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.

White House Graphic Leaves a Page Out of New "Simple" 3-Page Obamacare Application

    A Sunday blog post at Whitehouse.gov declares that "the new [Obamacare] application is so simple, it's 17 pages shorter than the current application you'd fill out to enroll in coverage in the individual market."  While the final version of the application has not yet been publicly released (several draft versions have appeared in the past), the White House blog features an animated GIF graphic to contrast the average 20-page application with the new 3-page Obamacare application:

The only problem is that close observation of the graphic shows that only two pages of the Obamacare application appear in the animation.  The slide labeled "Page 1" at the bottom appears as follows, with "Step 1" visible at the top:

However, when the slide changes to Page 2, the Obamacare application page doesn't change: "Step 1" is still at the top:

But when the slide changes again to "Page 3", the Obamacare application page suddenly changes to "Step 4" at the top:

Since October 1 is Tuesday, there won't be long to wait to see the real page 2 with the missing Steps 2 and 3.  But while the public might forgive the 33% error rate on this first attempt by the administration to unveil the new "simple" application, the actual launch of Obamacare on Tuesday will doubtless be subject to stricter scrutiny, and the ultimate success or failure of the program may ride on how well, or how poorly, the launch goes.

Audit Finds Maryland Overcharged Federal Government in 95% of Cases in Waiver Program

    A Social Security program administered by the Centers for Medicare & Medicaid Services (CMS) allows states to apply for waivers for longterm care of individuals with developmental disabilities in home and community settings instead of institutions.  For the three years ending June 2012, the State of Maryland claimed $648.6 million from the federal government under its Community Pathways waiver program.
    An audit by the Office of the Inspector General (OIG) of the Department of Health and Human Services (HHS) found that errors in paperwork filed by the state resulted in overcharges to the federal government in excess of $20 million.  But even more startling than the dollar amount is the 95% error rate uncovered by the audit.  The OIG explains in the Findings section of the report [emphasis added]:

The State agency did not comply with Federal and State requirements when it claimed costs for residential habilitation services under the waiver.  Of the 100 claim lines that we sampled, 5 complied with Federal and State requirements; however, 95 did not.  The 95 claim lines had 135 errors:  

• For 81 claim lines, the State agency included unallowable costs for room and board.    
• For 54 claim lines, the State agency reduced provider payments to reflect amounts in excess of room and board that providers had collected from beneficiaries but did not reduce claims for Federal reimbursement accordingly.   

Forty claim lines included both errors.We estimate that, as a result of these errors, the State agency claimed at least $20,627,705 (Federal share) in unallowable costs.
The State agency claimed these unallowable costs because it lacked internal controls to ensure that unallowable costs were not included in claims for provider per diem payments.  

    In response, the State of Maryland agreed with the finding of the audit, including the recommendation to reimburse the federal government for the $20 million overcharge.  The state agency responsible also noted steps being taken to prevent a reoccurrence of the errors.
    As the Affordable Care Act begins to take full effect in 2014, Maryland is one of the states participating in the Medicaid expansion that is part of the law.  State agencies will have an expanding workload as the Medicaid expansion kicks in, increasing the need for safeguards to be sure that the states are in compliance with reimbursement guidelines.

President Obama Sends OFA Email Attacking Republicans

    The President of the United States sent an email today via his former campaign organization attacking Republicans in Congress for the showdown over Obamacare and the continued funding of the government.  Organizing for Action (OFA) (formerly Obama for America) now bills itself as "a 'social welfare' organization within the meaning of section 501(c)(4) of the Internal Revenue Code."  The group has publicly stated that it is non-partisan, but the president writes that a "group of far-right Republicans in Congress is obsessed with making an ideological point", and that "Republicans are not focused on what's best for you." The email is signed "Barack."  The full text reads as follows:

Right now, the hard work we've put in to get our economy back on track is at risk. And there's only one reason for it: A group of far-right Republicans in Congress is obsessed with making an ideological point. 

They refuse to pass a budget unless I let them sabotage Obamacare, something they know is not going to happen. Now, we're left with only four days before a government shutdown. 

This is reckless and irresponsible. Republicans are not focused on what's best for you. They're playing political games. 

I called House Speaker John Boehner the other night to tell him that Americans like you have worked too long and too hard to dig our nation out of the financial crisis, and the last thing we need is for Washington to manufacture another.  

I want to make sure that message gets through. Add your voice -- remind Speaker Boehner that Congress has a job to do.  

Passing a budget is the most basic duty the Constitution gives to Congress. 

Congress needs to hear from the people who sent them to Washington.  

As we get closer to the September 30th deadline, that might mean picking up the phone, getting the facts out to friends on social media, or showing up at your local congressional office. OFA will be asking a lot of you, and I hope you'll get involved. 

Start today by telling Speaker Boehner that Congress must come together to pass a budget: 

Thank you,
Barack

     As is typical of OFA emails, the links in the email first take users to a page to enter an email address and indicate support for the cause.  After that comes the ubiquitous donation solicitation page.


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

John Kerry Shakes Hands With Iranian Foreign Minister Zarif

    Speculation ran high at the United Nations this week about whether or not President Obama and Iranian President Rouhani would shake hands.  Ultimately, the two leaders did not as the gesture was deemed “too complicated” for Iran at this time, “given their own dynamic back home.”
    However, those complications did not prevent a handshake between Secretary of State John Kerry and Iranian Foreign Minister Zarif at a ministerial meeting on Thursday.  The following exchange took place at a press briefing between a reporter and an unnamed Senior State Department official:

SENIOR STATE DEPARTMENT OFFICIAL: So Minister Zarif – we were in a U-shaped table. When Zarif came in, Helga Schmid got up so that he could sit next to Lady Ashton, and cornered with Zarif was the Secretary of State. So they were sitting next to each other on the corner, and at the end of the meeting, the Secretary leaned over and said, “Shall we talk for a few moments?” Now, informally, there had been a little bit of chatting that that might happen, and so neither one of them were surprised. And we -- 

QUESTION: It’s like being asked to a dance -- 

SENIOR STATE DEPARTMENT OFFICIAL: Right. (Laughter.) We had -- 

MODERATOR: There was no dancing. 

SENIOR STATE DEPARTMENT OFFICIAL: Yeah, no dancing. (Laughter.) 

QUESTION: And they did shake hands? 

SENIOR STATE DEPARTMENT OFFICIAL: Trust me, no dancing. They did. 

QUESTION: Shake hands? 

SENIOR STATE DEPARTMENT OFFICIAL: They did shake hands... They shook hands when they met.

    The Senior State Department official, though unnamed, went on to identify herself as a woman with the following comment on diplomatic protocol with the Iranians:

SENIOR STATE DEPARTMENT OFFICIAL: ... I did not shake hands for all the reasons you know, because I try to be respectful of the tradition that they would not shake hands with a woman...

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

Obamacare Marketplaces Will Function as Payment Clearinghouses for Insurers

    As full implementation of the Affordable Care Act draws nearer, some aspects of its operation have received relatively little attention.  The October 1 launch of the marketplaces, or exchanges, is less than a week away, but outside of offering a Price Line-like shopping experience for health insurance, not much has been released about their function once a plan is chosen.  Although, the marketplaces have been primarily promoted as a place to shop for, compare, and choose coverage, they will actually function as payment clearinghouses as well.
    According to Betsy Charlow, the Communications Manager for the Maryland Health Connection, Maryland's marketplace, businesses that purchase coverage for employees through the Small Business Health Options Program (SHOP) will have an ongoing relationship with the marketplace, unlike individuals who will be passed on to private insurers soon after chosen policies are in place.
     "All employer bills get handled by Maryland Health Connection (federal requirement) regardless of whether it's employee choice or employer choice," said Ms. Charlow via email.  "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."
    One of the apparent reasons for the ongoing relationship of businesses with the Marketplace is the opportunity businesses will have to offer a variety of plans from different insurers to employees, yet have the convenience of a single bill. (This option will not be available on the federal government's Marketplace until 2015.) Again by email, Ms. Charlow said, "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."
    Given that the security of the marketplaces and the data they will be collecting has been called into question in recent months, the revelation that not only will the exchanges be collecting personal and health information on individuals but financial information as well to facilitate payments could give rise to further concerns.  An email inquiry to Ms. Charlow regarding methods of payment to be available on the Maryland Health Connection (credit card, debit, check) has not yet been answered.
    Although the operation of the Maryland marketplace likely mirrors the operation of other state-run exchanges, not all states are operating their own marketplaces.  The federal government will be operating marketplaces for the non-participating states through the Healthcare.gov website.  Earlier in the month, THE WEEKLY STANDARD reported on a no-bid, emergency contract awarded in August to a Pennsylvania firm to provide a "financial management services system" for the Centers for Medicare & Medicaid's (CMS) operation of the marketplace.  The award noted:

With the impending and mandated October 1, 2013, Marketplace enrollment and January 1, 2014 go-live deadlines nearing, CMS' need for contractor-provided financial management services has reached an unusual and compelling level of urgency. The prospect of a delay in implementing the Marketplace by the operational date of January 1, 2014, even for a few days, would result in severe consequences, financial and other. 

    The contract description of the services required included accounting, printing and mailing, tracking of accounts receivable and accounts payable, documenting funds collected by CMS, data validation, debt management functions, and referral of debt to the Department of the Treasury, among others.  When inquiry was made to CMS about how these services related to the function of the federal Marketplace, particularly relative to transactions between consumers and the Marketplace, Richard Olague of the Media Relations Group for CMS replied via email on Tuesday, September 24, "We’re working on getting you more information."  No additional reply has been received as of this time.
    A single-payer national health system has been discussed for decades, but has never gained much popular support.  The structure of the state-run marketplaces, and possibly the federal marketplace, would go a long way in smoothing the path to such a system.  Businesses who use the exchanges will soon be remitting payments to the government for health insurance coverage, and even individuals will apparently have that option for the initial payment on their new policies.  The government already runs huge health insurance programs (Medicare and Medicaid), and the number of persons insured by Medicaid is expected to expand dramatically under the Affordable Care Act.  With more and more persons insured through the government and a growing number remitting payment for insurance through the government, the United States will certainly find itself closer than ever to national healthcare than at any time in its history.


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

Nancy Pelosi Confuses Constitution With Declaration of Independence

    Speaking last Wednesday at the Center for American Progress (CAP), Democratic Leader of the House Nancy Pelosi became a little confused at one point, stumbling over her words and flipping through her notes while referencing one of the founding documents of the United States.  Rep. Pelosi was recalling the early women's rights convention held in Seneca Falls, NY 165 years ago.  The full video is posted on CAP's website, but here is a clip of her remarks:

"And so, it was 165 years ago, 165 years ago.  Imagine the courage it took for those women to go to Seneca Falls and do what they did there, to even leave home without their husband’s permission, or father’s, or whoever  it was.  To go to Seneca Falls, and to paraphrase what our founders said in the Constitution of the United States: they said the truths that are self-evident, that every man and woman, that men and women were created equal and that we must go forward in recognition of that."

    It is of course the Declaration of Independence and not the Constitution that contains the reference to self-evident truths:

We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.

    The website of Rep. Pelosi includes a transcript of the speech that was edited to correct Pelosi's error:

To go to Seneca Falls, and to paraphrase what our founders said in the [Declaration of Independence] of the United States: they said the truths that are self-evident...

    Pelosi went on to name three priorities that she and those in her audience at CAP want Congress and the president to address: paycheck fairness, including raising the minimum wage; paid leave to care for sick family members via the Healthy Families Act; and universal child care.


UPDATE: As I discovered a few hours after this article ran at The Weekly Standard, Nancy Pelosi is not the only Minority Leader of the House to experience confusion over the Constitution and the Declaration of Independence.  None of than Republican House (then Minority, now) Majority Leader John Boehner made the same error back in 2009.


Note: A version of this article (before the update) first appeared at The Weekly Standard.