So sorry -- apologies matter -- Oct. 31, 2013 column

By MARSHA MERCER

In the health exchange website debacle, Washington has moved through denial, anger and finger pointing. Now we’ve hit the apology stage.

On Wednesday, Kathleen Sebelius, the secretary of health and human services, called the online marketplace where people were supposed to be able to compare and buy insurance easily starting Oct. 1 “a miserably frustrating experience for way too many Americans.”

“You deserve better,” she said at a House Energy and Commerce Committee hearing. “I apologize.”

And when the terrier from Tennessee, Republican Rep. Marsha Blackburn, snapped at Sebelius, asking who was responsible for the mess, Sebelius said, “Hold me accountable for the debacle. I’m responsible.”

A day earlier, Marilyn Tavenner, administrator of the Centers for Medicare and Medicaid Services, the agency responsible for setting up the online marketplaces, also apologized.
  

“To the millions of Americans who’ve attempted to use HealthCare.gov to shop and enroll in health care coverage, I want to apologize to you that the Web site has not worked as well as it should,” Tavenner said at a House Ways and Means Committee hearing.

President Barack Obama, while stopping short of an actual apology, has said “nobody is madder than me.” He apparently can’t brake for pronouns at a time like this.

Seriously, the president must be mad at himself for letting this fiasco befall his signature legislative achievement. It’s his legacy at stake. Obama struck a confident note Wednesday in Boston, insisting that the rollout problems are solvable. A lot is riding on whether the website is running smoothly Nov. 30, as promised,

In his speech at Faneuil Hall, Obama sought to clear up confusion about his oft-repeated promise that people could keep their insurance under the new system. Some people who buy health insurance on the individual market have received cancellation notices. Obama explained that a few policies fail to meet consumer protection standards in the health law, but the people will be eligible for better coverage and possibly for premium subsidies.  

Typically, embattled public figures follow the old legal advice to doctors facing malpractice claims: “Defend and deny.” Testifying before Congress, the lawyered-up contractors who engineered the troubled marketplace avoided showing even a smidgen of remorse.  

When a top-level public servant like Sibelius has the wit to apologize and sound sincere, she conveys the sense that she gets it, that she knows real people are being hurt by her agency’s ineptitude.   

Don’t get me wrong. An apology – many apologies -- from Washington won’t shorten anyone’s wait on HealthCare.gov or pay the insurance premium. People want results; they want their government to work.

At the same time, though, people should realize that Obamacare is a moving political target.

“We did not wage this long and contentious battle just around a website,” the president says. As rocky as the rollout of the exchanges has been, the president insists, the Affordable Care Act is already working to make insurance more readily available and affordable. That, of course, won’t satisfy the law’s foes.

Obama repeatedly says he’ll work with anyone who wants to fix the law, but congressional Republicans have no interest in mending it. If it’s not the website, it’s the canceled policies or the cost of premiums or something else. The GOP needs to be accountable too.

Where,Republicans, is your long-promised alternative to the health law? Let us see it – or help fix what’s broken.    

A president saves his apologies for big moments. Obama reportedly apologized to irate German Chancellor Angela Merkel after news broke that the United States had been listening to her phone calls for years. He apologized Oct. 8, during the government shutdown, for the unfolding fiscal dramas in Washington.

“To all the American people: I apologize,” he said, but he couldn’t resist turning the apology into a rebuke, saying what he needs to do is to break his foes of their bad habits in negotiations.  

Speaking of apologies, I’ve yet to see tea party Republicans apologize for shutting down the government or 
sending the world’s blood pressure sky high with games over raising the debt ceiling.

An apology is not a solution, but it is a start. It takes guts to say you’re sorry. Who’ll be next?

© 2013 Marsha Mercer. All rights reserved.

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Battle of man vs. machine hits insurance exchanges -- Oct. 24, 2013 column

By MARSHA MERCER

President Barack Obama has called in the cavalry to fix the health exchange rollout fiasco. He has a new tech czar and “some of the best IT talent in the country” working 24-7 to remove the chewing  gum clogging the system.   

Too bad Obama can’t fix human nature. People naturally resent playing by tech rules, even when it’s in their best interest. More on that in a minute.

Congressional hearings with political overtones are investigating the botched healthcare.gov website. Contractors who engineered parts of the contraption blame each other and the federal government. Republicans, and even a few Democrats, want the head of Health and Human Services Secretary Kathleen Sebelius. She will face the wrath of the House Energy and Commerce Committee next week.

The Centers for Medicare and Medicaid Services, which was in charge of the rollout, went ahead with it despite warnings the system wouldn’t work.

An insurance executive who was involved in an industry testing group told The Washington Post that it was clear a month before the launch that CMS was still working on how the exchanges would handle enrollment, federal subsidies and the security of consumers’ personal information, such as income.

That’s a lot. But the last item -- security of personal information – is most crucial. Millions of people have to give up their birth dates, Social Security numbers, employment and income information to sign up for insurance. For people to sign up, they must be confident the government will keep their sensitive information safe.   

And that leads to another issue. As bad as the tech problems are, the inevitable conflict between man and machine is more troublesome. The insurance marketplaces – like other online accounts – safeguard personal information by requiring customers to answer security questions to verify their identity.

Big problem: Many people are flummoxed by online security questions, The Wall Street Journal reported Wednesday.

Among the questions: What was your high school mascot? Favorite childhood superhero? Street you lived on in third grade?

“I don’t think they took baby boomers into account when they invented those questions,” a 58-year-old massage therapist in Texas told the Journal. Margo Benge said she gave up when she could answer only two of the 12 possible questions – and she needed to answer three.  “I barely remember two weeks ago, let alone childhood,” she said.

And I thought it was just me.

I’ve been resisting online security questions for years. The problem is the questions sound so reasonable.  In what school did you start first grade?

Anyone would know that, right? Not necessarily. An Air Force brat, I went to 10 schools before I graduated from high school. I don’t remember a thing about my school in first grade, except that it was in Germany.

The street I lived on in third grade? No clue. It was in Maryland.

Favorite color? It varies.

Favorite song? Movie?  Ditto. Ditto.

In California, the state’s insurance exchange presents 30 security questions; shoppers must  answer five, the Journal reported. Among them: “What is your significant other’s favorite color?” and “what is your youngest child’s birth weight?” And the ever popular: “What color was your first bicycle?”

These are details a machine can summon effortlessly. It’s not as easy for men and women. Life is messy. Our memories overlap, fade and reconstitute.     

Best friend? Don’t make me choose.

Please don’t misunderstand me. I want websites to do whatever they can to assure privacy. But many web-savvy people say the questions don’t stop determined hackers anyway. Sarah Palin’s email was hacked by someone who found out her birth date, ZIP code and the name of her high school – information that’s widely available on Google and Facebook.

Here’s a solution. Anyone can arbitrarily decide from today forward that he or she had Miss Raven as first grade teacher, lived on Lenore Street in third grade and rode a red bike to Edgar Allen Poe Elementary School.  Stumped by security questions? Nevermore.    

We humans just have to remember what we made up. We can make a note. On paper.

© 2013 Marsha Mercer. All rights reserved.

We all pay for shutdown in dollars and trust -- Oct. 17, 2013 column

By MARSHA MERCER

President Barack Obama says there were no political winners in the crisis over the federal government shutdown and debt limit. Most Americans, regardless of their political persuasion, probably agree.

In Washington, though, every moment has a winner and a loser. Once the latest financial calamity was averted, most political analysts thought the president was a winner because he showed some spine, gave up nothing and kept his signature health care legislation intact.

Conservative Republicans, on the other hand, were losers because they totally misread the political landscape. Their ill-conceived attempt to defund Obamacare shut down the government, idled 800,000 workers for 16 days and hurt the economy – but it yielded only a minor tweak in the health care law. People who seek subsidies to buy insurance on the exchanges will have to provide income verification.

Some tea party Republicans cling to the fig leaf notion that their failed fight over the shutdown actually awakened the nation to the evils of the Affordable Care Act and support will blossom.  Really?  

Meanwhile, every Democrat, Republican and independent coast to coast will pay the cost of the federal shutdown in dollars -- and also in the incalculable currency of trust.

The pricetag of the latest shutdown hasn’t been released, but two shutdowns lasting a total of 26 days in 1995-96 cost more than $1.4 billion, the Congressional Research Service reported. That’s $2.1 billion in current dollars. Most of the money went for back pay for furloughed federal workers.

The dollar waste is unnecessary and maddening. Trust in our institutions and government is in short supply.  

To squander the people’s trust hurts our political system and is heartbreaking.  

“The American people are completely fed up with Washington,” Obama said Thursday.  He’s right, of course, but it would be nice if he or anyone else could say that Washington has learned from its misadventure and will work to rebuild the trust it has squandered. There are only glimmers that some in Congress have learned lessons.   

In reaching the deal, members of Congress did what they should have done months ago. They did their jobs. 

The bipartisan agreement reopened the government and raised the debt limit, allowing the United States to pay the bills it racked up with two unfunded wars and an unfunded Medicare drug benefit. It’s merely a reprieve that postpones the fight. In two months or so, we may face another fiscal crisis. 

The plan Obama signed Thursday funds the government through Jan. 15 and raises the debt ceiling through Feb. 7. On the way there, a bipartisan, bicameral budget conference is supposed to come up with a long-term plan on tax and spending policies by Dec. 13. The two Republicans on the conference committee voted against the bill ending the crisis, and the two Democrats voted for it. That’s hardly a promising sign.

A glimmer of hope is the 14 centrist senators led by Sen. Susan Collins, Republican of Maine, who worked together on an agreement that served as a point of departure for the final deal. The centrists were disappointed their plan didn’t prevail, but they pledge to keep working together.   

The next round of negotiations could take place in an even  more acidic political atmosphere because of the calendar.  

Obama chided Republicans on Thursday, saying, “You don’t like a particular policy or a particular president, then argue for your position. Go out there and win an election. Push to change it. But don’t break…what our predecessors spent over two centuries building.”

Some analysts say the looming 2014 congressional elections could have a sobering effect on conservatives in the House. In most congressional districts, though, a Republican incumbent fears a challenger from his right more than a Democratic one. For most House members, compromise in Washington can be a terrible career move.

Traditionally, people hate Congress but like their own member of Congress. That may be changing. About three in four people said they want to see most members of Congress defeated next year. And about four in 10 said they’d like to retire their own member of Congress, a new Pew Research Center survey found.

It’s very possible that we’ll  lurch once again from one financial crisis to the next. That not only would be a shame but would be a drain on what’s left of trust in government.

© 2013 Marsha Mercer. All rights reserved.

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My latest on aarp.org: http://bit.ly/15J5t25

What You Need to Know About This Year's Medicare Open Enrollment Period

If you have Medicare, you don't need to participate in the new health insurance marketplace

by Marsha Mercer, AARP, October 15, 2013

During Medicare's open enrollment period you can shop for Medicare Advantage and Medicare Part D prescription drug plans, or keep the coverage you have. — Richard Drury/Getty Images

If you’re a Medicare beneficiary, here’s something for your autumn to-do list: Go Medicare shopping.

Subscribe to the AARP Health Newsletter

Review your benefits and costs for 2014, compare alternatives and decide whether to keep or change plans during Medicare’s annual open enrollment period Oct. 15 through Dec. 7.

This year, Medicare’s open enrollment overlaps with open enrollment for the new insurance marketplaces or exchanges created under the Affordable Care Act, also commonly referred to as Obamacare — but don’t let that throw you. Medicare’s 50 million-plus beneficiaries, most of them seniors, will steer clear of the marketplaces.

Got questions? Here’s what you need to know about Medicare’s open enrollment in the marketplace era.

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Q: I have Medicare. Can I use my online state insurance marketplace to compare and buy a Medicare Advantage, supplement or prescription plan?

A: No, the marketplaces (also known as health exchanges) are not for Medicare beneficiaries. They are mostly for uninsured Americans and do not offer Medicare Advantage, medigap supplemental policies or Part D prescription plans. Medicare is not changing because of the marketplaces. For a medigap or Medicare Advantage plan, consultwww.medicare.gov.

Q: What if I mistakenly sign up for insurance on the marketplace, will my Medicare coverage be automatically canceled?

A: No, if you have Medicare coverage, you won’t qualify for insurance on the marketplace. But if you do sign up for a plan accidentally, cancel the marketplace policy.

Q: But I’m a Medicare beneficiary, and someone contacted me and said I could buy insurance through the marketplace. What’s up?

A: It’s illegal for someone to knowingly sell a Medicare beneficiary a marketplace plan. Watch out for scammers during open enrollment. Do not share your Medicare number or personal information with anyone who says he or she can sell you a plan through the marketplace.

Q: Can I get the premium tax credit that people get when they buy insurance on the marketplaces?

A: If you’re enrolled in Medicare, you’re not eligible for the tax credits that some people qualify for on the marketplaces, but you already get a substantial break on costs. The overall costs of care under Medicare Part B, which pays doctors’ visits, and Part D, the prescription drug benefit, are subsidized 75 percent from federal general revenues. Plus, if you’re a Medicare beneficiary with limited resources and income, you may qualify for low-cost Part D drug coverage under the Extra Help program. Go to www.ssa.gov, call 800-772-1213 or visit your local Social Security office.

Next page: More about Medicare and the health insurance marketplace. »

Q. I’ve just become eligible for Medicare, but I haven’t signed up yet and haven’t started collecting Social Security. Can I choose coverage on the marketplace instead of Medicare?

A. Yes, but be aware that if you fail to sign up for Medicare during your initial seven-month enrollment period — the three months before the month you turn 65, your birthday month and three months after your 65th birthday — you may have to pay a late enrollment penalty for as long as you have Medicare. Also, if you don’t enroll in Medicare Part B during your initial enrollment period, you can sign up only during what’s called the general enrollment period — Jan. 1 through March 31 — and your coverage won’t begin until July of that year.

More Medicare

• Money-saving changes come to Medicare
• What's the "Medicaid expansion"?
• The health care law and Medicare
  
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Q: I’ll turn 65 next year and will become eligible for Medicare, but I don’t have health insurance now. Can I use the marketplace?

A: Yes, you’re uninsured and can buy a plan on the marketplace now that will be effective Jan. 1. Once you receive Medicare coverage, you should cancel the marketplace plan.

Q: I’m 65, a legal immigrant with a green card and have lived in this country for three years. Can I get Medicare coverage?

A: No, Medicare requires that you have lived in the United States continuously for five years. You may qualify for a health insurance plan on the marketplace, which does not have a residency waiting period.

Q: I’m 65 and Medicare-eligible, but I’m still working and covered by my employer’s health plan. My employer says she may terminate the company plan next year. What are my options?

A: If you didn’t sign up for Medicare Part A or Part B when you were first eligible because you were covered by a group plan based on current employment — yours or a spouse’s — you can sign up for Part A or Part B (or both) anytime you’re still covered by the group plan or during an eight-month period that begins the month after your coverage ends.

Q: I’m eligible for Medicare but didn’t sign up on time, and I haven’t bought insurance through the marketplace. Will I have to pay a fine?

A: Yes, if you’re uninsured and don’t qualify for an exemption to the requirement that everyone carry health insurance in 2014, you will have to pay a penalty. Exemptions include being a member of a federally recognized Indian tribe or having income too low to file a tax return.

Q: I have only Medicare Part A. Do I need to buy more insurance to meet the legal requirement that I have insurance?

A: No, whether you’re in a traditional Medicare or a Medicare Advantage plan, you meet the insurance requirement.

Q: I’m 60 and retired, but I’m too young for Medicare. I get my insurance through my former employer’s retiree health plan. Do I need to get additional coverage on the marketplace to comply with the health law?

A: No, retiree plans generally meet the requirement.

Next page: So many choices ... where should you begin? »

Q: What happens during the regular annual Medicare open enrollment?

A: Medicare beneficiaries can change their health and prescription plans for the next year. Changes go into effect Jan. 1. You can: 

• Change from original or traditional fee-for-service Medicare to a private, managed-care Medicare Advantage plan
• Change from a Medicare Advantage plan back to traditional Medicare
• Switch from one Medicare Advantage plan to another
• Switch from a Medicare Advantage plan that doesn’t offer drug coverage to one that does
• Switch from a Medicare Advantage plan that offers drug coverage to one that doesn’t
• Join a stand-alone Medicare prescription plan
• Switch from one prescription plan to another
• Drop your prescription drug coverage altogether

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You can save on vision care, prescription drugs, hearing aids and more

Q: I’m not thrilled with my plan, but there are a lot of choices. Where do I start?

A: Use the Plan Finder tool at www.medicare.gov to compare costs and benefits for each plan available in your area. Details of 2014 plans are available now. If you need personal help, call your State Health Insurance Assistance Program (SHIP). Contact information is at www.shiptalk.org. If you have Medicare Advantage or a Part D prescription drug plan, you should have received a notice of changes for 2014 in the mail. It will tell you whether your premiums, deductibles, copays and benefits will change next year.

Q: Can’t people change their Medicare coverage later than December?

A. Yes, between Jan. 1 and Feb. 14 every year, people with Medicare Advantage plans can leave their plans and switch to traditional Medicare, if they choose. In specific circumstances, such as a move, people can change Medicare coverage anytime.

Q: I’m happy with my current Medicare choices. What do I do during open enrollment?

A: Not a thing. Your current choices will continue next year.

Q: Where can I find more Medicare information?

A: For enrollment information, go to Social Security’s website, www.ssa.gov or call 800-772-1213. For coverage information, go to www.medicare.gov or call 800-MEDICARE (800-633-4227).

Marsha Mercer is a freelance writer in the Washington, D.C., area who covers health policy.

History says Obamacare may yet thrive -- Oct. 10, 2013 column

By MARSHA MERCER

The new health benefit got off to a rocky start. Complaints about long wait times were flying, and politicians wanted to ditch the law.  

“Any time Washington passes a new law, sometimes the transition period can be interesting,” the president said.

“That,” The New York Times reported dryly, “was something of an understatement.” 

But it wasn’t President Barack Obama, responding last week to complaints about overwhelmed servers and long waits to access the new online marketplaces to buy health insurance under the Affordable Care Act.

It was President George W. Bush in March 2006, trying to defuse anger over a new prescription drug benefit for seniors, known as Medicare Part D. Democrats and seniors hated it.

“This is lousy legislation,” then-Sen. Tom Daschle, D-S.D., declared when Bush signed the major new entitlement in December 2003. “We may spend the rest of our careers repairing the flaws of this bill.”

Sen. Ted Kennedy, D-Mass, thundered at a rally against the drug benefit:  “Who do you trust? The H.M.O.-coddling, drug-company-loving, Medicare-destroying, Social Security-hating Bush administration? Or do you trust Democrats, who created Medicare and will fight with you to defend it – every day of every week of every year?”

The week Bush signed the prescription benefit, only one in four seniors approved.  Republicans and Democrats were – surprise! -- polarized. Forty-nine percent of Republicans approved and 52 percent of Democrats disapproved, according to an ABC News-Washington Post poll. 

Nearly 10 years later, you’d hardly know anyone ever objected to the prescription benefit.

It’s optional, but nine in 10 seniors choose it. Of these, 90 percent say they’re satisfied with their drug coverage and 60 percent are very satisfied, according to a survey commissioned by Medicare Today, an industry group.

So what does all this say about today’s political flashpoint – Obamacare? It likely is on more solid ground than you might think, despite House Republicans’ dozens of votes to repeal it and multiple proposals to defund or delay it.   

Only about one in three people has a favorable opinion of the health law – far from a ringing endorsement. But when you think that only one in four seniors approved of the drug benefit, one in three is not so shabby.

Plus, while those who think Obamacare goes too far make the most fuss, about 7 percent of those who disapprove of the health law think it didn’t go far enough. There’s still support for a single-payer system.

   

Even its most devoted critics concede that once people actually see the Affordable Care Act in action, they’ll really like it.  

In July, Sen. Ted Cruz, R-Tex., told Fox News, “What the administration desperately wants is to get to January, to get the exchanges in place…they want people hooked on Obamacare so it can never be unwound. If we’re going to repeal it, we’ve got to do so now or it will remain with us forever.”

Cruz persuaded his House colleagues to shut down the federal government in the erroneous belief that Obama would cave on Obamacare. Republicans succeeded in shutting down the government, but funding was already in place for the rollout of Obamacare. Open enrollment began as scheduled Oct. 1.

Republicans have backed off repealing and defunding Obamacare, although they’d still like to delay it.

Obama insists that one day his signature health law will be as beloved as the Medicare drug benefit. As even Cruz indicated, it’s hard to see how Congress can take back health insurance after millions of Americans with pre-existing conditions get coverage starting Jan. 1.

Ironically, the government shutdown Cruz and others orchestrated has given the exchanges breathing room. The shutdown is more newsworthy than computer problems plaguing the rollout.

The glitches don’t get the media scrutiny they would if the marketplaces were the big news story in town. 

The Obama administration talks about the millions who have gone on the marketplaces, but it has not said how many people have been able to close the deal and buy insurance so far. Open enrollment continues through March 31.  

As another president once said, “Any time Washington passes a new law, sometimes the transition period can be interesting.”

© 2013 Marsha Mercer. All rights reserved.

It's time for two 'dirty' words: compromise and negotiate -- Oct. 3, 2013 column

By MARSHA MERCER

A few hours before the federal government pointlessly shut down for lack of a budget, President Barack Obama called House Speaker John Boehner.

   

“I’m not going to negotiate,” the president said Monday night, according to Boehner’s account of the conversation. On the House floor, Boehner even regaled his pals with a poor imitation of the president’s “I’m not going to negotiate.”

As bad as the shutdown is, the real crisis could come when the United States reaches its limit for borrowing money Oct. 17 and faces a default on some of its debts.  Republicans are insisting on spending cuts or entitlement reform equal to the amount of the increase in borrowing authority. The White House feared that if it started negotiating now over the budget, it would be weakened in the coming fight over the debt ceiling.

For his part, Boehner pledged to Republicans last January that he would not negotiate one-on-one with Obama ever again. Boehner felt heat from tea party members, who see compromise as caving, pure and simple.  Plus, he felt the White House mistreated him after he attempted to reach a grand bargain on deficit reduction in 2011 and 2012.

So here we are. The country’s most powerful Democrat and Republican refused on principle to negotiate, the federal government ground to a halt for the first time in 17 years, and the worst is yet to come.

Whether you believe Obama or Boehner is right, something is very wrong when both parties dig in their heels and lead the country into a costly, stressful, avoidable crisis. We’re better than that. It’s good that the president finally invited congressional leaders to the White House to talk, but it should have happened sooner.    

Boehner has acquiesced when conservative House Republicans’ claimed compromise by passing bills that everybody knew were dead on arrival in the Democratic Senate. That’s brinksmanship, not compromise.

Obama likes to say that “one faction of one party in one house of Congress in one branch of government” can’t shut the government down. Except that it has. Now what?  

A recent poll indicated that most people prefer a candidate who “stands up for what he or she believes” over one who “compromises to get things done.” But that’s a false, either-or choice. We should have both: principled leaders compromise for the greater good.

New Jersey Gov. Chris Christie is running a new re-election campaign ad around the novel notion that compromise isn’t a bad thing.

“See, I think as long as you stick to your principles, compromise isn’t a dirty word,” Republican Christie says in the ad. He insists that his every accomplishment as governor has been the result of bipartisanship.

New Jersey has a strong Democratic base, which requires bipartisanship. In the U.S. House, though, because of the way districts are drawn, lawmakers need to appeal only to like-minded constituents. There’s little, if any, upside to cooperation.  

With neither side inclined to budge, we’re stuck. But what would happen if Obama and Boehner called in a true negotiator to break the impasse?

They could agree to listen to someone like Kenneth Feinberg, who has been the go-to mediator of compensation for victims of almost every major disaster in recent American history. Feinberg negotiated settlements for the victims of 9/11, the Virginia Tech shooting, the BP oil spill in the Gulf of Mexico, and the shooting victims in Aurora, Colo., and Newtown, Conn.  He most recently has been negotiating payments for victims of the Boston Marathon bombing.

He got his start in this difficult work in 1984 in a case involving Vietnam veterans who suffered exposure to Agent Orange.

  

For anyone who’s sick of business as usual in Washington -- and who isn’t? – it’s intriguing to consider what could happen if someone who cares about fairness, not political gain, was in charge.

As the shutdown began on Tuesday, World War II veterans came to visit their memorial in Washington only to find the memorial closed. Around the country, everyone -- Democrats and Republicans alike --  cheered upon hearing that the old soldiers simply walked or rolled their wheelchairs around the barriers.

What we need now is someone who will remove the barriers between Congress and the president, and get us rolling on the path to a functional government. Calling Ken Feinberg.

©2013 Marsha Mercer. All rights reserved.

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