that. It’s a remarkably secretive program:
It’s still unclear just how ready these digital systems will be on Day One and how much is already being done to mitigate the inevitable glitches. The administration has remained tight-lipped about the operational details. That has frustrated states and insurers, both of which need to connect to the new under-construction system. “From where I sit, it’s hard to monitor their progress on the data hub, because it is a black box until it either works or doesn’t work,” says Dan Mendelson, CEO of Avalere Health and a former official at the Office of Management and Budget.
I continue to be puzzled by the way the Obama administration is developing the federally run Exchanges in the 35 states in which they will have to run them. …. [W]hy all of the secrecy? … Last week Washington was abuzz with detailed reports in the Washington Post about how personal phone and computer records are being monitored by the federal government. It’s notable that more is now known about that national security enterprise than exactly where HHS is on “ObamaCare” implementation! Why is the implementation of “ObamaCare” by the Obama administration a top-secret enterprise?
The Exchanges are software, so let’s talk about testing.[1] Testing is, one hears, in process as of July 12:
States and health plans [can they not be named?] have begun testing some data Exchange with the federal hub. But states have been testing “clean” data, meaning that every name is spelled perfectly and every Social Security number is entered correctly.[2] Ultimately [that is, in 81 days], the data hub will need to identify people and their information even with typos and errors.
The only state we’ve been able to get detail on testing for is Maryland. (“Covered California” +testing” yields no hits.) And for good reason. As of June 13:
[Rebecca Pearce, executive director of the Maryland Insurance Exchange, told the audience at a recent Gorman Health Group forum outside Washington, D.C.:] “We are the only state to have actually connected to the Federal Data Services Hub live during the FDDR [Final Detailed Design Review]. I can tell you[3] that all of the 18 state-based Exchanges must be in some sort of test phase with CMS on the Federal data hub. And that is definitely happening.” The demo included verification of Social Security numbers, citizenship and eligibility for advance premium tax credits.
The Maryland test apparently took place May 30:
Last week, I received my weekly email update from the Maryland health insurance Exchange:
Maryland Health Connection completed its Final Detailed Design Review (FDDR) live system demo on Thursday, May 30. The FDDR is a federal stage-gate required of all state-based Exchanges. Maryland Health Connection successfully demonstrated end-to-end enrollment of a split family scenario including user log in, eligibility determination, real-time data verification through the Federal Data Services Hub, enrollment into plans, payment and file generation to be sent to an insurance carrier. This major information technology milestone received high marks by federal partners. We will continue with development of Maryland Health Connection over the next several weeks and begin user acceptance testing in July.
So what the heck is a Final Detailed Design Review? The Google yields one hit besides dupes of the above quote: The RFP for the Nebraska Exchange:
1. CMS ENTERPRISE LIFE CYCLE ARTIFACTS
The project will comply with CMS’ Enterprise Life Cycle requirements by ensuring that the deliverables and artifacts associated with CMS reviews are prepared and available to the Exchange at least three (3) weeks prior to each of these reviews. For reviews that have already occurred (such as the Planning Review and Design Review), the Exchange will require the contractor to review the artifacts and make appropriate updates to reflect the contractor’s solution and methodologies.
a. Project Reviews
b. Architecture Review (AR)
c. Project Baseline Review (PBR)
d. Preliminary Design Review (PDR)
e. Detailed Design Review (DDR)
f. Final Detailed Design Review (FDDR)
g. Pre-Operational Readiness Review (PORR)
h. Operational Readiness Review (ORR)
In a perfect world, I’d use the names of those “life cycle artifacts” as search terms to find [PDF, no doubt, ick] status reports for all the other states with their own Exchanges, but it’s very late. (Enterprising readers?) Here, however, is the [PDF of a PowerPoint deck, double ick] status report from the Massachusetts Health Connector (“HIX”). Remember RomneyCare? Of course you do. From the Board of Directors Meeting, May 9, 2013:
• The HIX-IES project recently completed the Federal Detailed Design Review (FDDR) which comprises a comprehensive IT systems and infrastructure review, including the following areas:
–System architecture
–Detailed system design specifications
–Business rules and use cases
–Data, interface and integration design
–Privacy and security
–Project schedule
• Key upcoming Federal milestones
–Pre-operational Readiness Review (Optional) –TBD, likely August
–Operational Readiness Review (Required) –TBD, likely September
OK, so there we have a timeline. But now get this slide:
At this stage, the team continues to aim for a successful launch of the Exchange on October 1st, with ACA-required core functions available to our customers
–Further development, testing and stabilization of the system will continue throughout 2014
• However, we are mindful that there is zero “wiggle room” in our timeline. While the project team is working at maximum capacity, we continue to anticipate risks and uncertainties, both internal and external, that will expose us to additional pressure
Let’s look at that slide more closely. Does anybody remember the great designer Edward Tufte’s brilliant demolition of the slides NASA’s engineers used in the Columbia Disaster? Here’s Tufte’s key insight in PowerPoint Does Rocket Science:
As the bullet points march on, the seemingly reassuring headline fades away. Lower-level bullets at the end of the slide undermine the executive summary. … The format reflects a common conceptual error in analytic design: Information architectures mimic the hierarchical structure of large bureaucracies pitching the information. Conway’s law again [q.v.].
We see the exact same pattern here: For the Directors (and for CMS (HHS (Sebelius (Obama)))) the key point is “successful launch.” For the project manager, “Further development.” For the cube dweller down at the bottom of the food chain, “zero ‘wiggle room’.” (At this point we are reminded of the programmers of the Connecticut Exchange working nights and weekends after Obama changed the application form.)
And yet the Massachusetts Health Connector has had a working, fully implemented Exchange since 2006, for seven years. Even they are finding “risks and uncertainties” in moving through Pre-operational Readiness Review to Operational Readiness Review to launch in 145 days (May 9 to October 1, 2013). So, surely states that have never launched an Exchange at all must feel even greater levels of concern?
And now let’s return to Maryland. Remember what the Exchanges are supposed to do:
Building the Exchanges has proven a heavy lift.[4] To make them work, the federal government needs not only a consumer-facing website and call centers stocked with customer-service representatives in 34 states but also a brand-new, complex IT structure to make the system work across the country. The law says that when an applicant enters her information online, various federal agencies must validate her income, citizenship status, residency, and eligibility for Medicaid. The portal must also connect to the Veterans Administration, the Defense Department, the Office of Personnel Management, and the Peace Corps. Plus, it needs to communicate with every health plan selling insurance in each state.
And let’s repeat what the Maryland Exchange is said to have done, when successfully completing its Final Detailed Design Review:
Maryland Health Connection successfully demonstrated end-to-end enrollment of a split family scenario including user log in, eligibility determination, real-time data verification through the Federal Data Services Hub, enrollment into plans, payment and file generation to be sent to an insurance carrier.
Alrighty then. Maryland is the only state to have connected to the Federal Data Services Hub and that is reported to have successfully performed “eligibility determination,” which includes income validation, in real time, just as advertised.[5]
But if Maryland’s income validation FDDR on May 30 was indeed successful, then why did Obama triage income validation on July 6?[6]
- Was the Maryland FDDR really not successful?
- Did the Maryland FDDR merely test the Federal Hub API with fake data? And now it turns out the Hub can’t deliver real data?
- Are Maryland (and Massachusetts? and Washington?) still the “only” states to have reached the FDDR stage in the CMS Enterprise Life Cycle?
- And what about California?[7] Surely, if the huge, Democratic, Hispanic “battleground” state’s Exchange had passed its FDDR, victory would be in Obama’s grasp?
- Or (as some on the right think, reinforced by Howard Dean) is this all a cunning [Kenyan Socialist] plot to encourage people to join the Exchanges by making fraudulent attestations about their now unverified income?
I don’t know. But I do know this: When the project lead (project manager (department head (CEO))) start triaging requirements, that’s a sign of a project that’s out of control:
“I think that the administration right now is in a triage mode. Seriously, they do not have the resources to implement all of the provisions on time,” Washington and Lee University law professor Timothy Jost, a supporter of the ACA, testified Wednesday at a House Ways and Means Committee hearing on the delay in employer penalties.
And, as I keep saying, LBJ implemented Medicare for all over-65s in a year, back in the day when crewcut guys in white shirts wearing skinny ties shoveled punch cards into the ravening maws of giant steam-powered mainframes. Of course, Medicare has a very simple single payer systems architecture: Over 65, bang, done, let’s go deliver some health care. LBJ didn’t need to engineer a cluster**** of rentier-driven complexity to keep the sucking mandibles of the health insurance companies firmly planted in our unprotesting flesh. ObamaCare’s “wicked” implementation problems are one and all a consequence of a “market state”-style policy choice by the political class[8] that ignored proven health care successes in favor of rental extraction.
At this point, Serco, Obama’s July 4 pick to administer to the ObamaCare rollout starts to look a lot like the backup plan Sebelius said didn’t exist:
White House officials say that in many cases federal and state computers will be able to verify a consumer’s income and citizenship status and determine eligibility in a matter of minutes [huh? That’s not “real time”!]. But contract documents indicate that federal officials still expect that one-third of the 19 million [not 7 million?] applications in the first year will be filed on paper.
Because if the Exchanges go belly up, good old-fashioned paper has passed the test of time. I’d say “Pass the popcorn!” if so many people wouldn’t suffer.
NOTES
[1] Time for this hoary old chestnut: “Program testing can be used to show the presence of bugs, but never to show their absence!”
[2] We know the problems with dirty big data from looking at the issue of false positives in NSA’s surveillance programs.
[3] “I can tell you?” What kind of language is that? It’s like Obama’s “insider threat” program got applied at HHS, besides DOD.
[4] I hate the Beltway insider phrase “heavy lift” with the hatred of a million burning suns. Try working in an Amazon warehouse. That’s a heavy lift.
[5] Washington is also reported to have done testing. From July 14:
Michael Marchand, spokesman for Washington’s Health Benefit Exchange, said the state’s online marketplace had conducted frequent tests with the federal data hub, which had worked well so far.
But “worked well so far” doesn’t tell us where Washington state is in terms of Lifecycle Artifacts, which is the key question for determining whether they are on time.
[6] Hat tip Katiebird for this insight. And I don’t care that “progressives” and Obots say that income validation really wasn’t all that important. If it wasn’t important, it would never have been a requirement!
[7] I’m seeing an FDDR completion date of 3/1 in what looks like a Covered California Grant Proposal. That’s all I can find. Readers?
[8] Let’s face it: The Republicans would have no problem with RomneyCare if Romney were President. And ObamaCare is RomneyCare. Howard Dean: “Barack Obama’s health care bill is nothing new. Mitt Romney signed one just like it four years before.”
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The theft and abuse subroutines are ready, because…priorities.
So, there is some schedule upside.
Asset-backed money is the greatest way to create wealth ever invented but there are two ways to issue it:
1) As Liabilities – this supposedly indebts both the bank and the borrowers but because of the Fed, government deposit insurance and the lack of a Postal Savings Bank, the liability of the bank is mostly virtual while the liability of the borrowers is very real. Plus borrowers are liable for interest that does not necessarily even exist in aggregate except as more debt and even then the banks may tighten lending to eliminate even that source!
2) As Equity – this “shares” wealth and power as people consolidate their capital, including their skills and labor, for economies of scale. THERE IS NO NECESSARY DEBT, much less interest to be paid.
So why aren’t McDonalds’ workers sharing in the profits and power of McDonalds? Short answer: Why “share” with the workers when via loans from the government-backed credit cartel one can legally steal their purchasing power instead?
I should add that though borrowers are victims, the most so-called “creditworthy” of them are also villains though perhaps unwillingly because of competitive pressure to steal.
It’ll all be alright on the night: see
http://en.wikipedia.org/wiki/Novopay
‘The Massachusetts Health Connector has had a working, fully implemented Exchange since 2006, for seven years. Even they are finding “risks and uncertainties” …’
Good point. Why would other states not license what Massachusetts has developed? After all, there’s no substitute for seven years of real-world experience in dealing with health consumers and the often defective, missing or contradictory documentation which they present.
Coding new callouts into the MassCare app to adapt to the different carriers, databases and regulators in other states seems trivial, compared to engineering a consumer-facing app from the ground up.
Knowing no more than what I’ve read in the MSM truthfeed and in Lambert’s vastly superior digital samizdat, I can forecast that the grim exchanges with their manual paperwork fallback option will play out like the notorious automated baggage system when the Denver airport opened:
http://calleam.com/WTPF/?page_id=2086
And the Denver airport baggage system didn’t have a shadow squadron of hackers taking potshots at it.
Let us hope the army of gestoras [bureaucratic sherpas] funded under Obamacare are capable of printing neat block letters on paper forms, even if they haven’t mastered such scholarly arcana as ‘reading cursive.’
Oho, oho, and off for care we go!
I’d imagine the State of Massachusetts doesn’t have ownership of the code, just a license to use. It’s common for a custom software shop of any size to charge a premium for rights above the bare minimum. Uncounted licenses, exclusive licenses or work-for-hire contracts increase opportunity costs for the developer.
Friends;
Being one of the working class drones that will probably have my employer supplied healthcare dropped for exchange healthcare on January 1 2014, I’m wondering just how loud the howls of rage, and later, unmedicated pain are going to be. I know that I’m going to ditch this h—hole of a job right fast when that happens. I’d be better off with under the table part time.
Lambert, have you seen this?
http://fdlaction.firedoglake.com/2013/07/16/administration-to-let-employers-avoid-mandate-by-offering-worthless-insurance/
Lambert,
A family member was on one of the losing teams of the contract that went to Serco. That contract was for staffing and setting up the eligibility determination system for the Federal Exchanges. These are the folks who will open up the paper applications, double check the online applications, and handle the customer support for the Federal Exhanges.
The contract that went to Serco is not plan B. It is Plan A. Basically, for much of the last 3 years, CMS has been formulating all the specifications for how the exchanges were supposed to be implemented, and the work was finally put out for bid approximately 9 months ago. You can check out the timeline at CMS here: http://tinyurl.com/ky57y3b
So, what does this mean? It basically means that the Eligibility support systems for the Federal Exchanges have been worked on for….approximately 16 days. While Serco no doubt had a basic plan for implementation, they certainly didn’t perform much heavy lifting before they got the contract on July 1.
I don’t have any information on the contracting for the data systems and online portal for the Federal Exchanges, but I doubt the contracting was much faster for that.
Bottom line: the states may have gotten to the stage where they are testing their systems, but the Federal Exchanges have barely been built.
LBJ didn’t have to operate under the rules of the current Federal procurement system.
Thank you, thank you, thank you. Let me add some words here to push the foul language off the sidebar–
This is the mostest fucking awesome piece of kayfabe EVAH. Obama is a GENIUS, a veritable Sultan of Shill.
* * *
And especially thanks for the CMS link; I do try to keep track, but real informtion is not easy to find.
MaxStirner, a followup:
What the heck was Maryland connecting to, then? Or we can set up communication via email, if you like.
Lambert,
I would suggest digging around on that website I linked you to. The contract for the Fed exchange online portal and data systems integration has to be around there somewhere.
Obamacare has two things at the heart of it: Eligibiliy verification, and something called the Federal Data Services Hub. This is the central node through which the states can connect to make and receive their data requests. The Hub is supposed to interface with the different federal agencies, and verify income, access to employer insurance, subsidy elibility, citizenship, etc.
If what Maryland claims is true, then at least the hub is partially working. However, if they are verifying income on the honor system, and waiving the penalties for the employer mandate, it’s pretty clear there must be some elements of the hub (or agency connections) that are not working yet.
If you can find out the bureaucratic jargon they are using for the various systems, you should be able to use the public procurement notices to identify and track progress of the elements.
The big thing I have no information on is exactly who is building the interface for the Federal exchanges. That site needs to tap into all these different systems behind the scenes, yet offer a signup process that is relatively easy for consumers to navigate. And it has to be up and running in 10 weeks!
That is about the extent of what I know. Good luck digging – you have been doing a great job so far.
Now you got me curious so I did a bit of online digging.
The company that got the contract to build the Federal Data hub is Quality Software Services Inc.(QSSI)
Which of course (cue the Dr. Haddon voice from Contact)…is a fully owned subsidiary of…UnitedHealthcare.
Read it and weep:
http://bit.ly/YzUZMP
Max,
Corrente was all over PQS and the connect to UHC months ago. There’s some good threads over there if you feel like visiting. Suggest you search for “PQS” or “federal data hub” or United Health Care.
Thanks very much for the close-first hand account of the apparently quite mysterious business with Serco and exactly what it is doing or has done.
“All over” as much as we could be. I’m not an expert in the Federal procurement process, and I don’t know the players. That’s why I found Max’s comment helpful. We’re trying, gawd knows, but we’re a small crew to handle a humongous story.
Ok, maybe “all over” was technically hyperbole. But I do not think it was hyperbole insofar as Lambert and others who are *not* experts were alert and astute enough to ask the question and follow through as well as they could. And I think it was a pretty good “amateur hour” — facts putting some meat on the bones of an otherwise ignored “story” were found and reported!
The thing about the story is that nobody seems to know how all the pieces of the puzzle fit together. Lambert has done a great job of at the very least identifying where the myriad trouble points are. Several months ago, I had to help pitch a healthcare client on what the future of the ACA looked like. They had no clue how it would play out. I can’t say that I do either. Alas, I lost the work. But Lambert has done a great job of picking out many of the trouble areas and uncertainties.
Here is the thing: I don’t think anybody really knows what the hell is going on with the exchanges. The implementers at the lowest levels have probably been saying “boss, this isn’t going to work,” The bosses try to intervene, and can’t make it happen, so they go to to their bosses and make the same “not going to work” speech. Eventually someone sat down with Obama and explained that it’s not going to work. My guess is that all the late stage waivers and rule bending is a last ditch by the administration to somehow make it work.
As a subsequent commenter said, the main directive is now not to embarrass the President. Hubris, meet the Mythical Man Month.
Is it impossible for the Federal Government to take on large projects (or small!) in-house anymore? Have they taken a “no new employees” pledge or something?
Is it just taken for granted that everything will be managed by outside contractors?
It’s reasonable to outsource the development and implementation of these sorts of programs, because the agencies can tap into experts/firms that specialize in *building* exactly these sorts of systems in states and in other countries. Since most work in the agencies is generally incremental, there is no reason to have a crack IT staff on hand just in case they are going to reform the entire healthcare system in the US.
However, the agencies are very good at administering these types of programs on a continuing basis. CMS would do a dandy job administering the eligibility verification for Obamacare on an ongoing basis. They probably aren’t doing that because someone at a higher level figured that it is probably cheaper to outsource the work to a private contractor that will hire workers in low wage Southern states, than it is to hire a bunch of new Federal Workers.
For those of you who don’t bother to follow the link, a few details are worth calling out:
The value of the contract to Serco is at least $114 million and as possibly much as $1.2 billion. The period discussed in the proposal describes it taking at least a year (“a 12-month base period”) plus possibly an additional 4 years (“four (4) 12-month option periods”). This is a large project, even taking into account the military-sized budget and attendant graft.
Now to be slightly fair, the project might all be front-loaded, and the juicy deliverables might all be in the first year — but as Lambert and MaxStirner are pointing out, there is NO FUCKING WAY this thing is going to be done in 10 weeks. It’s an absurd con to state otherwise.
And then there is also this:
http://fdlaction.firedoglake.com/2013/07/16/administration-to-let-employers-avoid-mandate-by-offering-worthless-insurance/
Apparently the definition of “insurance” is flexible and some employers are going to be permitted to provide insurance plans that don’t actually insture against anything at all.
That’s why the story of a huge rate drop in New York — which pre-empted the completely unrelated story of Obama outsourcing income verification to Equifax — is such a crock. We don’t know what we’re getting for the price, and since actuarial values are an art and not a science, we won’t even know what we’re buying when we compare plans.
There is no rate drop in NY. I just got the letter — there’s a massive *coverage drop*. To get the same coverage as a standard state-approved plan had before, you now need a “Platinum Plan” PLUS a “rider”.
The abolition of private health insurance may be a good thing in the long run, but it’s going to create a mess for a long time first.
OK, just rechecked the numbers and I stand corrected. There is a significant rate drop, though nowhere near 50%.
The new “platinum plans” are going to be ~$800/mo as opposed to the former ~$1200/mo. Add the extra cost for the “rider” — probably $200/mo, I’d guess — and there will still be a rate drop.
But how does it all net out? Rate drop + coverage drop + co-pay? + deductible? Also, remember that actuarial values aren’t commensurate between plans; see the Kaiser study cited here.
Unfortunately it is becoming increasingly apparent that at the moment of purchase (i.e., when the citizen — consumer — clicks “buy” on an Obama Exchange or signs a piece of paper saying they promise to pay for policy X) the True Cost and True Content of the Product Will Be Unknown and Unknowable. And this is not an accident. And this is why ObamaCare, far from “reforming” a private health insurance system that caused personal bankruptcies and other untold harm to citizens, perpetuates and creates a government-sponsored framework for a Junk Product that will inevitably carry with it WMDs of family budgets (whether families are one person or 10).
It is a horror show.
On note [3], this looks like a “performative” construction:
http://en.wikipedia.org/wiki/Performative_utterance
It allows a speaker to disassociate him/her-self from a statement that may not be true.
Another example: “But I want to say one thing to the American people. I want you to listen to me. I’m going to say this again: I did not have sexual relations with that woman, Miss Lewinsky.”
Is the Beltway Subjunctive another example of that? “I would advise you not to try the veal.”
“No one has a greater knowledge of the Washington health policy scene than Bob Laszewski—political, economic, social, and straight merit dimensions. Bob also has uncanny forecasting powers. And he calls the shots exactly as he sees them, unusual for Washington.”—John McLaughlin, The McLaughlin Group.
Using Equifax for income reporting is like using Wikipedia for fact checking. There is almost no reality to either business’s data.
“Catch-22 says they can do anything we can’t stop them from doing.”
McWatt, you summed it up nicely.
Equifax, Wikipedia, … Reliability Is Us.
It is not exactly on the topic of the exchanges but:
http://www.dailymail.com/News/201307150168
Tuesday July 16, 2013
Delays threaten W.Va. Medicaid expansion
by Dave Boucher
Daily Mail Capitol Reporter
CHARLESTON, W.Va. — Gov. Earl Ray Tomblin cast further doubt Monday on the prospect of West Virginia meeting the federal deadline for expanding its Medicaid program coverage under the Affordable Care Act.
In a letter to U.S. Department of Health and Human Services Secretary Kathleen Sebelius, Tomblin asked a series of questions he believes are crucial to the state meeting the deadline.
He blamed federal delays for the state’s problems with rolling out its new Medicaid system and new insurance exchange.
“It concerns me that incomplete rules and guidelines provided by the federal government, to this point, will not support a successful implementation of the requirements for Medicaid Expansion and the functionality of the insurance exchange,” Tomblin said in a news release….
” … incomplete rules and guidelines provided by the federal government, to this point, …”
Wow. This is dated July 16 — yesterday. And Legacy Roll-Out Day is what, 60-some-odd days away? What exactly has HHS been doing for 3 years since this damned and ignoble legislation was passed!?
But then they can’t say anything else, can they? Given that Obama nailed his colors to the mast of the October 1 launch date in his April 30 presser: “We will implement it.” So, no matter what, we can expect — the ObamaCare rollout being, after all, an off-year employment opportunity for campaign operatives — a ribbon cutting ceremony, a public relations campaign, happy “consumers,” parades, ponies, rainbows, and so forth. Maybe even cute videos and some apps! Something’s going to go up at healthcare.gov, no matter what and come what may. But what?
For anyone that doesn’t work in technology and fails to grasp the significance of this, let me stress that this is a Very Bad Thing.
Put simply, the goal of the overall project is no longer related to healthcare in anything more than a tangential sense. The real goal, towards which everyone concerned will be devoting every iota of energy, is this:
Do Not Embarrass The President.
Any actual healthcare functionality will only be delivered if it is 100% essential to meeting that goal.
What could go wrong?
“Put simply, the goal of the overall project is no longer related to healthcare in anything more than a tangential sense. The real goal, towards which everyone concerned will be devoting every iota of energy, is this:
Do Not Embarrass The President.”
Thank you, thank you and thank you. To hear this from someone with IT expertise is extremely significant. Those of us who aren’t IT people have read many other tea leaves to reach your same conclusion, but as Lambert writes, ACA is a software system. So your comment is much appreciated.
here’s something I haven’t seen mentioned before: catastrophic plans do not qualify for subsidies. So if all you can afford now is that, what is the point of the whole pantomime about subsidies for low income folks?
And except for chancing not getting into an accident or a big illness before the end of a calendar year, why would anyone, esp. the not quite old enough for medicare, buy any insurance policy? $95 penalty for basically no coverage, vs $2500+ for also no coverage except for catastrophes.
Or let me put it this way: 8 years of penalties and wait for medicare, vs 8x$2500.
8x$2500. Are you kidding?
More like 8x$8000+
PUN INTENDED
It’s ludicrous, really absurd, that the Greatest Nation on Earth is playing catch-up in Health Care, and doing so badly.
Most of the more developed nations of the EU have had National Health System (NHS) for at least 5 decades – yep, half a century. That’s at least two generations of children who have been protected by a NHS. And all of them at total costs of one-half to one-third of the US.
And what has been happening in the US? A Private Insurance HC-scheme has been ripping-off the American worker for just as long. With a first-class HC-system that costs an arm and a leg (pun intended) and is not universal.
But ObamaCare changes all that, doesn’t it? Not really. It just drives more of the uninsured (around 15% of American men, women and children) into expensive Private HC-schemes. Supposedly cheaper because they are “competing”. Yeah, right, we’ll see about the competition. There is none today, which is why HC in the US is so damn expensive.
Americans will still be paying “an arm-and-a-leg” for Health Care for years to come.
How does that happen? The Private Insurance has to be paid by someone. So, companies who purchase it will simply impute the cost to the retail prices of their goods/services. Meaning what?
That, fellow Americans, you are paying for Health Care – whether you have it or not – every single time you go shopping.
MY POINT?
I have lived in Europe since the 1980s. I have known fellow Americans who would never go back to America’s unfair HealthCare system. They are used to the European variety that doesn’t scalp you. A simple GP-visit costs me (net) $10/12 in France.
It is a birthright in the EU – meaning you are entitled to it when born. It is first-class, since med-schools here are also top-notch. (And a great many American students would like to enter them since they are one-third the cost of the stateside variety. But, times being what they are, the limited number of places are going to EU-nationals.)
And, yes, that is why we pay higher taxes here in Europe. Namely, for Social Justice – in the form of a National Health System.
MY POINT?
How do we convince Americans that Health Care is not just “another business”. It is a key Public Service and, as such, should not be offered only by Private Medicine. In the UK, you can get both – National and Private. Since the NHS is 100% coverage of all costs, you can imagine where most people go. (And, yes, they complain about the long wait lines.)
NB: For camparative Total (per capita) Health Care costs, see this infographic here resulting from a 2006 OECD study.
All state-based exchanges (except perhaps Idaho and New Mexico) are currently testing with the federal data services hub. For example, Covered California announced that it had completed Wave One testing with the data hub at its May 23 board meeting.
As for Serco, they currently process all the paper applications from US citizens applying for passports. 10 weeks is tight, but this isn’t that big a lift for them.
http://www.healthexchange.ca.gov/BoardMeetings/Documents/May%2023,%202013/PPT%20-%20Executive%20Director%27s%20Report_May%2023,%202013.pdf