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Sunday, March 23, 2014


In the beginning there were over 40 million uninsured in the United States. President Obama said, “This is not good “ and commanded “Let there be light” and behold it was so (or was it?)

The latest figures for the uninsured who have enrolled in  the Affordable Care Act is around 4.6-5.0 million.  The original number targetted by was 5.0 million new enrollees.   Their goal was very conservative since the original number for the uninsured was over 40 million.

Either way the reality is that the number of uninsured has only diminished to 45 million. Perhaps HHS and CMS were prescient in setting such a low goal to not disappoint, or make themselves feel successful.

The 5.0 million enrollees was the threshold for the new algorithms to guarrantee solvency for the new risk pools, and that may be why that goal was named.

Unfortunately the enrollment period ends on March 31st.  This date is not an arbitrary date mandated by HHS, and is the insurance industry standard for enrollments.

There is nothing preventing the date from being extended.

The options would be to:

1. Halt enrollment and  have enrollees insured this year.
2. Continue enrollment throughout 2014
3. Consider halting further enrollment until another plan is designed.

Many uninsured evaluated the offers and decided to wait and see. Many factors were in play, including provider directory errors, web site difficulties, subsidized rates were confusing as generated by the benefit exchanges. There was a lack of clarity how Medicaid would be expanded and no details in regard to financial requirements, assets, family size, etc.  For those familiar with Medi-caid there are asset restrictions to remain eligible for Medicaid.    There was no mentioin of how  ACA Medicaid is different from ordinary Medicaid.

Those who have already enrolled should not be disadvantaged by a newer version of the ACA and can be maintained until the new program is operatiional.

Government, insurance companies and other regulators have piled more bureaucracy with each new idea on how to save money.  Each change decreases reimbursement and increases overhead for providers and hospitals. Despite this never-ending demand, providers and hospitals have outsmarted all these efforts as a meaure for survival.

The initial result is not only disappointing and reveals the inadequacy of the planners and the impossibility to predict demographics of enrollees.

The only thing which will guarrantee solvency will be federal guarrantees. This may be the first phase of a health industry bailout .  The Federal Reserve needs to warm up the printing press.

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