Tag Archives: ObamaCare

ACA Open Enrollment 2.0

The ACA open enrollment period for 2015 coverage ended on February 15.

Before the ACA, consumers could purchase health insurance 12 months out of the year. Now consumers are limited to an “open enrollment period.”

This is meant to increase access. Or something.

In any case, the federal exchange website continues to be pathetically bad.

It would not accept the login information I had recorded in my passbook. I tried the “forgot my password” options successfully implemented on thousands (millions?) of websites around the world. After hours of frustration over successive days of effort (it rejected all my answers to questions about my pet’s name, best childhood friend, favorite kind of food, etc.), I gave up and created a new account.

This did not end my problems. Every time I entered my Social Security Number, the system kicked me out. It knew, you see, that a person with that SSN already had an account (it just disagreed with me about that person’s favorite pet and best childhood friend). I was only able to create the new account when I skipped the first field asking for my SSN.

I then entered a mystifying cycle of being asked for my state, clicking the button to start the process, being delivered to a new screen where I was asked for my state, clicking the button to start the process, being delivered to a new screen asking for my state, etc. This went on, to the tune of “I Got You Babe,” until I made a snow sculpture with Bill Murray and started clicking random buttons to break the cycle.

After that, I answered a series of questions and viewed some options. Eventually, I was told that I had to enter a Social Security Number if I wanted to buy coverage. This seemed counter to what I know of the law, but I was simply grateful that I was able to enter the number at that point without getting kicked out for impersonating that other Sarah Baker with the same Social Security Number but a lesser predilection for Mexican food.

I successfully purchased (I think!) a health plan for 2015.

All in all, it took hours of effort over a series of months to complete this process. This is in sorry comparison to what could be accomplished on a website like ehealthinsurance.com before the federal government decided to “make things easier.”

I was not alone in experiencing continued glitches with this ridiculous website. Peter Suderman gets a money quote from a federal government employee who emailed him with frustrations over the process:

“Today’s some sort of deadline, they’re e-mailing me like mad,” he wrote. “I signed in to try and fix that and tell them that my [relative] already got insurance. I was able to log in, but that’s about all, there were buttons, I clicked them and nothing works. This is a solved problem, Amazon, Google, Facebook, hell every bank and probably 50% of small businesses have a more functional website than this.”

Anyway, now that we all have health insurance (except for the tens of millions who still don’t) let us not forget that having health insurance is not the same thing as getting health care. Being forced to buy the former in no way ensures the latter.

Premiums spent on high-deductible policies sap funds available to pay for actual care. Having insurance at all results in higher charges per visit, even when the patient is paying out-of-pocket for the deductible.[1] Narrow networks sometimes mean people cannot see the doctors they want or need unless they come up with the money on their own. Compounding the problem, providers are increasingly opting out of the lower reimbursement rates and higher headache rates associated with the plans.

The doctor shortage is not just an abstract problem. It is a real-world problem with real-life consequences for patients like Julie Moreno, who needed cataract surgery:

For three months after her November 2013 diagnosis, the 49-year-old Mountain View resident said, she tried to get an appointment, but each time she called, no slots were available. Desperate and worried, she finally borrowed $14,000 from her boyfriend’s mother to have the procedure done elsewhere last February.

When Noam Friedlander needed back surgery, she found that the surgeons who were covered by her insurance operated out of hospitals that were not—or vice versa:

Unable to match a hospital and a surgeon that were both covered, Friedlander started haggling between doctors for a cash price for the surgery. She chose a surgeon who wasn’t covered by her insurance but who operated in a hospital that was covered. … In the end, she had to take out two credit cards so she could pay $16,000 out of pocket.

The ACA’s defenders will argue that however flawed it may be, the system is an improvement over what came before. No one disputes that reform was needed. But the ACA fails to address the root cause of outpaced inflation at the point of service. It fails to address the medical school cartel and doctor shortages that push prices higher. It fails to repeal expensive employer mandates that drive health insurance (and health care) costs higher and incomes lower. It fails to deliver better tax treatment for out-of-pocket expenses or equal tax treatment for individual and employer plans.

In many cases it instead exacerbates these problems.

In short, it fails to take advantage of the myriad free market alternatives that might remediate the root causes of high health care costs and result in a truly better—and not just different—system.


[1] I discovered this strange phenomenon in 2014. For the nine years prior to that, I had the same plan, which I had purchased myself in the individual market. It was cancelled at the end of 2013 due to the passage of the ACA. For several reasons (the unworkable website and my rebellious nature among them), in 2014, for the first time in my adult life, I went without heath insurance. I was pleasantly surprised to discover that office visits were $50-$60 lower once I had no insurance, and more expensive procedures, such as mammograms, were hundreds of dollars lower.

Sarah Baker is a libertarian, attorney and writer. She lives in Montana with her daughter and a house full of pets.

SCOTUS Has Accepted Appeal of Case That Could Topple Obamacare


On Friday, United States Supreme Court agreed to hear the appeal in King v. Burwell. The plaintiffs in that case assert that the Patient Protection and Affordable Care Act only allows tax credits to people who buy insurance “from an exchange established by a state.” The Fourth Circuit Court of Appeal disagreed and ruled that the federal government may interpret that language as allowing tax credits to purchasers who bought insurance on one of the federal exchanges, operating in the more than 30 states that declined to create their own.

On the same day the Fourth Circuit delivered its decision in King, a panel in the D.C. Circuit found for the plaintiffs in a companion case captioned Halbig v. Burwell. This conflict would ordinarily invite SCOTUS to weigh in. However, the D.C. Circuit then accepted a rehearing en banc in Halbig. Thus, even though the King plaintiffs appealed, many observers speculated SCOTUS would wait to see if a conflict really developed, or if after rehearing in Halbig, the courts ended up aligned.

As a result, it is somewhat surprising that SCOTUS accepted the King appeal, and it may signal bad news for the Affordable Care Act. As Nicholas Bagley writing a SCOTUSblog explains:

[F]our justices apparently think—or at least are inclined to think—that King was wrongly decided. … [T]here’s no other reason to take King. The challengers urged the Court to intervene now in order to resolve “uncertainty” about the availability of federal tax credits. In the absence of a split, however, the only source of uncertainty is how the Supreme Court might eventually rule. After all, if it was clear that the Court would affirm in King, there would have been no need to intervene now. The Court could have stood pat, confident that it could correct any errant decisions that might someday arise.

There’s uncertainty only if you think the Supreme Court might invalidate the IRS rule. That’s why the justices’ votes on whether to grant the case are decent proxies for how they’ll decide the case. The justices who agree with King wouldn’t vote to grant. They would instead want to signal to their colleagues that, in their view, the IRS rule ought to be upheld. The justices who disagree with King would want to signal the opposite.

And there are at least four such justices. If those four adhere to their views—and their views are tentative at this stage, but by no means ill-informed—the challengers just need one more vote to win. In all likelihood, that means that either Chief Justice Roberts or Justice Kennedy will again hold the key vote.

If I read this correctly, the speculation is that four (or more) SCOTUS justices agreed to accept the case in order to send a signal to the lower courts still considering challenges to this provision of the ACA. The signal they wanted to send is that those other courts should not necessarily follow King, because SCOTUS might think it was wrongly decided.

A reversal of King (i.e., a finding in the plaintiff challengers’ favor) would seriously undermine—perhaps fatally—the structure of the Affordable Care Act. Fully 87% of the people who purchased policies through the federal exchanges during the first open enrollment period are receiving subsidies. If the government cannot give subsidies to low-income purchasers, it cannot tax them for failing to have the insurance, and the entire system collapses under its own weight. Fewer people can afford the insurance, the risk pool shrinks, costs rise, and more people are forced to opt out.

If on the other hand, SCOTUS upholds tax credits not authorized by Congress, it would be one more in a long line of revisions, waivers, exemptions, delays and modifications made to the law made by the very administration that purports to uphold it.

Sarah Baker is a libertarian, attorney and writer. She lives in Montana with her daughter and a house full of pets.

Leadership on the right still has no freaking clue

Writing at the Wall Street Journal, Karl Rove offered some advice about how to defeat the anticipated onslaught of socialized medicine.  In the column, he used an example of socialized medicine he helped to promote to illustrate why Democratic socialized medicine is bad, but Republican socialized medicine is good:

Advocates say a government-run insurance program is needed to provide competition for private health insurance. But 1,300 companies sell health insurance plans. That’s competition enough. The results of robust private competition to provide the Medicare drug benefit underscore this. When it was approved, the Congressional Budget Office estimated it would cost $74 billion a year by 2008. Nearly 100 providers deliver the drug benefit, competing on better benefits, more choices, and lower prices. So the actual cost was $44 billion in 2008 — nearly 41% less than predicted. No government plan was needed to guarantee competition’s benefits.

The last time I checked, Medicare Part D is all about redistributionism.  One can’t even make the flimsy argument that current beneficiaries have paid into the system.  I work and they take money from me to offset the price of medicine for seniors.  What’s worse, they don’t have enough money to pay the bills.  As a result, my children will end up picking up most of the tab, along with the interest charges.

I was beginning to have some hope that the GOP would at least take on the Obama administration regarding socialized medicine, but it appears they don’t even understand the rhetoric of free-market economics anymore.  What’s next in the GOP playbook? Directly quoting Karl Marx?