Viewpoints: Marketplaces' 'technical foibles' may keep young people from coming back; health law may be ushering in era of narrow networks

Oct 15 2013

The Washington Post: Obamacare's Balky Web Sites Endanger Its Launch
The encouraging view is that the overwhelming number of visitors to the site indicates high demand for insurance in the new system. That's critical, because the more people who participate, the better the system works. The danger is that the technical foibles since Oct. 1 will discourage people from coming back, particularly the young and healthy customers the system needs to keep rates reasonable. With some big deadlines approaching, the Obama administration needs to fix the bugs, and fast. People who need insurance from the federal marketplace have until mid-December to buy coverage that begins Jan. 1. If enrollment figures aren't robust by then, the new health-care system will have a problem even bigger than a frustrating Web (10/11). 

The Wall Street Journal: ObamaCare's Serious Complications
The functional failures of the Affordable Care Act websites are well-documented, but the fundamental flaw is the law's mind-numbing complexity. The officials who planned ObamaCare blame their Web engineers, but they're passing the buck. ObamaCare is a hugely complicated approach to addressing problems in health care that have simpler solutions. Software glitches are no surprise with such a complex system. For example, signing up uses a Byzantine process to check if a family is entitled to a subsidy, requiring data from dozens of federal and state agencies using databases built on different technology platforms (L. Gordon Crovitz, 10/13).

Bloomberg: Glitchy Rollout Doesn't Spell Doom For Obamacare
More than 8 million Americans tried to log on to federal or state exchanges, despite concerted efforts by conservatives to dissuade them. Software glitches foiled many of these inquiries and undermined supporters' claims that the program is ready for prime time. The confusion also underscored again that this measure is the focus of greater partisan rancor than any major U.S. legislation in recent memory. High emotion often distorts reality. The Oct. 1 rollout was interesting, instructive and not all that important. Over the next year or so, there are at least four crucial benchmarks (Albert R. Hunt, 10/13).

The New York Times: Obamacare: The Rest Of The Story
Unless you've been bamboozled by the frantic fictions of the right wing, you know that the Affordable Care Act, familiarly known as Obamacare, has begun to accomplish its first goal: enrolling millions of uninsured Americans, many of whom have been living one medical emergency away from the poorhouse. You realize those computer failures that have hampered sign-ups in the early days -; to the smug delight of the critics -; confirm that there is enormous popular demand. You have probably figured out that the real mission of the Republican extortionists and their big-money backers was to scuttle the law before most Americans recognized it as a godsend and rendered it politically untouchable. What you may not know is that the Affordable Care Act is also beginning, with little fanfare, to accomplish its second great goal: to promote reforms to our overpriced, underperforming health care system (Bill Keller, 10/13). 

Bloomberg: One Way Obamacare Could Save You Money
The opening of the Affordable Care Act's state insurance exchanges has produced justified guffaws about the ability of the federal government to build a working website. It may also spur something more useful: a reconsideration, with new information for both employees and employers, of the tradeoff between greater choice and lower costs in health care. ... Florida's experience is instructive. The state's largest health insurer, Blue Cross Blue Shield, has a narrow-network plan, Blue Select, for individuals shopping on the Florida exchange. The plan has also seen increased demand from companies, which can cut their premiums by 5 percent to 15 percent. WellPoint Inc. (WLP), which offers exchange plans in 14 states, says it too has seen more interest in narrow networks because of the exchanges. This suggests that Obamacare may be softening a longstanding taboo in American health care: Limiting choice, something associated with health-maintenance organizations (10/13).

The New York Times: It's Not Only Mothers And Children
Traditionally, Medicaid, and other government anti-poverty programs, have largely ignored childless adults under the antiquated rationale that only children, their parents, older Americans and the disabled are deserving of help. The sheer number of childless adults in poverty defies that notion, as does compassion and economic necessity -; an economy cannot thrive with a significant share of the working-age population stuck in poverty. That is why one of health reform's greatest goals is to extend Medicaid to all low-income childless adults with the federal government paying all of the costs for three years and at least 90 percent after that. The refusal of many states to go along undermines that important step forward (10/12).

The Los Angeles Times: Another Special Interest Tries To Wriggle Out Of Paying For Obamacare
Now that the medical device industry appears to be on the verge of snaking out from under its Obamacare-related tax, another industry lobby has stepped up to the plate with the words, "Us too!" We're talking about the health insurance industry, which has launched a campaign to kill a premium excise tax that will start being collected next year. As with the medical device tax, this is an example of pure special pleading. The Affordable Care Act is shot through with fees and taxes affecting almost all stakeholders in healthcare, largely because conservatives in Congress insisted that the law pay for itself. The health insurance industry simply doesn't want to carry its share (Michael Hiltzik, 10/11).

JAMA: Young Adults And The Affordable Care Act – Invincible Or Convincible
As the marketplace for the Affordable Care Act (ACA) opened for business last week, software glitches and the volume of consumer interest prevented some people from accessing the sites, perhaps an encouraging sign of demand. But the success of the ACA hinges not just on the overall number of people who ultimately purchase insurance but also on whether a substantial number of those who sign up are young adults-;those aged 18 to 35 years, about 19 million of whom are currently uninsured (Dave A. Chokshi, 10/11).

The New York Times: Out Of Network, Out Of Luck
For several hundred patients at the University of Pittsburgh Medical Center, it started with a certified letter informing them that they were no longer allowed to see their physicians. The reason? They were unlucky enough to have insurance called Community Blue, which is offered by a rival hospital system. Astoundingly, they were barred even if they could pay for the care themselves. ... Community Blue is sold by a company called Highmark. Like U.P.M.C., it is both a hospital system and an insurance provider, part of a growing trend toward vertical consolidation in the two industries. These and other companies insist that such consolidation streamlines the caregiving system and thus benefits the patient. But in the short term, they are waging a vicious war over patients -; and as the experience in Pittsburgh shows, it's often the patients who are losing (Theresa Brown, 10/12).

And on other topics --

The New York Times: Hope For A Malaria Vaccine
The most ambitious clinical trial of a malaria vaccine has shown some effectiveness in children over an 18-month period. While its efficacy is modest, it is nonetheless a significant advance in the long struggle to control a disease that kills some 600,000 people a year, mostly children under the age of 5 (10/13).

The Washington Post: Miriam Carey Didn't Have To Die. Police Need Better Training In Mental Illness.
Officers fired 17 shots over several minutes before one round killed the driver, 34-year-old Miriam Carey, on the northeast side of the Capitol. Of course, the officers couldn't have known that Carey had been diagnosed with postpartum depression with psychosis and that her understanding of their commands may have been clouded by an alternate reality in her head. But if they'd had better training, they might have realized that she wasn't intentionally defying their orders as much as she was panicked, confused and in the midst of an emotional breakdown. They might have figured out a way to calm her down without killing her (James Mulvaney, 10/10).