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Life Health > Health Insurance > Health Insurance

On the Third Hand: Numbers

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I was going to write this blog entry about just how interesting the latest off-exchange health insurance price index from eHealth Inc. (Nasdaq:EHTH) is.

The company runs the private “health insurance exchange” (aka Web-based insurance sales site), and it’s used data for its own sales of nonsubsidized, off-exchange individual and small-group health insurance to come up with an indicator of what might be happening throughout the individual health insurance exchange market.

What eHealth is reporting might bode well for the guaranteed-issue, mostly community-rated system that the drafters of the Patient Protection and Affordable Care Act (PPACA) hoped to create.

What the index graph shows is that the average age of people applying for individual coverage has fallen to about 36 this month, from close to 45 in November. 

If those results hold true for the rest of the individual health insurance market, they may mean that the risk pool for the individual commercial “qualified health plans” (QHPs) sold through the PPACA public exchange system is either a mess or a huge mess, but that the demographics for the overall individual market will be fine, or just moderately bad.

Break out the lukewarm diet soda!

Analysts at the Henry J. Kaiser Family Foundation came up with another interesting PPACA performance measure: The percentage of state residents who might be expected to qualify for PPACA QHP tax credit subsidies who have actually gotten the subsidies.

The analysts found, for example, that the apparent subsidy take-up rate seems to range from 13 percent in the District of Columbia to 32 percent or more in Washington state, Connecticut, California, Rhode Island and Vermont.

So, on the one hand: Maybe PPACA World will muddle through. Maybe it will be a failure in some ways, but pretty good in other ways.

Maybe even some of what we all think of as failure — yuppies getting mad about getting treated like Medicaid enrollees, and having to wait a long time to see distant providers, will, ultimately, lead to important conversations we ought to be having about the quality and convenience of the care poor people and sick people get. Maybe it’s good for society for people who have widely read blogs to spend some time in a Medicaid enrollee’s shoes.

But, on the other hand, what hit me as I was writing this, is that the U.S. Department of Health and Human Services (HHS) keeps dribbling out interim QHP selection numbers, with little or no context, at random times, and in semi-random locations in the Web or off-Web universes. 

The Internal Revenue Service (IRS) has, apparently, already started making a lot of subsidies available, but HHS doesn’t seem to have authorized anyone at the IRS to give even partial or very rough information about early tax credit subsidy payments. Are the IRS QHP tax credit payments smaller than a thimble? Bigger than a breadbox? I have no idea.

When I go to state exchange websites, I see exchange boards that once devoted acres of Web space to papers on marketing strategies, or gender rights issues, or how to serve populations that speak nearly extinct languages, with no information at all about their recent board meetings or their strategies for fixing their dysfunctional enrollment programs. 

Maybe, say, the board of the Nevada exchange looks bad because it has to admit that it’s left thousands of applicants in various types of coverage limbo, and the District of Columbia exchange looks bad because it hasn’t gotten that many of the residents who should have subsidies signed up for subsidies — but maybe those boards look a little bad simply because they’re being brutally honest. Maybe those are really the exchanges that will muddle through pretty well.

Maybe the best question to ask is: If an exchange doesn’t have evidence of pain, misery and vendor terror in the board meeting section of its website, what the heck is wrong with that exchange? What is an exchange that has “clean sheeted” itself hiding?

On the third hand: Whether a website works well or poorly is, in the long run, easy to fix. If the current PPACA exchange system has the risk management mechanisms right it could, if Congress were more functional, be fairly easy to fix. 

If we can’t trust the exchange regulators and exchange managers to release reasonably complete, reasonably accurate performance information in a reasonably neutral way, even when the information makes the exchange look bad, how can we possibly rely on the exchange system? Even when it seems to be working, how can we have any confidence in the numbers that show it’s working? 

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