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Life Health > Health Insurance > Health Insurance

On the Third Hand: The 3 Rs

By Allison Bell

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Programming computers is hard, and it’s one of those things that never seems to work the way it ought to work.

One information site I’ve visited (details changed to protect the afflicted) randomly puts bits of text in 14-point bold italics.

People act as if Amazon.com is perfect, but, of course, anyone who depends on the Amazon Cloud knows it sometimes goes down.

And my own HealthCare.gov account is working a lot better today than it was a week ago. I could log in, navigate quickly around the site, and, for the first time, see my eligibility determination notice. (The system said, incorrectly, that I was eligible for a subsidy. I couldn’t figure out how to find out whether that was because I goofed or because the system goofed.)

So, it seems meanspirited to call for U.S. Department of Health and Human Services (HHS) officials to resign over website problems. 

Republicans have invested a lot of resources in showing that Satan took over the HealthCare.gov development team, but it seems as if what they’ve proved is that inexperienced project managers ask for dumb changes too late and that — gasp! — politics shaped HealthCare.gov. Politics. Who would have ever thought of such a thing.

I think the reason to have concerns about HHS officials is not so much the site problems, or the politics, as HHS reluctance to communicate any details whatsoever about HealthCare.gov, from the names of most of the senior people involved with managing the project to HealthCare.gov application activity numbers.

If this were only about HealthCare.gov, yawn. The HealthCare.gov issue is just a new way for Republicans and Democrats to clobber each other.

The problem is not HealthCare.gov, but “Patient Protection and Affordable Care Act; Program Integrity: Exchange, Premiums Stabilization Programs, and Market Standards; Amendments to the HHS Notice of Benefit and Payment Parameters for 2014″ (CMS-9957-F2; CM-9964-F3), a final rule.

That’s a set of HHS regulations that, among other things, affects what happens if some health insurers end up with a lot of sick people and some with a lot of healthy people. The insurers with the healthy people are supposed to somehow send cash to the insurers that end up with a lot of sick people (or successfully pretend that they insured a lot of sick people).

This could affect the flow of a lot of money, and whether the exchange plans really kind of work or don’t work at all.

I did my best, figured out one toenail on one leg of that complicated elephant, and wrote about that toenail, to try to at least give readers an idea about whether they ought to read the regs. But my editors look at me funny when I try to write about the risk program elephant, and I know they’d really prefer that I write about some new funny problem with HealthCare.gov. (Maybe some problem with the questions about whether you or your relatives have been in jail lately.)

On the one hand, if PPACA World really starts up in 2014 and operates more or less as required by PPACA, layfolks, and people in the insurance community will depend on people at HHS and other federal agencies to run that complicated risk management programs in good faith, with some reasonable level of disclosure, and not just make risk program payments flow in a way that looks pretty on a PowerPoint slide.

If we can’t count on HHS to give us basic estimates of, say, how many people have tried to use HealthCare.gov to sign up for exchange plans in Texas or Florida — which is something we can at least start to figure out for ourselves — how can we count on HHS to be reasonably candid and competent when it comes to the much more abstract, much more contentious and, I suspect, much more complicated risk management programs?

On the other hand, Republican opponents of the exchange have certainly pounded HHS in an obnoxious way that’s all but forced the department to lawyer up and defend itself by having lawyers do their best to remove any possible bit of information from any sentence that an HHS official utters.

But, on the third hand, if HHS officials would just be a little bit candid about what’s going on with PPACA, maybe they could at least convey the idea that HHS officials are capable of having information in their heads. Maybe that by itself would elevate the level of discussion. 

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