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Thursday, October 24, 2013

Mounting Problems with the Affordable Care Act

At The Hill, Elise Viebeck reports:
The error-filled rollout of ObamaCare’s enrollment site appears to have put the administration well behind its initial estimate of registering half a million people in the new exchanges this month.
Experts also expect that many of the people who are enrolling are old and sick, and not the younger, healthier uninsured people needed to make the system work.
Figuring out precisely how many people have enrolled is impossible because the administration has refused to provide any details, but it is clear that only a handful of the 20 million people the White House has reported have visited have enrolled in ObamaCare.
An administration official confirmed that 476,000 applications had been filed as of last weekend, a step that precedes signing up for coverage. At least half of these were from the 36 federally facilitated exchanges that have been plagued with problems.
A good number of those 476,000 people, however, could be trying to sign up for the healthcare law’s expansion of Medicaid, and not ObamaCare.
The consulting firm Kantar US Insights estimated that only about 36,000 people, less than 1 percent of the site’s visitors, completed the ObamaCare enrollment process by Oct. 5.
The New York Times reports:
Of the roughly 2,500 counties served by the federal exchanges, more than half, or 58 percent, have plans offered by just one or two insurance carriers, according to an analysis by The Times of county-level data provided by the Department of Health and Human Services. In about 530 counties, only a single insurer is participating.
The analysis suggests that the ambitions of the Affordable Care Act to increase competition have unfolded unevenly, at least in the early going, and have not addressed many of the factors that contribute to high prices. Insurance companies are reluctant to enter challenging new markets, experts say, because medical costs are high, dominant insurers are difficult to unseat, and powerful hospital systems resist efforts to lower rates.
“There’s nothing in the structure of the Affordable Care Act which really deals with that problem,” said John Holahan, a fellow at the Urban Institute, who noted that many factors determine costs in a given market. “I think that all else being equal, premiums will clearly be higher when there’s not that competition.”