Wednesday, October 30, 2013

HHS Cancels November Conference for Contractors

    Last Thursday, representatives from four of the main contractors working on various aspects of the implementation of the Affordable Care Act testified at a Congressional hearing.  The contractors were hired by the Centers for Medicare and Medicaid Services (CMS), the division of the Department of Health and Human Services (HHS) that is responsible for administering the Obamacare insurance exchanges.  The testimony revealed a disturbing lack of coordination and communication between CMS and the contractors throughout the development period for the website, as well as related tasks.
    As if on cue, late Friday afternoon CMS announced the cancellation of a conference originally scheduled for November 4 entitled "Contracting with CMS Conference".  The conference was announced on September 16 with the following flyer:

    The announcement of the indefinite postponement that appeared on Friday afternoon read:
    CMS holds such conferences periodically to allow contractors to "[l]earn about future opportunities, ...forecast of opportunities, critical missions, and specific program initiatives."  A document for just such a conference in May listed CGI, the main contractor responsible for Healthcare.gov, as one of the companies represented.
    No reason was given for the postponement of the November conference.  An email sent to the address provided for the conference was answered with an automated reply saying that registration was not currently open, but that a conference would be held in Baltimore in the "near future."

Note: A version of this article first appeared at The Weekly Standard.

Monday, October 28, 2013

Obamacare Pledge: Info on Applications 'Won’t Be Used For Immigration Enforcement Purposes'

    Beginning with a speech last Thursday, President Obama is seeking to rejuvenate his administration's push to reform immigration laws and perhaps draw some attention away from the Obamacare launch debacle that has been dominating the headlines for much of October.  The day following the speech, a new topic appeared on the Healthcare.gov website entitled "What do immigrant families need to know about the Marketplace?"  While a previous entry listed the various immigration statuses that qualified for Marketplace coverage, the new entry is an extended discussion of the questions immigrants, regardless of status, might have about the insurance exchanges.  Among the subtopics discussed are: "Lawfully present immigrants and private insurance," "Immigrant access to Medicaid and CHIP," and "Disclosure of immigration status."
    Under "Disclosure of immigration status," the site goes to great lengths to explain that Marketplaces, whether federal or state, are not permitted to ask for the immigration status of family members who are not applying for coverage or benefits.  "States can’t deny benefits because the applicant doesn’t provide the SSNs of people who aren’t applicants for benefits or recipients of Medicaid or CHIP benefits, or those not required to provide SSNs," the site explains.  After describing how government agencies, including marketplaces, use the federal "data hub" to verify application information, the site notes that "[p]eople who aren’t seeking coverage for themselves won’t be asked about their immigration status."  If an application or the subsequent verification process does reveal problems with immigration status, the site goes on to assure applicants that "[i]nformation provided by applicants or beneficiaries won’t be used for immigration enforcement purposes."
    Elsewhere on the site, users are told that the "U.S. Department of Homeland Security [DHS] may verify your immigration status and/or naturalized citizenship status." But the new statement above suggests that if DHS is unable to verify legal status or the process reveals a possible violation, no action will be taken relative to immigration laws.  However, any false statements on applications may be pursued by law enforcement according to the individual privacy statement on the Healthcare.gov site, which includes the following caution:
If you don’t provide correct information on this form or knowingly and willfully provide false or fraudulent information, you may be subject to a penalty and other law enforcement action.
    As THE WEEKLY STANDARD reported early in October, the privacy policies of the exchanges for at least some states (Maryland, for one) include statements that they "may share information provided in your application with the appropriate authorities for law enforcement and audit activities."  But based on the above language at the Healthcare.gov site, possible violations of immigration laws will not trigger the "law enforcement action" threatened in other cases.

Note: A version of this article first appeared at The Weekly Standard.

Saturday, October 26, 2013

Medicare Pays $8.6 Billion to Doctors, Hospitals for Electronic Health Records Switch

    The Obamacare website Healthcare.gov has been grabbing all the headlines lately, but another aspect of the Affordable Care Act (ACA) may come under increased scrutiny in the weeks and months ahead: Electronic Health Records (EHR).  The ACA requires medical providers to transition to electronic record keeping by 2015.  In addition to increasing privacy concerns over the systems, the financial benefits of EHR are less clear after reports in January that the RAND Corporation had backed off from an optimistic $81 billion annual savings predicted in a 2005 report.  The New York Times reported that:
...evidence of significant savings is scant, and there is increasing concern that electronic records have actually added to costs by making it easier to bill more for some services. Health care spending has risen $800 billion since the first report was issued, according to federal figures...
     With savings from EHR in question, a recent report by the Government Accountability Office (GAO) may raise concerns about incentive payments through Medicare to medical providers for the EHR transition.  Healthcare providers and hospitals were paid $6.3 billion in 2012 alone, up from $2.3 billion in 2011.  Participation in the program by eligible providers approximately tripled from 2011 to 2012 matching the increase in incentive payments.  However, the GAO reports that not quite "half of eligible hospitals and less than a third of eligible professionals received Medicare EHR incentive payments for 2012," so participation is far from universal.
    While the maximum incentive payment to a hospital in 2012 was $4.7 million, the median amount was $1.4 million.  The median payment to individual health care professionals was $18,000.

Note: A version of this article first appeared at The Weekly Standard.

Friday, October 25, 2013

Obamacare Website Quietly Adds Back Missing Copyright Lines to Code

    A week after THE WEEKLY STANDARD reported that the Obamacare website Healthcare.gov was using a copyrighted web script without attribution, the lines have been quietly added back to the code.  In a tacit admission that the lines should not have been omitted, the full attribution now appears at the top of the script in question.  Up until now, the script appeared as follows, with only the name DataTables and the version mentioned:

    Now, the author of the script, the company (SpryMedia), the copyright, and the related licenses are all included:

    THE WEEKLY STANDARD had contacted the Department of Health and Human Services more than a week ago by email, but never received a response about the license violation.

Note: A version of this article first appeared at The Weekly Standard.

Thursday, October 24, 2013

HHS: Workplace Bullying Is Like Domestic Violence

    "Bullying doesn't just happen on the playground;" so begins an article in an online Health and Human Services (HHS) publication called Let's Talk.  The HHS's Federal Occupational Health agency cites a recent study finding that more than a third of Americans report being bullied at work, though only 15% report having observed bullying in the workplace.  The newsletter is illustrated with this graphic:

    The article defines bullying as "aggressive, inappropriate, and unreasonable behavior," and says that bullying "[h]as many of the same characteristics of domestic violence – the abuser uses intimidation and manipulation to get what he or she wants."  "Typical" behaviors by a workplace bully cited in the article include: threats, intimidation, humiliation, exclusion from your peer group, and harassment.
    Although the study referenced is not notated in the article, a CareerBuilder study from August 2012 reports the 35% figure.  That study reported that the most common forms of bullying were:
· Falsely accused of mistakes – 42 percent
· Ignored – 39 percent
· Used different standards/policies toward me than other workers – 36 percent
· Constantly criticized – 33 percent
· Someone didn’t perform certain duties, which negatively impacted my work – 31 percent
· Yelled at by boss in front of coworkers – 28 percent
· Belittling comments were made about my work during meetings – 24 percent
· Gossiped about – 26 percent
· Someone stole credit for my work – 19 percent
· Purposely excluded from projects or meetings – 18 percent
· Picked on for personal attributes – 15 percent
    Although the HHS article compared workplace bullying to domestic violence, neither actual violence  or threats of physical harm appeared on the list of reported behaviors.
    The newsletter offers these tips on "working it out yourself":
  • If you are being bullied and you don’t feel physically threatened, you can assert yourself by:
  • Telling the person how their behavior is negatively impacting your work
  • Setting boundaries – telling the person what types of behavior you will no longer tolerate
  • Warning the person that there will be consequences if his or her inappropriate behavior continues
    Recently, a high-up Democratic official was quoted by Politico's Mike Allen as saying about the GOP relative to its opposition to the president over the funding of Obamacare: "It's time to punch the bully in his nose."  This response to bullying is not specifically included on the list of tips from HHS.

Note: A version of this article first appeared at The Weekly Standard.

Inspector General: Gov't Partner Paid $500 Per Gallon of Gas in Afghanistan

    A recent report by the Special Inspector General for Afghanistan Reconstruction (SIGAR) recalls the 1980s stories of $640 toilet seats and $500 hammers.  In a report primarily addressing the construction of a hospital in Afghanistan that is two years behind schedule, SIGAR also found some egregious examples of overpayments to contractors, including one instance where USAid reimbursed a $300,000 charge for 600 gallons of diesel fuel, or $500/gallon:
In one instance, SIGAR found that IOM [International Organization for Migration] paid the contractor $300,000 for 600 gallons of diesel fuel—a cost of $500 per gallon. According to IOM officials, the market price in Afghanistan for diesel fuel should not exceed $5.00 per gallon. As a result, with a proper invoice, the fuel charge should not have exceeded $3,000. In another instance, IOM paid $220,000 for an automatic temperature control device that should have cost between $2,000 and$10,000. IOM could not provide us with a vendor invoice for either of these payments. USAID did not discover the overpayments and reimbursed IOM for these unwarranted costs.
     In response to the SIGAR report, USAid stated its intention to conduct a financial audit and recover these and any other overpayments.

Note: A version of this article first appeared at The Weekly Standard.

Wednesday, October 23, 2013

Maryland Postpones All Obamacare Small Business Forums

    The State of Maryland has been front and center on the launch of open enrollment through the new Obamacare insurance marketplaces on October 1.  The week before the launch, President Obama joined Maryland Governor Martin O'Malley in Largo, MD to boost public awareness of the marketplaces, and he said that if "every governor were working as hard as Governor O’Malley to make the Affordable Care Act work," even more Americans would reap its benefits.
    In the intervening weeks, however, the Maryland Health Connection has had its share of problems.  From concerns about the privacy policy on the site to functions not yet available to low numbers of enrollees, the launch has been anything but smooth.  Governor O'Malley finally acknowledged it could be six weeks before the "glitches in the portal" might be worked out.
    But even as the state concentrates on working on the problems of signing up Marylanders for individual policies, another deadline is approaching.  The Small Business Health Option Program (SHOP) is scheduled to kick off January 1, 2014 with coverage to start as early as March.  And in the case of businesses, not only will the marketplace function as a place to select coverage, but will be responsible for billing employers and collecting payments on an ongoing basis; the money will then be remitted to the various insurers by SHOP.  (Individuals can choose to pay the initial payment through the marketplace or directly to the insurer, but all future billings and payments are between the individual and the insurer.)  Elizabeth Charlow, communications manager for SHOP in Maryland, confirmed this in a September email to THE WEEKLY STANDARD:
All employer bills get handled by Maryland Health Connection (federal requirement) regardless of whether it's employee choice or employer choice.  Individuals who purchase can make their first premium payment on Maryland Health Connection or they can elect to pay the carrier directly. For all subsequent bills, the carriers would send these to individuals directly.
 According to Tequila Terry, director of plan and partner management, the employer would not get multiple bills. The SHOP would aggregate all carrier bills so the employer can make one payment. The Maryland Health Benefit Exchange would then distribute payment to the appropriate carriers on behalf of the employer.
     To help businesses in Maryland prepare for their more complex relationships with the marketplace, the Maryland Health Connection had scheduled multiple public forums on SHOP throughout the state.  On October 4, the Maryland Chamber Action Network published the following on its website:
Maryland Health Connection Holding Small Business Forums 
The Maryland Health Connection will hold a series of small business forums around the state to educate small business owners about the new Small Business Health Options Program (SHOP), which enables small businesses and their employees to compare and select from a variety of qualified health plans that suit their needs and budgets. SHOP is a program of Maryland Health Connection, the state’s new online health insurance marketplace. 
Attend one of the upcoming forums to learn more about:
  • Background of the Maryland Health Benefit Exchange.
  • Implementation and timeline.
  • Plan levels of coverage.
  • Health care tax credits for small business.
    However, on October 16, the notice was deleted and the following was posted:
Maryland Health Connection Small Business Forums Postponed 
The Maryland Health Connection has postponed the Small Business Forums, which were scheduled to begin later this month have been postponed. We will let you know if they are rescheduled for a later date. More information about the Maryland Health Connection is available on its website.
    When contacted via email, William Burns, Director of Communications for the Chamber Action Network, a state-wide alliance of Maryland chambers of commerce, said he didn't know why the forums were postponed, but he expected "to reconnect with them in the next couple weeks about rescheduling."  An email to the Maryland Health Connection from THE WEEKLY STANDARD inquiring about the postponements has so far gone unanswered.
    However, the announcement from the Chamber Action Network is not the only indication of the postponements.  Multiple scheduled forums that had at one time appeared on the Maryland Health Connection's calendar of events have been deleted without comment.  Events had been listed for SalisburyHagerstown, Baltimore (2), Takoma Park, Waldorf (2), Largo, Elkton, and Wye Mills. (All the event links provided here are from cached versions of the pages.)  Now, all the events have vanished from the site and are met with "Oops. Page Not Found." messages.  Below are screen captures of some of the event listings:

    In addition, the extended calendar used to reflect the upcoming SHOP forums:

    The same calendar view is now missing all the SHOP events:

    One event that is still on the schedule of the Maryland Health Exchange Board, the group that runs the Maryland Health Connection marketplace (including SHOP), is scheduled for October 31 in Beltsville, MD, and states that "Manager of Producer Operations Rebecca Bayne will present an overview of where the Exchange is going, as well as provide a SHOP overview."  In light of recent events, as well as in light of recently cancelled events, there may indeed be increased interest in what the board has to say about "where the Exchange is going."

Note: A version of this article first appeared at The Weekly Standard.

Tuesday, October 22, 2013

Drawstrings and the Nanny State

    On Tuesday, the Consumer Product Safety Commission (CPSC) issued a recall of some children's hooded sweatshirts due to "strangulation hazard."  The danger?  Drawstrings.

    As noted on the CPSC website, "Federal law bars any person from selling products subject to a publicly-announced voluntary recall by a manufacturer or a mandatory recall ordered by the Commission," and also, "It is illegal to resell or attempt to resell a recalled consumer product."
    Lest anyone misunderstand, I get that it is possible for such drawstrings to cause harm.  And yet the bottom line is that the federal government has criminalized a piece of clothing, or at least its sale or resale.  Are not warnings enough anymore? Is caveat emptor obsolete?  Must our government continually save us from ourselves?
    While pondering these questions, I decided to tweet the link and see if anyone else was pondering what I was pondering: "So, did everyone know that it is *illegal* to sell children's hoodies that have drawstrings?"  Much to my surprise, within minutes I received a reply from the CPSC:

    Whether the Twitter account of the CPSC is monitored or somehow generates automated tweets I do not know.  But the article to which the CPSC linked reads in part as follows:
Drawstrings can catch on items such as playground equipment or vehicle doors. CPSC has received 26 reports of children who have died when drawstrings in their clothes got tangled on playground slides, school bus doors and other objects. Waist and bottom drawstrings that were caught in cars and buses resulted in dragging incidents. 
CPSC first issued guidelines on drawstrings in February 1996. These were then incorporated into a voluntary standard in 1997. Since the clothing industry started following the voluntary standard, deaths involving neck or hood drawstrings  decreased by 75 percent and there have been no deaths associated with waist or bottom drawstrings. 
Still, we continue to see jackets, sweatshirts, and sweaters made with drawstrings that are dangerous. CPSC has issued more than 130 recalls involving clothes with drawstrings including 8 recalls between November 2011 and May 8, 2012. Here are some recalls from  just the past month (as of publication of this blog). So, check your child’s upper outerwear and make sure to follow the instructions on these recalls.
    So even after voluntary steps by the industry resulted in a 75% reduction in fatalities, the CPSC took the more drastic step of an outright ban.  But, one might argue, if it prevents the death of one child, it's worth it.  But isn't it possible our reliance on government to manage our safety in such minute ways has resulted in a more careless, less responsible society?
    Since the CPSC responded to my initial tweet, I attempted to continue the dialogue with a follow up. Having four children myself, I believe there is a clothing accessory that has endangered my children far more often than any drawstring: shoelaces.  I cannot find reliable statistics, but any parent could testify of the hazards of untied shoes.  So I asked the CPSC:

    So far, I have not received a reply.  Hopefully I haven't given them any ideas.  But just in case, I'm putting all my investment dollars into Velcro.

Sunday, October 20, 2013

White House: Obamacare 'Great News'—56,000 Added to Medicaid in Oregon

    In light of the beating the Obama administration is taking over the ignominious launch of the Obamacare insurance marketplaces, it makes sense that the White House would be looking for good news to share.  The White House Twitter account attempted to provide a boost Thursday with the following:
    On the surface, the news sounds promising.  But those who click through to the OregonLive article might draw a different conclusion.  Here is an excerpt from the story [emphasis added]:
Though the Oregon's health insurance exchange is not yet up and running, the number of uninsured is already dropping thanks to new fast-track enrollment for the Oregon Health Plan. 
The low-income, Medicaid-funded program has already signed up 56,000 new people, cutting the state's number of uninsured by 10 percent, according to Oregon Health Authority officials. 
Though the new exchange called Cover Oregon was originally intended to be used for Oregon Health Plan enrollment, the online marketplace doesn't work yet. Instead, new Oregon Health Plan members are being enrolled using a fast-track process that was approved by the federal government in August. 
Since late September the Oregon Health Authority sent out notices to 260,000 people already enrolled in the state's food stamps program since late October. 
The notices informed them that based on their income reported to the Supplemental Nutrition Assistance Program, they are pre-qualified for the Oregon Health Plan in 2014. Most of them are newly eligible thanks to the state's decision to expand the program's income caps under the federal Patient Protection and Affordable Care Act. 
To enroll, all they have to do is make a phone call or send a form consenting to be enrolled. So far, 56,000 people have done that, coming on top of more than 600,000 already enrolled. 
Under the new Oregon Health Plan income eligibility rules, in 2014 individuals must earn 138 percent of the federal poverty level or less to qualify, as compared to the 100 percent cutoff this year. The new cap means monthly income of $1,322 for an individual,$1,784 for a household of two, $2,247 for a household of three, and $2,704 for a family of four. 
Another change likely to boost enrollment: under new rules mandated by the federal health law, savings or property is no longer a bar to membership; application is now based strictly on income for the month in which someone applies. 
Many of the new enrollees are likely to have pent-up health needs. A survey of 38,000 people on the Oregon Health Plan waiting list in 2012 found 11 percent had diabetes, 8 percent heart problems, 30 percent high blood pressure, 22 percent high cholesterol and 5 percent cancer...
    What it boils down to is this: About 56,000 persons already on food stamps in Oregon have been added to Medicaid; many of them are in poor health, and some could have significant savings and property or had a single month of low income, but qualify anyway.  And all they must do is respond via phone call or consent form to be covered; no is application needed, which is a good thing, because the online marketplace doesn’t work anyway.  So the "number of Oregonians without health insurance dropped 10% in 2 weeks," true enough.  But none of them will actually be paying premiums in the new Obamacare insurance system.
    This is what passes for good news in the age of Obamacare.

Note: A version of this article first appeared at The Weekly Standard.

Thursday, October 17, 2013

Obamacare Website Violates Licensing Agreement for Copyrighted Software

    Healthcare.gov, the federal government's Obamacare website, has been under heavy criticism from friend and foe alike during its first two weeks of open enrollment.  Repeated errors and delays have prevented many users from even establishing an account, and outside web designers have roundly panned the structure and coding of the site as amateurish and sloppy.  The latest indication of the haphazard way in which Healthcare.gov was developed is the uncredited use of a copyrighted web script for a data function used by the site, a violation of the licensing agreement for the software.
    The script in question is called DataTables, a very long and complex piece of website software used for formatting and presenting data.  DataTables was developed by a British company called SpryMedia which licenses the open-source software freely to anyone who complies with the licensing agreement.  A note at the bottom of the DataTables.net website says: "DataTables designed and created by SpryMedia © 2008-2013."  The company explains the license for using the software on that website [emphasis added]:
DataTables is free, open source software that you can download and use for whatever purpose you wish, on any and as many sites you want. It is free for you to use! DataTables is available under two licenses: GPL v2 license or a BSD (3-point) license, with which you must comply (to do this, basically keep the copyright notices in the software).
    The software, a version of which is available at DataTables.net, contains the copyright notice in the opening lines of the code:

    At the Healthcare.gov website, however, the opening lines of the script appear as follows, with the copyright and all references to the author and SpryMedia deleted; a search of the entire script does not turn up the missing lines either:

    Even a cursory comparison of the two scripts removes any doubt that the source for the script used at Healthcare.gov is indeed the SpryMedia script.  The Healthcare.gov version even retained easily identifiable comments by the script's author, such as the following:
    Here is a screen capture from the SpryMedia script:

    Here is the same section at Healthcare.gov:

    THE WEEKLY STANDARD contacted SpryMedia for comment.  A representative for the company said that they were "extremely disappointed" to see the copyright information missing and will be pursuing it further with the Department of Health and Human Services, the agency that runs the Healthcare.gov site.

Note: A version of this article first appeared at The Weekly Standard.

Obamacare Exchange Confirms: 'We Are Required to Respond to Certain Requests from Law Enforcement'

    On October 8, THE WEEKLY STANDARD reported that the privacy policy of the Maryland Health Connection (MHC), the state's Obamacare insurance marketplace, included a statement that the marketplace "may share information provided in your application with the appropriate authorities for law enforcement and audit activities."  An email had been sent to the MHC on October 3 requesting clarification of the policy, and included these inquires: Does that include both federal and state authorities?  What type of information from the application might be of interest to law enforcement and/or state/federal auditors?  However, no response was received, and the story was published.
    A follow up email sent to the MHC a day after the story ran was answered by the MHC with the promise of a response the following day, but none was forthcoming.  A third email sent on Friday, October 11, was finally answered late that evening by Communications Manager Betsy Charlow.  The full response reads as follows:
The Maryland Health Connection Privacy Policy has been developed in compliance with federal regulations codified at 45 C.F.R. § 155.260 and 45 C.F.R. § 155.280 to ensure consumer protections and operations of the insurance marketplace. Like all state agencies, we are required to respond to certain requests from law enforcement.
     The regulations cited by Ms. Charlow, while stating that sharing personally identifiable information is proscribed for reasons "that are not permitted or required by law," do not specifically address what types of law enforcement and/or audit activities might qualify for an exception, nor do the regulations detail who is authorized to make the determination for what qualifies for an exception.

Note: A version of this article first appeared at The Weekly Standard.

Gov't Shutdown Didn't Stop the Energy Department's Solar Decathlon

    The past two weeks have been filled with stories of government offices, agencies, services, workers, monuments, websites, memorials and parks that have been closed, suspended, furloughed and even barricaded.  Perhaps the most notorious of the actions taken has been the barricading of the open-air World War II memorial in Washington DC, where veterans, some in wheelchairs, who had flown in on "Honor Flights" were denied access.  But one government sponsored-event that was spared the impact of the shutdown was the Department of Energy's 2013 Solar Decathlon, last held in 2011.  The event's website (a .gov site) describes the competition:
The U.S. Department of Energy Solar Decathlon challenges collegiate teams to design, build, and operate solar-powered houses that are cost-effective, energy-efficient, and attractive. The winner of the competition is the team that best blends affordability, consumer appeal, and design excellence with optimal energy production and maximum efficiency.
    There was some concern at the outset of the government shutdown that the event, scheduled for October 3-13, would be affected, but a post dated October 1 on the event's blog allayed such fears.  And not only would the event continue, but federal employees would be allowed to participate [emphasis added]:
Despite the government shutdown, the U.S. Department of Energy Solar Decathlon 2013 competition will continue as planned. 
The Solar Decathlon is funded by a mix of last year’s federal funding and at least 30 private-sector sponsors. Student teams from across the country and around the world have worked for two years to design and build their solar-powered, energy-efficient houses and have been working onsite for the past week to prepare for this highly-anticipated event. Federal employee participation is limited to personnel necessary to allow the show to proceed.
    Not all activities of the Department of Energy (DOE) escaped the effects of the shut down.  The main website of the DOE currently contains the following notice:

    The website for the Solar Decathlon, run by the DOE, however, was updated more than a dozen times during the last two weeks, as recently as Monday, October 14:

    With the National Park Service trying to cut off access to even privately owned and run facilities such as Mt. Vernon and the Claude Moore Colonial Farm due to tenuous government connections, it is difficult to see how a non-essential government competition such as the Solar Decathlon, even with its partial private funding, managed to be carried off and even include limited federal government employee participation.  The Obama administration's commitment to its environmental agenda is strong indeed if a solar-energy competition is elevated above veterans' access to war memorials.  In this case, it appears "green" trumped red, white and blue.

Note: A version of this article first appeared at The Weekly Standard.

Monday, October 14, 2013

Obamacare Website Source Code: "No Reasonable Expectation of Privacy"

    The launch of federal government's Obamacare insurance exchange, Healthcare.gov, has been plagued with delays, errors, and poor website design, prompting USA Today to call it an "inexcusable mess" and a "nightmare".  Now comes another example of why the website's reputation is in tatters.  Buried in the source code of Healthcare.gov is this sentence that could prove embarrassing: "You have no reasonable expectation of privacy regarding any communication or data transiting or stored on this information system."  Though not visible to users and obviously not intended as part of the terms and conditions, the language is nevertheless a part of the underlying code for the "Terms & Conditions" page on the site.
    After creating an account on Healthcare.gov, users are asked to click an "I accept" button under some routine Terms & Conditions prohibiting unauthorized attempts to upload information or change the website.  Once users click the button, they may proceed to shop for insurance and enter detailed personal information.  However, when the Terms & Conditions page is visible, the hidden sentence mentioned above along with several others can be seen by using a web browser's "View Source" feature.  A screen grab below shows the visible Terms & Conditions page along with a simultaneous view of the code underlying it:

    The full portion of the code which does not appear on the visible page displayed for users reads as follows:
You have no reasonable expectation of privacy regarding any communication or data transiting or stored on this information system.  At any time, and for any lawful Government purpose, the government may monitor, intercept, and search and seize any communication or data transiting or stored on this information system.  Any communication or data transiting or stored on this information system may be disclosed or used for any lawful Government purpose. [The sentence beginning "To continue" also appears again, but is only visible once on the page as displayed for users.]
    It is unclear why these sentences appear in the code at all since they are not displayed, although the code may simply have been copied from another website that does use the full warning.  In this case, the unwanted portion of the warning was rendered inert with HTML coding tags ("<!--" and "-->") usually used by programmers for inserting comments to explain the purpose of a section of code.  However, the code can be rendered "live" again by simply removing those tags, in which case the full text would appear on the screen to users.  However, it is unclear why the paragraph containing "no reasonable expectation of privacy" would ever have even been considered appropriate in this context.
    The phrase "no reasonable expectation of privacy" is actually a stock phrase used in the terms and conditions of many government websites and information systems, but those who are entering personal, medical and financial information at Healthcare.gov may not find that fact reassuring.  An email sent on Thursday, October 10, requesting comment from Department of Health and Human Services, the agency responsible for the website, has not yet been returned.

Note: A version of this article first appeared at The Weekly Standard.

Friday, October 11, 2013

After 10 Days, Maryland Obamacare Exchange Reports 1,121 Enrollments

    The Maryland Health Connection released updated statistics today for the state's Obamacare insurance exchange.

Unique website visitors, 10/1-10/10: 217,091 
Calls to call center, 10/1-10/10: 15,952 
Accounts created with verified identity, 10/1-10/10: 25,781 
Enrollment, 10/1-10/10: 1,121

    The report includes the follow graph on enrollments which does show some signs of acceleration:

    Based on total number of unique website visitors and calls to the call center, accounts with verified identity are running at 11%, and enrollments at less than one-half of one percent (.48%).

Thursday, October 10, 2013

No Doctors Found in Minnesota Obamacare Exchange, Either

    Tuesday morning, the WEEKLY STANDARD reported that the doctor search feature on the Maryland Health Connection Obamacare insurance exchange was not yet operational and returned a "no doctors are found" message.  A reader from Minnesota has reported that MNsure, the Minnesota exchange, has not yet activated a provider search feature either, and provided a screen grab from the site:

    The MNsure site notes that it is still undergoing regular maintenance:
Account and application system is available Monday – Saturday, 6 am – 10 pm. 
System maintenance is performed Monday – Saturday, 10 pm – 6 am, and all day Sunday.

Note: A version of this article first appeared at The Weekly Standard

Maryland Obamacare Exchange: 'No Doctors Are Found'

    "If you've got a doctor that you like, you will be able to keep your doctor," President Obama assured the worried public as he worked to sell the Affordable Care Act in 2010.  However, in July 2013, visitors to Healthcare.gov received a less confident "you may be able to" in answer to the question, "Can I keep my own doctor?"  Beginning October 1, users of the Maryland Health Connection, that state's Obamacare insurance exchange, might have an even more basic question: Are there any doctors?
    A consumer information update dated the day the exchange opened informed users (at least those who took the time to read the updates) that the doctor search function was not yet operational and they would need to visit an external website to find out which doctors accept which plans.  The full update reads as follows [emphasis added]:
Search for your physician. If you are interested in understanding which health plans a particular doctor participates in, please visit https://providersearch.crisphealth.org  – a new service sponsored by Maryland Health Connection. For the time being, doctors and other providers are not yet available in Maryland Health Connection; therefore, if you choose to search for them on the website, you will receive a message that “no doctors are found” message.
     This update and several other consumer updates might help explain why as of noon on Monday, October 7, only 326 people in the state had successfully completed the application process. For example [emphasis added]:

The application’s built in calculator may underestimate total out-of-pocket costs in some cases. Remember that if you are eligible for reductions in cost sharing, only silver plans will qualify. So a bronze plan might cost less in premium, but more in total out of pocket cost. We expect this to be fixed in the very near future, so if you would prefer, please check back in the next several weeks.
In some cases, the application has trouble processing multiple applications at once. In case this happens to you, there is a solution: shop for each person separately. The price will be the same as if you are shopping together 
Please calculate your salary using annual, weekly, quarterly or monthly calculations. Our application is currently miscalculating the bi-weekly salary. You will be able to see the calculated salary to ensure that the information you input is correct.
    The consumer update page does not yet indicate that any of these issues have been resolved.

Note: A version of this article first appeared at The Weekly Standard.

State Dept.: $130M For New Embassy in ... Mauritania

    A week before the government shutdown began, the State Department awarded a $130 million contract to design and build a new embassy compound in the city of NouakChott in the West African nation of the Islamic Republic of Mauritania, which lies between Mali and the Atlantic Ocean.  The contract went to Caddell Construction of Montgomery, Alabama, after having first been put out for bids in December 2011:

    According to the bid solicitation, plans included:
New Office Building (NOB), Marine Security Guard Quarters (MSGQ), warehouse, shops, maintenance facilities, perimeter security, vehicle and pedestrian access control facilities, utility building, bathhouse/cabana and surface parking.
    A report from the inspector general in March 2009 noted that a new embassy had already been slated for Mauritania as the existing facility was aging and overcrowded, but the 2008 coup in the country had delayed acquisition of land for a new compound.  The report recommended that the new facility be built on the existing property to save $5 million in costs for new land.  An email to the State Department inquiring if this recommendation was followed was not immediately returned.

    In August of this year, THE WEEKLY STANDARD reported that work had begun on a new embassy compound in another West African nation, Benin, at an anticipated cost of $178 million.

Note: A version of this article first appeared at The Weekly Standard.

State Dept. Awards $5M Contract for Crystal Stem and Barware For Embassies

    Just a week before the government shut down kicked in on October 1, the State Department awarded a five-year, maximum $5 million contract for custom handcrafted crystal stem and barware, according to a report in the Valley News, an online news site in Vermont (via Charlie Perkins.)  Valley News reporter Warren Johnston reports:
On eve of last week’s government shutdown, Simon Pearce won a potential five-year competitive contract for $5 million to provide 20 different styles of custom handcrafted stem and barware to the State Department for use in American embassies around the world. 
The contract stipulates that the items be made in the United States, Clay Adams, chief executive officer at Simon Pearce, said in an email. 
“Simon Pearce is a natural fit for this given its production in Vermont and Maryland. Simon Pearce received its first purchase order … for more than 12,000 pieces, most of which will be produced here in Vermont later this year,” Adams said...
    Notice of the contract award was posted on September 30 on the Federal Business Opportunities website:

    The contract is the result of a Small Business bidding solicitation first posted by the State Department in February of this year for an "Indefinite Delivery Indefinite Quantity" contract.

Note: A version of this article first appeared at The Weekly Standard.

Tuesday, October 8, 2013

Obamacare Marketplace: Personal Data Can Be Used For "Law Enforcement and Audit Activities"

    Maryland's Health Connection, the state's Obamacare marketplace, has been plagued by delays in the  first days of open enrollment.  If users are able to endure long page-loading delays, they are presented with the website's privacy policy, a ubiquitous fine-print feature on websites that often go unread.  Nevertheless, users are asked to check off a box that they agree to the terms.
    The policy contains many standard statements about information automatically collected regarding internet browsers and IP addresses, temporary "cookies" used by the site, and website accessibility.  However, at least two conditions may give some users pause before proceeding.
    The first is regarding personal information submitted with an application for those users who follow through on the sign up process all the way to the end.  The policy states that all information to help in applying for coverage and even for making a payment will be kept strictly confidential and only be used to carry out the function of the marketplace.  There is, however, an exception: "[W]e may share information provided in your application with the appropriate authorities for law enforcement and audit activities."  Here is the entire paragraph from the policy the includes the exception [emphasis added]:
Should you decide to apply for health coverage through Maryland Health Connection, the information you supply in your application will be used to determine whether you are eligible for health and dental coverage offered through Maryland Health Connection and for insurance affordability programs. It also may be used to assist you in making a payment for the insurance plan you select, and for related automated reminders or other activities permitted by law.  We will preserve the privacy of personal records and protect confidential or privileged information in full accordance with federal and State law. We will not sell your information to others.  Any information that you provide to us in your application will be used only to carry out the functions of Maryland Health Connection. The only exception to this policy is that we may share information provided in your application with the appropriate authorities for law enforcement and audit activities. 
     The site does not specify if "appropriate authorities" refers only to state authorities or if it could include the federal government, as well.  Neither is there any detail on what type of law enforcement and/or audit activities would justify the release of the personal information, or who exactly is authorized to make such a determination.  An email to the Maryland Health Connection's media contact seeking clarification has not yet been answered
    The second privacy term that may prompt caution by users relates to email communications.  The policy reads:
If you send us an e-mail, we use the information you send us to respond to your inquiry. E-mail correspondence may become a public record. As a public record, your correspondence could be disclosed to other parties upon their request in accordance with Maryland’s Public Information Act.
    Since emails to the marketplace could conceivable involve private matters regarding finances, health history, and other sensitive issues, the fact that such information could be made part of the "public record" could prevent users from being as free with their information than they might otherwise be.  However, as noted, any requests for such emails would still be subject to Maryland's Public Information Act which contains certain exceptions to the disclosure rules.

Note: A version of this post first appeared at The Weekly Standard.

Monday, October 7, 2013

Feds to Furloughed Employees: Checking Gov't Email During Shutdown a "Criminal Offense"

    A notice posted on the website of the Small Business Administration (SBA) warns idled employees that it is a "criminal offense" to use federal resources during the furlough period, including accessing government email accounts.  Although the notice is directed to SBA employees, presumably the directive applies to furloughed employees of all government agencies.  The full notice reads as follows:
Please be advised, during the furlough period, non-excepted employees will no longer be permitted to utilize SBA email or other federal resources. Please know that use of federal resources while on furlough status is prohibited by law and is considered a criminal offense. Employees must NOT represent the agency in any formal or informal capacity.
    The Office of Personnel Management (OPM) issued a document on October 4, 2013, entitled "Guidance for Shutdown Furloughs" for all government employees.  The guidance does not specifically address the email issue, and makes no mention of "criminal offenses."  The closest the document comes to addressing the issue appears under a section entitled "Working during Furlough" (page 3):
1. May an employee volunteer to do his or her job on a nonpay basis during a shutdown furlough?  
A.  No.  Unless otherwise authorized by law, an agency may not accept the voluntary services of an employee.  (See 31 U.S.C. 1342.) [Link added]
     During the lead up to a possible government shutdown in 2011, the SBA released guidance for its employees in preparation.  The website FedSmith published the guidance that was sent in by one of its SBA readers, and it included almost verbatim the email warning that is currently on the SBA website.

Note: A version of this article first appeared at The Weekly Standard.

Friday, October 4, 2013

HHS-Run Website Hacked; Now Selling NFL Jerseys, Ugg Boots, Armani Fragrances [UPDATED]

    A portion of the website of the Substance Abuse and Mental Health Services Administration (SAMHSA) was apparently hacked as long as two months ago.  SAMHSA is an agency of the Department of Health and Human Services (HHS).  HHS also runs the new Obamacare insurance marketplace, Healthcare.gov.
    Dozens of pages hawking retail merchandise have been uploaded to the SAMHSA site, ranging from NFL jerseys to Uggs shoes to Armani fragrances.  Screen captures of the various pages are shown here:

     Clicking on the pages in some cases takes users directly to an external website; other times, certain functions seem to operate within the samhsa.gov site.  Of the websites investigated, two domains are registered in the United States and one in China.
    All of the instances uncovered by this investigation are under the sub domain nace.samhsa.gov, which is the Native American Center for Excellence.  The first breach discovered dates back to July 29 of this year, and the unauthorized pages are still on the site.
    In September, a portion of NASA's website was hacked by a Brazilian group protesting reports of spying in that country by the National Security Agency.

UPDATE:  Shortly after this story was posted, the site (nace.samhsa.gov) returned an error message saying that the site could not be found.  Later, the following message appeared on the site (misspelling included, [since corrected]): "This site is undgoing maintenance. We are sorry for any inconvenience this has caused you."  Here's a current screen capture:

    While clicking on the original links in the story above return "file not found"messages, at least one of the pages is available via a Google cache here showing how the page appeared as of October 3.  A Google search of the site still turns up dozens of links to other pages from the hacking.  The "undergoing maintenance" message on the SAMHSA website comes in spite of the fact that many government websites have been shuttered or severely limited due to the ongoing federal government shut down.

Note: A version of this article first appeared at The Weekly Standard.

Thursday, October 3, 2013

Washington State Dems: Federal Shutdown Takes Food From Half of Babies in Our State

    In an attempt to dramatize the effects of the federal government shutdown, Washington State Democrats may have revealed more about their state, and about the state of the economy under President Obama than they intended.  The Advance, official blog of the Washington State House Democrats, posted the following on Thursday:
Federal shutdown could take food from half the babies in Washington state 
Half of Washington state’s babies—and one third of all pregnant women in the state—rely on the Women, Infant and Children nutrition program. 
The program is run by the state, but the funding comes from the federal government. Which is shut down. 
Now the money that feeds those pregnant women, babies and young children will run out in a matter of days, according to the state Department of Health.... 
Almost half of all babies, one third of pregnant women, and one quarter of children under five in Washington State are on the WIC Program. 
In Washington State, WIC reaches over 195,000 women, infants, and children in 205 clinics each month and provides services to over 315,000 individuals each year. 
WIC is funded by the United States Department of Agriculture and operated by the Washington State Department of Health.
    Democrats hold eight of the twelve seats that make up Washington's federal congressional delegation, and eight of nine elected statewide offices in the state are held by Democrats.  The governor of Washington State, Jay Inlsee, is a Democrat and the party holds majorities in both houses of the state legislature.

Note: A version of this article first appeared at The Weekly Standard.

Valerie Jarrett Tweets Joke of Senator Getting Mistress Pregnant to Promote Obamacare

    Monday morning, White House Senior Advisor Valerie Jarrett tweeted (and the White House retweeted) the following:
    The tweet links to a video at the website www.funnyordie.com starring Jennifer Hudson as a "scandal fixer" who debunks "scandals" related to Obamacare.
    One scene features Hudson in a fictional senator's office where he reveals that his mistress is pregnant and doesn't have health insurance.  Hudson sets his mind at ease be telling him how he can sign her up for full coverage (but not before muttering a profanity.)  The senator then tells Hudson that his split with his wife is "quite amicable" and his constituents "fully approve."
    The video ends with "visit Healthcare.gov for more information."

Note: A version of this article first appeared at The Weekly Standard.

Despite Gov't Shutdown, Army Awards $2,163 Contract for 'Massage Chair'

    Sometimes timing is everything.  Yesterday was Day One of the federal government shutdown, and one of the biggest stories of the day was the barricading of the World War II memorial in Washington DC, nearly preventing a group of 92 veterans from Mississippi who had flown in via an Honor Flight from visiting the site. But it was also the day that the US Army chose to award a $2,163 contract for a "massage chair":

    The chair was ordered for Fort Belvoir in Virginia, the site of many of President Obama's local golf outings. The classification is "Furniture", so it is not clear if the chair is intended as a rehabilitation tool, or just a relaxation aid.  A partial description of the chair reads:
Zero Gravity positions you back to minimize pressure along the spine. The chair is equipped with twin rollers to mimic the feel of human thumbs & Fingers, enhancing the massage experience. MP3 player with Music sync with two speakers in the backrest. LED light in the side panel create one kind of nice environment. Designed with a set of S-track movable intelligent massage robot, special focus on the neck, shoulder and lumbar massage according to body curve...
 Other groups of veterans planning visits to the memorial in Washington DC have reportedly been threatened with arrest if they breach the barricades as the Mississippi veterans did on Tuesday.  According to the Daily Caller, Mississippi Rep. Steven Palazzo said that both the White House and the Department of the Interior declined to intervene and allow the veterans an exception for their Tuesday visit.

Note: A version of this article first appeared at The Weekly Standard.

Wednesday, October 2, 2013

Most Popular Question at Healthcare.gov: How to Get Exemption From Lack-of-Coverage Penalty Fee?

    One day away from the launch of the Obamacare marketplaces, the question most on the minds people visiting the Healthcare.gov website is not about coverage, but rather about avoiding the penalty, or tax, for not having health insurance.  As of Monday morning, here is how the website listed its "Most Popular" items:

    As the website explains, the fee (tax) in 2014 is 1% of annual income or $95 per person, whichever is higher. The fee increases each year. By 2016 it increases to 2.5% of income or $695 per person, whichever is higher.

Note: A version of this article first appeared at The Weekly Standard.

Tuesday, October 1, 2013

Obamacare Website Admits: You May Not Be Able to Keep Your Plan

    On the very day the Obamacare insurance marketplaces opened for business, a new topic appeared on the HealthCare.gov website:

    Although the topic was just added, it is already listed as "most popular":

    The write up on this new topic begins:
Starting 2014, most individual plans must offer new benefits and protections. Some plans will be changed or replaced with plans that offer these protections. 
If this happens, you can choose to buy a plan in the Health Insurance Marketplace instead. If you switch to a Marketplace plan, you may qualify for lower costs based on your income.
    Further down, the post states:
Your plan or choices may change
Given the changes required in 2014, insurance companies offering individual plans have two choices:
  • They can make changes to your plan to provide these benefits. If they do, you’ll see these changes to your plan by the time you renew during 2014. For example, if your renewal date is in July 2014, you’ll see the changes no later than July.
  • Your insurance company may decide to offer you other individual plans rather than renew the particular plan that you have today.
    While the post says that "insurance companies offering individual plans have two choices," this does not take into account that some insurance companies will simply choose to cancel the plan and not offer any alternatives, as some have already done.
    President Obama and his supporters have been insisting since before the Affordable Care Act was signed into law that if "you like your plan", you can keep it.  Now that the Marketplaces are open, the administration is finally acknowledging that that will not always be the case.

Note: A version of this article first appeared at The Weekly Standard under the headline "New Topic on HealthCare.gov: What If My Plan is Not Offered in 2014?" 

Obamacare Website Quietly Deletes Reference to "Free Health Care" [UPDATED]

    Even as President Obama and his administration are making a last minute push to encourage enrollment in Obamacare, a quiet change was made on the Healthcare.gov website regarding those who will still not be able to afford coverage after the program kicks in.  From at least June 26, 2013 to as  recently as September 15 under the topic "Where can I get free or low-cost care in my community?", the following statement appeared:  "If you can't afford any health plan, you can get free or low-cost health and dental care at a nearby community health center."  Here is how the page in question appeared:

     However, sometime between September 16 and September 23, the reference to "free" care was dropped.  The title of the topic was changed as well, now reading: "Where can I get low-cost care in my community?" Here is how the page currently appears:

    The page in question is not a new one, as the webpage's internet address remains the same, still containing the word "free": "www.healthcare.gov/where-can-i-get-free-or-low-cost-care/".  However, there is no notation anywhere on the page that it was revised; the change just appeared unannounced.
    Other changes include dropping references to "dental" care and the availability of "prescription drugs," as well as exchanging the phrase "specialized care for more serious conditions" for the milder "referrals to specialized care."
    Since President Obama has been emphasizing of late how inexpensive Obamacare will be for many Americans, advertising the availability of "free" health care might have been viewed as a deterrent to purchasing even the least expensive option from the government-run exchanges.  Since the "bronze" and "silver" level plans that the president has recently been touting as equaling "the cost of your cable bill" and "less than your cell phone bill" will still entail significant out-of-pocket costs for medical care, "free" might still look more attractive to many on the lower end of the income scale.  It may be that community health centers will still offer free care to some, but visitors to Healthcare.gov will no longer be made aware of the option.

UPDATE: Brian Cook, director of media relations for Centers for Medicare & Medicaid Services, basically confirms the crux of this post and says in statement:
"This part of the website which HHS updated as part of its routine changes, describes Community Health Centers, which provide services on a sliding scale with some people getting care at no cost to them."

Note: A version of this article first appeared at The Weekly Standard.