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On the Third Hand: Rise and fall

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On the one hand, I’m not an especially well-organized person.

I can barely get thank-you notes for a children’s birthday party ready to send them out.

I can believe the idea that just about everyone involved with setting up, or overseeing, a health insurance exchange, a CO-OP health insurer, or anything else to do with the Patient Protection and Affordable Care Act (PPACA) is a nice, well-meaning, kind, honest person who did his or her personal best, to the point of starting to think of Red Bull as something to drink before bedtime. Views about the goals or methods of PPACA aside, some jobs are hard to do.

And, certainly, one goal for setting up a health insurance exchange might be to create an environment where some companies flourish and others fail. Why should selling health insurance guarantee a company a nice, safe, steady income? Maybe, arguably, health insurers should be closer to the edge.

But, on the other hand, even though the regulators of PPACA World tried hard and meant well, they somehow — due to the inexorable operation of Murphy’s Law (“Everything that can go wrong, will go wrong”) — have ended up creating a world where regulators can adjust just about any PPACA World parameter to make the negative headlines go away.

Is it hard for employers and insurers to deal with the PPACA reporting rules?

OK, push back the deadline for complying with the rules.

Did individual policyholders ignore the fine print in Barack Obama’s voice and got the impression that they really could keep any coverage they owned and happened to like after Obama signed the law that became PPACA and before Jan. 1, 2014?

OK, let people keep those old, insurer actuarial assumption shattering policies.

Is it hard for employers to comply with the coverage mandate rules?

Push that back.

Is it hard for insurers to implement PPACA-compliant appeals and external review programs?

Hey, let’s not even think about that!

But, on the third hand, suddenly, when it’s time for the regulators and public exchange managers to find a way to keep the CO-OPs alive for a year or two, or even until the end of 2015, suddenly, regulators remember how to use Google search to find the 25th revision of the eighth set of rules they set for CO-OPs, and make those rules stick.

The rules really apply to CO-OPs. And they really, really, really apply to the poor New Yorkers stuck in Health Republic Insurance of New York. At press time, regulators seemed to be scrambling to put something helpful together, but, while the rescue effort was in progress, the message for those enrollees were getting was, “No seamless transition to emergency backup coverage for you enrollees! Go on Kickstarter and have your friends crowdsource the gallbladder operation you have scheduled for December, why don’t you.”

It seems as if one of the essential characteristics of a successful exchange is that it has to, at least, seem fair, from a distance, and that it looks, from a distance, as if companies rise and fall because they did well or messed up. The PPACA public exchange system doesn’t seem to pass that test.


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