Durbin’s claim that 10 million now have health insurance because of Obamacare
By Glenn Kessler, The Fact Checker @ washingtonpost.com, Feb. 10, 2014

[....]

The Pinocchio Test

Even if one took the high end of these estimates, the most one could claim is that about 4 million people have gained insurance because the Affordable Care Act, but that’s being extraordinarily generous.

In the meantime, given the fuzzy nature of the numbers and the wide publicity devoted to the recent surveys, Durbin has little excuse for going on national television and claiming that every one of these people had been previously uninsured. This has now become a Four Pinocchio violation.

Four Pinocchios

New Health Fix Offers Subsidies for Insurance Policies Bought Outside Exchanges
By Robert Pear, New York Times, March 1/2, 2014

WASHINGTON — The Obama administration said Friday that it would allow some people to receive federal subsidies for health insurance purchased in the private market outside of health insurance exchanges. The sudden shift was the latest in a series of policy changes, extensions and clarifications by federal officials trying to help beneficiaries and minimize political damage to Democrats in this election year.

Federal officials said they had agreed to provide such assistance retroactively because technical problems had prevented consumers from using online exchanges to obtain insurance and financial aid in some states.

Gov. John Kitzhaber of Oregon, a Democrat, had specifically asked the federal government to allow financial assistance, in the form of tax credits, for people buying insurance outside the state’s troubled exchange. Other states running their own exchanges, including Hawaii, Maryland, Massachusetts and Minnesota, have also experienced technical difficulties, creating political problems for their governors.

The Obama administration’s decision came as a surprise because the Affordable Care Act is clear: Federal subsidies are available only to people who enroll in a “qualified health plan” through an exchange.

But some of the online state exchanges have not been working well enough to determine if people are eligible for coverage, one of the basic functions of an exchange [....]

Health Law’s Small Co-ops Have Had a Mixed Success So Far
By Reed Abelson, Katie Thomas and Jo Craven McGinty, New York Times, Feb. 26/27, 2014

[....]  “We’ve got a great story to tell,” Ken Lalime, the chief executive of HealthyCT, said recently from his office in Wallingford, Conn.

But so far, few in Connecticut are listening. Just 1,700 customers have signed up for plans through the co-op, about 3 percent of those who have bought coverage in the state’s new insurance marketplace, where other carriers, Anthem and ConnectiCare, have outpaced it. “Our goal was five times that, by this point,” Mr. Lalime said.

The story of HealthyCT and its disappointing enrollment figures illustrates how uneven the co-ops’ performance has been more than halfway through the sign-up period in the first year of the new insurance exchanges, an analysis by The New York Times shows. In contrast to Connecticut, the co-op in Maine, Maine Community Health Options, has grabbed the majority of enrollment, outpacing Anthem, its sole competitor, which is owned by one of the nation’s largest insurers, WellPoint.

How the co-ops fare will be a key indicator of the success of President Obama’s highly charged health care law because they are crucial in determining whether the law can inject more competition into the nation’s entrenched insurance market.

The co-ops were a late addition to the Affordable Care Act, proposed as an alternative to the so-called public option [....]

New Law’s Demands on Doctors Have Many Seeking a Network
By Abby Goodnough, New York Times, March 2/3, 2014

TAYLORSVILLE, Ky. — Dr. Sven Jonsson, a primary care physician in this rural community, is seeing a steady tide of new patients under President Obama’s health care law, the Affordable Care Act. And so far, it is working out for him. His employer, a big hospital system, provides expensive equipment, takes care of bureaucratic chores and has buffered him from the turmoil of his rapidly changing business.

“This is just a much saner place for me right now,” said Dr. Jonsson, 52, who left private practice to work for the system, Baptist Health, in 2012. “I’m probably going to live another five years.”

About 25 miles away in the more affluent suburb of Crestwood, Dr. Tracy Ragland, 46, an independent primary care physician, is more anxious about the future of her small practice. The law is bringing new regulations and payment rates that she says squeeze self-employed doctors. She cherishes the autonomy of private practice and speaks darkly of the rush of independent physicians into hospital networks, which she sees as growing monopolies.

“The possibility of not being able to survive in a private practice, especially primary care, is very real,” she said.

Dr. Jonsson and Dr. Ragland represent two poles of that primary care system. Both live and work on the outskirts of Louisville [....]

Has some interesting proposals for how to pre-empt potential "narrow network" rebellion while still introducing more management of care:

In Health Care, Choice Is Overrated
By Ezekiel J. Emmanuel, New York Times op-ed, March 5, 2014

[....] First, the exchanges should require that networks meet a minimum level of adequacy — meaning there are sufficient numbers of each type of practitioner in every geographic area. The National Committee for Quality Assurance, a nonprofit group, has already created network adequacy standards that could be applied.

Second, we need more transparency. Insurance companies should have to publish the measures they use to select their “high performing” or “efficient” networks. This will discourage them from looking at price alone. And consumers should be able to easily find which doctors and hospitals are included in a network. The size of a plan’s network should be as transparent as its premium.

Third, we need more reliable ways of measuring the quality of networks and the doctors and hospitals within them. The N.C.Q.A. or Consumer Reports could develop a grading system, from A to F. When comparing different plans, no one should have to rely on U.S. News and World Report’s flawed rankings or hearsay from acquaintances.

Finally, insurance companies — which desperately want to avoid repeating the managed-care backlash — should incorporate a “safety valve” for patients like the mother with colon cancer in Colorado. They should allow any enrollee who develops a serious condition like cancer to obtain a second opinion at a recognized center of excellence (like Memorial Sloan–Kettering, for cancer, or the Cleveland Clinic, for heart disease) for the price of an in-network deductible or co-payment. The companies could negotiate good prices with these centers in exchange for a large volume of referrals [....]

I especially like point two. The size of a plan’s network should be as transparent as its premium really gets at my disappointment with the exchanges from the getgo, the whole "buying a pig in a poke" thing. I was hoping it was going to be an online marketplace where you could easily compare complex information about the products offered. If they couldn't provide that, they should have waited until it was possible. (Some didn't even have their networks fully set up but were still creating them as they were selling, waiting to strike deals with providers until they had a better prediction of sign-ups.) I saw that as key to making it popular and to greasing more reform towards more managed care being found not just acceptable, but more popular, in both private insurance and in Medicare and Medicaid, too.

Groups, Insurers, Officials Mobilize For Health Law Enrollment
Kaiser Health News, Mar 06, 2014

March 31 is the deadline for signing up for insurance, and young adults and minorities are among the groups being targeted [....]

an extensive round up of news links on topic.

White House Tightens Health Plan’s Standards After Consumers Complain
By Robert Pear, New York Times, March 14/15, 2014

WASHINGTON — The Obama administration issued stringent new standards on Friday for health insurance to address a flood of complaints from consumers who said that costs were too high and that the choice of doctors, hospitals and prescription drugs was too limited in many health plans offered this year under the Affordable Care Act.

In deciding which products can be sold in the federal marketplace next year, officials said, they will scrutinize health plans more closely and rely less on evaluations by state insurance regulators and private groups that accredit health plans.

Consumer advocates welcomed the standards and said they should have gone further. But insurers and employer groups complained of burdensome overregulation and said the White House should focus first on getting the online exchanges to work properly.

The federal government sets standards for insurers in the federal exchange, which serves three dozen states with about two-thirds of the nation’s population. States running their own exchanges generally build on the federal standards [....]

Officials issued the new standards, buried in a stack of documents, at 7:15 p.m. on Friday even as President Obama was stepping up efforts to increase enrollment in health plans this year.

The administration proposed new insurance regulations to go along with the new standards. In so doing, officials acknowledged problems that have bothered many consumers for months.

“We are concerned that some enrollees, particularly those with certain complex medical conditions, are having trouble accessing in a timely fashion clinically appropriate prescription drugs,” said a preamble to the proposed rules. They were issued by Kathleen Sebelius, the secretary of Health and Human Services, and Marilyn B. Tavenner, the administrator of the Centers for Medicare and Medicaid Services.

Many health plans held down premiums this year by limiting the choices of doctors and hospitals available in the exchanges, and consumers expressed concern about such narrow networks. The administration said it would examine health plans to make sure consumers have “reasonable access” to care in 2015.

Federal officials will look, in particular, at whether health plans have enough hospitals, primary care doctors, cancer specialists and mental health experts in their networks.

Consumers Union, the American Cancer Society and other groups representing patients had urged the administration to conduct a more rigorous review of provider networks [....]

MHO: Just wasn't ready for primetime. People signing up in the next enrollment period will benefit greatly from this year's guinea pigs. If it survives the political hay being made of all of the not-ready-for-primetime problems, that is.

Insurers May Get Cost Break Thanks To Rocky ACA Rollout
By Jay Hancock and Julie Appleby, Kaiser Health News blog, March 13th, 2014, 5:20 PM

The Obama administration keeps changing the rules on implementing the Affordable Care Act. Insurance companies keep complaining. But they’re unlikely to grouse about the latest adjustment.

On Tuesday the Department of Health and Human Services signaled its intention to temporarily give insurers a break on the portion of premiums they must spend on medical care or return to policyholders. The switch could shrink consumer rebate checks. But considering what insurers have gone through with balky online marketplaces and shifting regulations, even consumer advocates don’t seem to object.

The change, reported Wednesday by InsideHealthPolicy (subscription required), has to do with the ACA’s medical loss ratio, which requires insurers to spend at least 80 percent of the premiums collected for plans sold in the individual and small group markets on medical care or consumer rebates. The idea was to limit what carriers could devote to profits, administrative costs and CEO salaries to 20 percent of the premium pot.

Some insurers say their administrative costs have soared, however, because of the rocky rollout [....]