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On the Third Hand: Watchdogs

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The U.S. Department of Health and Human Services Office of Inspector General (HHS OIG) recently posted an interesting report about how poorly many of the new nonprofit, member-owned CO-OPs did in 2014.

The U.S. Government Accountability Office posted another interesting report about the problems the public exchange managers had with meeting an enrollee tax information reporting deadline

On the one hand, health reform is really hard. Before President Obama signed the Patient Protection and Affordable Care Act (PPACA) bill and the Health Care and Education Reconciliation Act bills, Congress had been debating many of the provisions that ended up in PPACA since the days of the Truman administration. Maybe since Teddy Roosevelt was politically active.

Whatever ideas you have for reforming for the U.S. health care system, whether they involve a single-payer system, no commercial health insurance whatsoever, or anything in between: If you could wave a wand and bring Wandcare to life, plenty of people would hate you and your Wandcare program, too.

And, of course, to paraphrase Theodore Sturgeon: 90 percent of everything could best be described by a word unsuitable for inclusion on a respectable website.

PPACA spawned 23 CO-OPs. If two or three end up doing well, then the CO-OP program would be doing about as well as anyone could reasonably expect.

But, on the other hand, the Internal Revenue Service (IRS) seems to have the ability to report on the ups and downs it is experiencing with its efforts to implement PPACA without sounding like it hired former North Korean Ministry of Information officials to write its reports and congressional hearing testimonies.

The GAO, which is a congressional watchdog agency, and HHS OIG, a watchdog agency which reports both to the HHS secretary and to Congress, seem to have the ability to come up with some tables of summary information about HHS PPACA programs.

HHS has… the HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE). Which produces “reports” in which the data presented all seem to be chosen specifically to support the predetermined thesis that PPACA is Peachy.

Why are the only places to get candid updates on CO-OP finances watchdog agencies? Why can’t HHS itself bring in a mutt of its own to produce its own warts-and-all reports about its own programs?

It would be great to see HHS try to emulate the IRS, the GAO and HHS OIG and produce regular little bursts of unspun data about the PPACA exchange program and the effects of the new PPACA commercial health insurance rules.

On the third hand, maybe the truth is that HHS is so dysfunctional that it has no idea how the CO-OPs are doing, how many people small-group exchange plans are covering, or how much HealthCare.gov user fee money HealthCare.gov plan issuers have sent in.

If HHS is unable to tell us how many people small-group exchange plans cover, even rounded off to the nearest 100,000: How can insurers trust it to shuffle billions of dollars in cash from one insurer to another through the PPACA risk corridors and risk-adjustment programs?

And, if HHS does have plenty of PPACA World data, and it’s just sitting on the data, how can anyone trust HHS to be transparent about the risk corridors and risk-adjustment program calculations?

Why should insurers think that the company-specific numbers HHS gives them will be any more complete than the general summary numbers HHS gives ordinary taxpayers?