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Old 06-19-2013, 04:11 PM   #21
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For several weeks I have been watching the HealthCare.gov link the OP provided us hoping for some news about the Florida ACA marketplace. But I haven't found anything there, and not much on Florida.gov sites either.

Does anyone know of any source for updates on Florida?

Thanks in advance.
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Old 06-19-2013, 05:14 PM   #22
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The WSJ has interesting editorial today The young won't buy ObamaCare

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Media outlets lately have emphasized the challenge of enticing healthy young adults to sign up for ObamaCare, "exactly the type of person insurance plans, states and the federal government are counting on to make health reform work," as the L.A. Times put it. These pieces are useful as far as they go, but miss a key point that Supreme Court Justice Samuel Alito managed to convey in many fewer words during last year's Supreme Court argument on ObamaCare.
Mr. Alito pointed out that young, healthy adults today spend an average of $854 a year on health care. ObamaCare would require them to buy insurance policies expected to cost roughly $5,800. The law, then, isn't just asking them to pay for "the services that they are going to consume," he continued. "The mandate is forcing these people to provide a huge subsidy to the insurance companies . . . to subsidize services that will be received by somebody else."
Since he puts it that way, why would they sign up for ObamaCare, especially since the alleged penalties will be negligible and likely unenforced?
Most of the pricing info I've seen provided by the article Michael has linked seem pretty affordable for us 40-60 somethings. But it looks pretty expensive from the stand point of a 20 something, struggling to find a decent job in this economy and burden by student loans.
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Old 06-19-2013, 05:52 PM   #23
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The WSJ has interesting editorial today The young won't buy ObamaCare

Most of the pricing info I've seen provided by the article Michael has linked seem pretty affordable for us 40-60 somethings. But it looks pretty expensive from the stand point of a 20 something, struggling to find a decent job in this economy and burden by student loans.
This is the big question, as young people represent a large part of the uninsured today. There is catastrophic coverage option which may appeal to many, and premium assistance for those earning less than 4 x the FPL. I can see a real struggle for a 30 year old earning 4.5 x the FPL and having to buy a full price policy with after tax $$.

Two links here for anyone interested. One is a KFF poll that shows young people want health care coverage (here) the other an interview between Ezra Klein from WonkBlog and Aaron Smith from Young Invincibles (here)
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Old 06-19-2013, 06:07 PM   #24
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And many states waited and waited and waited to decide, and some even switched their answer yet-even-later. .
No doubt some states have vacillated, or had the Feds turn down their proposal for joint projects. Those delays are understandable. However, Federal Exchanges were always a part of the ACA and several states have made clear from the start they would default to these Federal Exchanges. For those states, IMHO there is no excuse for HHS not meeting the Oct 1 deadline.

marko- Agree 100% that many feel Obamacare = totally free health care. Very, very few ave folks understand even the basics of how ACA will (hopefully) work.

MichaelB- Thanks for GAO link, although still not much 'actionable info' for individuals needing HI in Jan. IMHO affording full price HI will be a bigger struggle for those making 4.5X FPL at 55-60yo vs 30 yo (due to 2.5-3X age rate multiplier).
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Old 06-19-2013, 08:08 PM   #25
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Mr. Alito pointed out that young, healthy adults today spend an average of $854 a year on health care. ObamaCare would require them to buy insurance policies expected to cost roughly $5,800.
clifp:
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Most of the pricing info I've seen provided by the article Michael has linked seem pretty affordable for us 40-60 somethings. But it looks pretty expensive from the stand point of a 20 something, struggling to find a decent job in this economy and burden by student loans.
So the young will subsidize the middle age in the ACA program. Just as the middle income fund current retirees in the social security program.

Mebbe I'm just a glass half empty guy, but i foresee alot of generational warfare in our nation's future.

Prolly many single young folks will pay the fine [$95] the first year rather than sign up. The fine increases to $325 in 2015 & $695 in 2016. If the young continue to not sign up, those affordable premiums for the middle prolly won't remain affordable.
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Old 06-19-2013, 10:52 PM   #26
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I cannot get into details, but let me just say that recent info I have overheard gives me further reason to believe the watchdog's report.

I am beginning to think we're going to see what will become the next "textbook case" of the damaging impact of under-funding.
Or underperformance. I'm struggling to see how creating an online marketplace for health insurance is rocket science given the numerous similar online marketplaces already in existence.
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Old 06-19-2013, 11:01 PM   #27
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Or underperformance. I'm struggling to see how creating an online marketplace for health insurance is rocket science given the numerous similar online marketplaces already in existence.
Must be a lot of rules, regs, and procedures that have to be all followed before the numbers can be posted on exchange. I am as anxious as anyone to see what I am going to have to pay, but if they got so far behind they delayed it a year, my wallet would not fall into a great depression that is for sure.
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Old 06-19-2013, 11:52 PM   #28
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Or underperformance. I'm struggling to see how creating an online marketplace for health insurance is rocket science given the numerous similar online marketplaces already in existence.
I suspect you may be overestimating the similarity to other marketplaces. There is no COTS systems out there that does all of the things exchange software must do. None of us could even spell MAGI until recently.

Another example. Each and every state system must rework its Medicaid systems to allow on-line sign-ups using the new MAGI-based eligibility criteria. Some state's legacy systems that need to be overhauled use COBOL.

This is a pretty good summary of the software / system requirements and challenges, mostly written in non-technical terms.

http://www.nasi.org/sites/default/fi..._Exchanges.pdf

Reading through it gave me flashbacks to an unpleasant detour in my career. I managed a government software project that handled real-time and near-real-time data among several agencies. Rocket science? Probably not, but it sure wasn't easy to accomplish on a tight schedule.

I feel for the IT folks grinding away.
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Old 06-20-2013, 04:38 AM   #29
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Or underperformance. I'm struggling to see how creating an online marketplace for health insurance is rocket science given the numerous similar online marketplaces already in existence.
After you've spent a year working on the systems development, you'll have gained some significant insights on the challenges.

It is not uncommon for folks to grossly underestimate what it takes to do something they want done, but aren't responsible for doing themselves.

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Must be a lot of rules, regs, and procedures that have to be all followed before the numbers can be posted on exchange.
The biggest challenges involve linking together myriad systems, such as for verifying eligibility - IRS, SSA, INS, HHS, etc., and then all the linkages into the states' various systems. Their systems have to all talk to each other for this. Also, the requirements on the software itself are more stringent than ever before - such as with regard to accessibility.

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I feel for the IT folks grinding away.
I'll relay your sentiments to at least one of them.
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Old 06-20-2013, 09:12 AM   #30
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It pains me to say this Sam, but I think as a whole you give the masses too much credit... Almost half of Americans still don't even know the Act exists as law.
Three quarters of the other half probably won't understand what they signed up for until after they need the benefits, anyways.
Along those lines, makes me wonder if there won't be sign up avenues at every ER and doctor's office. "You don't have health care?, Sign up now."
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Old 06-20-2013, 09:25 AM   #31
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Along those lines, makes me wonder if there won't be sign up avenues at every ER and doctor's office. "You don't have health care?, Sign up now."
The hospitals and docs currently are responsible for handling the health insurance of patients and determining benefits and billing/collecting copays. They might as well sign folks up and collect premiums while they're at it. Doesn't seem like the business and computer majors are up to the task.
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Old 06-20-2013, 09:52 AM   #32
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Business and computer majors aren't in the business of "signing folks up and collecting premiums". They're in the business of developing software systems to do such things. It's a bit like the difference between the medical technician who operates the X-ray machine and the people who design the X-ray machine.
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Old 06-20-2013, 10:03 AM   #33
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Business and computer majors aren't in the business of "signing folks up and collecting premiums". They're in the business of developing software systems to do such things. It's a bit like the difference between the medical technician who operates the X-ray machine and the people who design the X-ray machine.

Chop Chop.
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Old 06-20-2013, 11:04 AM   #34
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...........

The biggest challenges involve linking together myriad systems, such as for verifying eligibility - IRS, SSA, INS, HHS, etc., and then all the linkages into the states' various systems. Their systems have to all talk to each other for this. Also, the requirements on the software itself are more stringent than ever before - such as with regard to accessibility.
............
I recently posted that the SS administration had just now "connected" with the IRS such that they could dun me for an overpayment that occurred in 1971. This kinda put it all into perspective for me.
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Old 06-20-2013, 11:33 AM   #35
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My wife works on a health exchange project (though she's actually leaving that project in a couple of weeks) and what she's heard is that some of the health exchange projects have been so badly underfunded by Congress...........

Or the states are inept and/or corrupt at getting the job done..........
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Old 06-20-2013, 12:58 PM   #36
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Or the states are inept and/or corrupt at getting the job done..........
Irrelevant to states who always intended to use the Federal Marketplace, which (by definition) is to be done by Feds/HHS. But I agree that certain states have messed with the process. For example I don't see how California adding voter registration to its Health Exchange helps speed up ACA implementation.
California's health exchange to serve as voter registration hub - Health and Medicine - The Sacramento Bee

FWIW- Another take on HHS progress and past misstatements- even to even to Sen Baucus who was deeply involved in drafting & passing ACA. Does not give one a warm fuzzy feeling that individual Exchanges will be functional on Oct 1-

Audit Finds ObamaCare Exchanges Are Well Behind Schedule - Investors.com
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Old 06-20-2013, 07:35 PM   #37
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After you've spent a year working on the systems development, you'll have gained some significant insights on the challenges.

It is not uncommon for folks to grossly underestimate what it takes to do something they want done, but aren't responsible for doing themselves.....
I actually was responsible for financial systems of a company with over a billion of revenue during one of my jobs so the challenges of systems development and implementation are not new to me. My only point is that they are spending tens or even hundreds of millions on this effort and it still seems to be woefully behind being ready for prime time. Given the amounts they are spending it is hard to see underfunding as the issue. But we can agree to disagree on that I guess.
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Old 06-21-2013, 05:10 AM   #38
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We'll have to. My spouse and I have worked for some of the largest software companies in the world, on some of the most complex systems, and from what we (mostly my spouse) can see, the level of under-funding of the health insurance exchanges is remarkable. Read over the PDF that Htown Harry posted - it describes a system that would necessarily have to be one of the most complex of its class ever undertaken, simply on the basis of the number and variety of external interfaces. Interfacing with INS, itself, is a large undertaking, and that's just one of many external interfaces.

To be fair, this kind of short-changing has been common in large government projects, at times in the past, and that cheapness is now leeching into non-government projects, from what I can see.
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Old 06-21-2013, 08:25 AM   #39
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We'll have to. My spouse and I have worked for some of the largest software companies in the world, on some of the most complex systems, and from what we (mostly my spouse) can see, the level of under-funding of the health insurance exchanges is remarkable. Read over the PDF that Htown Harry posted - it describes a system that would necessarily have to be one of the most complex of its class ever undertaken, simply on the basis of the number and variety of external interfaces. Interfacing with INS, itself, is a large undertaking, and that's just one of many external interfaces.

To be fair, this kind of short-changing has been common in large government projects, at times in the past, and that cheapness is now leeching into non-government projects, from what I can see.

We were told that all this had already been done in Massachusetts. Now we are five years in and you're telling me it's too complex and expensive to implement? Thats incredible.
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Old 06-21-2013, 08:30 AM   #40
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We were told that all this had already been done in Massachusetts. Now we are five years in and you're telling me it's too complex and expensive to implement? Thats incredible.
I'm telling you that the Massachusetts legacy system didn't interface with INS or with other federal systems for which the linkages were mandated by ACA as a compromise with those who wanted to more strongly ensure that illegal immigrants wouldn't gain subsidies.

Also, I'm telling you that the Massachusetts legacy system was not accessible by the vision- or hearing-impaired as per WCAG 2.0.

Just two of many complicating differences, for-instance.
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