Where Obamacare is working well

Obamacare is working quite well, in some places, for quite a large number of people.  But you wouldn’t know that from the constant media drumbeat about the problems with the healthcare.gov enrollment portal and the relatively small (fewer than 6%) of the population whose individual insurance policies have to be replaced because they don’t meet the law’s benefits and ratings standards.

Now, before I get a rash of comments about how I can be so naïve about the problems with the Obamacare launch (I know, I will probably get them anyway), let me state from the outset that it is inexcusable that the administration launched an enrollment website that clearly was not ready.   It is completely inexcusable that a toxic combination of poor management, politics, under-performing contractors, and an apparent complete lack of transparency and accountability resulted in such a chaotic launch.  It is also clear that the president’s promise — “if you like your health plan, you can keep it” – was false.

The website problems, the cancellations, and Obama’s broken promise have led to weeks of negative news stories about Obamacare.  Support for Obamacare has fallen as result, although most Americans do not want it repealed.

Some have pointed to the rollout problems as evidence that Obamacare is fundamentally doomed because, as Bill O’Reilly claims, “the federal government is not capable of running the health care system.”

But the fact is that Obamacare already is working as it is supposed to in many states.  Just look at California and Kentucky.  California is a “blue” (reliably Democratic) state that is so large that it often is a national trendsetter, although it also is the state with the biggest numbers of uninsured behind Texas.  Kentucky is a small, poor, southern state that votes “red” (reliably Republican) in presidential elections, although it has a conservative Democratic governor and legislature.  They couldn’t be more different, except when it comes to the ACA: both states are fully on board with Obamacare, and both are having very promising initial success in signing people up.

Kaiser Health News reports that as of November 19, 80,000 people had signed up for coverage in California’s ACA marketplace, and nearly 23% were between the ages of 18 and 34, which “more or less matches their makeup statewide.”

Kentucky’s rollout also is going smoothly.  The Washington Post published a striking account of the poor, rural Kentuckians who are signing up in droves for ACA coverage, and what it means for them and their families. “If the health-care law is having a troubled rollout across the country, Kentucky — and Breathitt County in particular — shows what can happen in a place where things are working as the law’s supporters envisioned,” writes Post reporter Stephanie McCrummen.  She tells us about Courtney Lively, “who has been signing people up since the exchanges opened in early October.”  Lively told her the reporter that, “people have been ‘pouring into’ her office” and “one woman cried when she was told she qualified for Medicaid under the new law.”

But it isn’t just California and Kentucky where Obamacare enrollment is picking up.  The fourteen states running their own marketplaces are reporting an “enrollment surge,” doubling enrollment to about 150,000 from 79,000, according to state and federal statistics.

So if Obamacare is fundamentally unworkable, as it critics claim, then how can it be working in California, Kentucky and most of the other 12 states that are running their own ACA marketplaces?  And if it isn’t working so well, so far, in the remainder that are being funneled through the troubled website, isn’t that at least partly the fault of the governors of those states that chose not to set up their own marketplaces, leaving it to the feds to do the job for them?  And if the federal government fundamentally is incapable of running a health care system, then how do we account for the fact that it has been successfully running Medicare for 38 years now, and very few Americans (even die-hard conservatives) are in favor of ending government-run Medicare as we know it?

It would take rose-colored glasses to not see that the rollout of the federal government’s  incompetence in rolling out the web portal has been nothing short of disastrous.  But one would have to be blinded by ideology to not see that Obamacare is working the way it is supposed to in California, Kentucky and many other states, signing up tens of thousands of people who otherwise would be without affordable health insurance coverage.

With apologies to New York City and Frank Sinatra, if Obamacare can make it there (in California and Kentucky), it can make it anywhere.  Once the feds get that darned website fixed, that is.

Bob Doherty is senior vice-president, governmental affairs and public policy, American College of Physicians and blogs at The ACP Advocate Blog.

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  • Duncan Cross

    Thanks for this, though I would point out that while Healthcare.gov is the centerpiece of the Obama reforms, it’s hardly the whole of the ACA. Other important changes — that work — include the ban on pre-existing condition exclusions, allowing young people to stay on their parents’ insurance longer, and mental health parity. These are all big steps. I also think the website is now fixed: I went shopping for insurance earlier this week, and everything worked.

    • Bob

      What doesn’t work are government computer systems, any of them. And as demonstrated by the Gorlick Wall, we insist that they must not “speak to each other in the same codes” and then design a system dependent on making financial adjustments based on the social security system that hasn’t been a viable identification system since 1975, 40 years after the US postal service developed it, And then they tie it into the Homeland Security, evidently to determine the illegal alien factor and a few other system that cause the output to be garbage. The old term GIGO “garbage in Garbage out” comes to mind and it will end up in the trash of history. Too bad!

      • Duncan Cross

        The Internet was a government computer system until the ’90s. The NSA is a basically a government computer system.

        • Bob

          Check your facts Jack, you sound like Al Gore. The NSA is simply a collection agency accumulating and storing all phone and internet traffic so they can track terrorists or other people of interest after the fact! In general it is a large trash basket getting huger everyday and we will pay to add storage forever.

  • NormRx

    “Lively told her the reporter that, “people have been ‘pouring into’ her
    office” and “one woman cried when she was told she qualified for
    Medicaid under the new law.”

    I am sure the law is a GREAT success for those getting it for free on Medicaid. Let’s see how many sign up for the over priced large deductible plans. Isn’t is great to get something for free and have your neighbors pay for it?

    • safetygoal

      And that’s exactly why the ACA is going to implode. It’s unsustainable.

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    “Obamacare” working or not has very little to do with a website, no matter how much the media loves to bash/defend it.
    What is working very well in most places that allow it, is Medicaid enrollment, which probably has nothing to do with a health insurance exchange, except in Arkansas, and I don’t know what is happening there, if anything at all.
    The commercial piece that is beginning to work better now, consists of government picking up most of the tab for the outrageous premiums on the individual market, and telling people that insurance is now affordable. Next year, they will have to do the same for many more people that get their “coverage” from employers now.
    I am all for health care being paid from tax revenue by government for all of us, but I am not at all happy with the incredible waste of money, and reduction in quality brought on by this faux “market” solution.

    • ninguem

      Besides government taxes, the people paying the higher rates to fund all this, is independent business.

      Bring the unions and government employees back in, stop exempting politically favored groups.

      Let them overpay, same as me.

      • http://onhealthtech.blogspot.com Margalit Gur-Arie

        Sure. Everybody should be in. That’s the best way to make it affordable and maintain some semblance of quality, I think.

        • ninguem

          Well, it’s been said that was the intention all along…..to create a monstrosity so bad, it will ruin everything and leave healthcare destroyed, leave us with no choice but single-payer.

          • Bob

            But the costs will be over 25% of our GDP, causing disruption to education budgets and bankrupting America and causing huge inflation problems.

    • Bob

      Concise and well said.

  • southerndoc1

    Regardless of what one thinks of Obamacare, isn’t it rather strange that officers of the ACP feel called upon as part of their job to put a positive spin on its rollout?

    Seems like practicing internists have more than enough problems facing them to keep their execs plenty busy without this propaganda campaign.

    This just comes across as brown-nosing.

    • May Wright

      By involving themselves so heavily in pushing political propaganda for the Democrats, they’re doing a good job of alienating half of the population. It’s like their stance on the gun control issue, or gay marriage: the ordinary “Joe” on the streets is getting the idea that all physicians are activist Democrats. Which isn’t helpful, since most real-life physicians I know, liberal and conservative, would just as soon keep politics out of their consulting rooms entirely.

  • ninguem

    How many of these Kentucky or California signups are Medicaid?

    Washington State, it’s been about 90% Medicaid.

    Did we need Obamacare to increase Medicaid access?

    • NormRx

      In 2-3 years the 100% fed subsidy for the additional Medicaid patients will end, then the states will be forced to pick up the additional cost. They are in for a rude awakening.

      • ninguem


        And you didn’t need Obamacare to increase Medicaid access…….just fund it, the matrix was already in place.

        The States and the Feds are not very forthcoming with this information. I have to conclude that the overwhelming majority of Kentucky signups are Medicaid, unless someone has info to the contrary.

        What I suspect will help the subsidy is to stop relying on politically disfavored groups (independent small business) to pay disproportionately to fund Obamacare.

        Put the unions and government employees in the pool.

        • May Wright

          This is from CNBC a few weeks ago, but I assume the trend is still holding:

          “Kentucky also has seen something that has been a trend nationally: most enrollees so far in new health coverage offered by Kynect are going to receive Medicaid coverage, not private insurance sold by companies through the exchange.

          “Kentucky’s exchange had enrolled a total of 40,572 people in new health coverage as of last Friday morning, with 33,561 of them enrolled in Medicaid, the joint federal-state insurance program for the poor. A total of 7,011 had enrolled in privately sold insurance through Kynect.”

          So, yeah. Like the rest of the country, we’re just adding more people to the welfare rolls, something we didn’t really need Obamacare to accomplish.

          • ninguem

            Indeed. If that’s all we were going to accomplish…..then just fund Medicaid. It can be useful as a guard against catastrophic expenses for people of limited means.

            Thing is, for primary care, payment is so bad, most medical practices will not accept Medicaid. So, access to specialty care if they can figure out a way to get primary care.

        • Bob

          It finds all the citizens who despise welfare and have qualified or now do as being 133% of poverty. ACA eliminate it being seen as welfare, and they use all other types of welfare to promote ACA.

      • Bob

        Until then what happens in the half of the states whose hospitals depend currently on DSH?

    • Bob

      Not to worry, Bob Doherty and all the other administrative types who write but don’t doc will be changing into their scrubs and working as PCP 24/7 to provide the care that the shortage of physicians know is coming in 3 weeks.

  • Duncan Cross

    Have you tried the phone number?

  • PoliticallyIncorrectMD

    I guess denial is not just a river in Egypt.

  • Tiredoc

    This article is missing a fundamental point. All of the plans that people are signing up for start January 1, 2014. Until caregivers receive payments for services rendered, no one has benefitted.

  • guest

    Wait a minute…are we seriously defining “working well” by how many people are signed up? What about whether there are enough providers to offer care or whether existing providers can cope with ACA-associated regulatory micro-management? Do we know anything at all about the quality of care that people have access to? Since none of these insurance policies are effective until January 1, I think not.

    The point of the ACA was to improve people’s access to medical care. Until we see how that medical coverage actually works, we have no idea if the ACA is “working well,” or not.

    • ninguem

      I just can’t understand why there is this big froth of worry about the “shortage” of doctors.

      If…..worst-case scenario, people can’t access healthcare because doctors are overloaded (as some claim)……status-quo-ante was no access to healthcare because of no insurance (as some claim)……so it’s a wash.

      With these 90-plus-percent of Obamacare signups Medicaid, all that has been accomplished is people still can’t access primary care because no doc will accept Medicaid……because their practice would go bankrupt on Medicaid payments.

      Medicaid will provide a shield against catastrophic expense. So that formerly uninsured person who couldn’t get a doctor because of no insurance, now can’t get a doctor because the doc won’t take Medicaid. If that patient gets a catastrophic event, say a heart attack, formerly that patient went to the hospital uninsured, maybe got Medicaid retroactively, but if not, faced with a staggering hospital bill. Now, with Medicaid, the patient still ends up getting medical care in the ER, just without facing the catastrophic bill.

      The hospital and ER docs…….I suppose they at least get ten cents on the dollar from Medicaid. Maybe better than zero, which was status-quo-ante. So, a wash, or maybe a little better, but still no access to primary care.

      At least not until the govenment tries to force the docs to accept Medicaid. Quebec tried to force primary care docs to physically go to ER’s and attend patients, by force if necessary. That experiment was actually tried in 2002. It didn’t last long. Massachusetts tried to force docs to accept Medicaid as a condition of licensure.

      It is an axiom. Whenever there is socialism, somewhere, there is someone with a gun forcing people to do things.

      • Bob

        You forgot to mention that state exchanges drop docs and hospitals to force all newly insured to “favored ones” thereby making physicians and hospitals less available while state exchanges give “Medicaid lite” payments to get great prices by limiting choice!
        Can you imagine the emergency rooms of those favored hospitals in a month?

    • Bob

      I am the great wiz of Oz!

    • Bob

      The point of the ACA was SAID to improve access but in 2 weeks what it will show is a scheme to sneak in universal care by signing up as many as can be signed up for Medicaid and subsidized insurance which are the only winners as 1) millenniums who spend $100 a month on their cell phones and $100 on their cable TV every month get value from those expenditures, but don’t have an extra $100 a month to invest in health insurance they never have used and don’t intend to. It’s like paying $100 for a cell phone that doesn’t work if you need to make a 911 call, or cable that only gets local channels. If they use it for a physical it’s a $1,200 dollar visit 1 in 12 months. Everybody pays more to cover expanding Medicaid whether your state ops in or out, and those residents who opt out still pay for the extra Medicaid in state’s that don’t.
      That sure is a new form of universal care! Even communist countries couldn’t get away with!

  • kullervo

    My insurance isn’t changing. Same company, same doctor, same price. What is changing is that I now have prescription drug coverage, and as I have collected a couple of diagnoses this year my coverage can’t be yanked. The peace of mind is priceless.

  • Bob

    In healthcare issues it has always been said in the industry that ever new trend starts in California and moves east. That was always a good thing but tragedy will do so too, except in states that refused the Medicaid deal and opted out.
    As for Medicaid the Ryan budget of block granting it will become the only way to settle the issue making it again a state run program with no federal involvement.

    • Jess

      70% of doctors in California don’t want anything to do with patients from the exchanges, because they’re only going to get paid Medi-Cal rates from the insurers for them. I wonder whether that’s a trend that will move East.

      • Bob

        Only if it starts west of Central LA.

  • Bob

    Sometimes it hurts to get what you wished and voted for. I’m sorry for your loss.

  • Mrs.w

    “But one would have to be blinded by ideology to not see that Obamacare is working the way it is supposed to in California, Kentucky and many other states, signing up tens of thousands of people who otherwise would be without affordable health insurance coverage.”

    Just not true. In COlorado where we have a state exchange, we’ve enrolled supposedly 89K people. But that does not mean it’s “working.”

    That number is less than half of the projected “worst possible scenarios.” So it’s half of the worst. Doesn’t that mean it’s more than worse? The insurers cannot pay their bills with such little enrollment.

    So the masses of Coloradans experience entire chaos while 89,000 people get care paid for by those in chaos.

    Don’t confuse some sign up numbers with efficacy. We wouldn’t practice medicine with that shoddy approach to data. I don’t think I’m the one with rose- colored glasses on…

  • Kim

    ObamaCare may be working in two states: but what about the rest of us?? That’s a pretty awful success rate. Two out of 50. I still want to know who is going to pay my 71% increase for my premium and my increased out of pocket costs.

  • Tiredoc

    The product has been outsourced to conventional insurance programs. The only thing any of us has seen is a spectacular failure in the government’s ability to take orders online. That says precisely nothing about the product itself.

  • doc99

    The Farce Is Strong in This One.

  • Bob

    Candidate Obama promised to rescind the Reimportation Act, then made the PhRMA deal in the White House, after which Mr. Axelrod told John King:


    OBAMA: We’ll let Medicare negotiate for lower prices. We’ll stop drug companies from blocking generic drugs that are just as effective and far less expensive. We’ll allow the safe re-importation of low-cost drugs from countries like Canada.

    (END VIDEO CLIP) KING: “We’ll allow the safe re-importation of low-cost drugs from countries like Canada.” The president promised that in the campaign. We’ve talked to several Democratic senators this week who say, when they tried to put that language into health care reform, it is the Obama White House lobbying against it, against what the president promised, saying we can’t do that, because we’ve made a deal with the pharmaceutical industry. They’re going to support the big bill if we don’t put that in there.

    AXELROD: Let me be clear: The president supports re- importation, as he said, safe re-importation of drugs into this country. There’s no reason why Americans should pay a premium for the pharmaceuticals that other — people in other countries pay less for. And we will move forward on it.

    KING: Just not in this health care reform bill?

    AXELROD: Yes.

    KING: That’s a promise you’ll make to the American people?

    AXELROD: The president is committed to moving forward once we resolve the issues that the FDA has. That’s his responsibility, to protect the American people.

    Rebates to Medicare were estimated the to save $80 billion for consumers and $19 billion for Medicare but never happened

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