Obamacare Report Card: Califorina Gets A+ While Florida Fails

Obamacare Report Card Califorina Gets A+ While Florida Fails

You thought Senator Ted Cruz was a problem. Well, he is only one among many clouding successful nationwide Affordable Care Act implementation. A handful of states are obstructing Obamacare’s implementation — and sabotaging enrollment for the nation’s 32 million uninsured. Alas, tech glitches still persist.

Ah, real-life stories. God love ’em. I recently read about a Paul Sullivan in The New Yorker, a Texas sweetheart of a fellow in his 50s with a college degree, a small business, three cars, a house … and no health insurance. Before long, a sickness caught him, as those sneaky buzzards will. Medical bills for hospital stays and precancerous-lesions treatment rapidly piled high, overwhelming the man. There went the cars, and eventually the home. Sullivan wound up in a homeless shelter, alive but at zero. The Affordable Care Act was designed to keep such tragedies from happening. But Texas is a “Fail” in terms of health-care reform. Its refusal to accept Obamacare funds to expand Medicaid will leave more than 1 million of its poor without access to health insurance, according to a new report from Kaiser Commission on Medicaid and the Uninsured, reported Bloomberg.

So, we have California and New York making a real effort to inform citizens, implement the law, and enroll people for health insurance.


Then we’ve got the obstructor states, including Indiana, South Carolina, Texas, Utah and more, that are obstructing and sometimes flat out sabotaging Affordable Care Act implementation.

Star Pupil

Back to California. A++. You are a model state! (Yes, we are pardoning you for having to pull your online directory of medical providers because we trust you’ll restore it quickly.) Billboards. Radio ads. TV commercials. Outreach teams. Enrollment specialists. Your state, home of the largest state-run health insurance exchange, Covered California, is shelling out a whopping $94 million to reach and help enroll your 7 million uninsured citizens (an estimated 15 percent of the nation’s total uninsured), according to The New York Times, and the Obama administration also coughed up an additional $910 million for the cause.

It paid off. Cali-citizen demand for health insurance via the exchange skyrocketed, far exceeding expectations. In Covered California’s first five days, 16,000 applications were completed, which would cover nearly 30,000 adults and children, and an additional 27,000 applications were in the process of being completed (not clicks, not scrolls, but filled-out applications), reported the Times.

Perhaps you, Cali, can put a call into Florida, Indiana, South Carolina, Tennessee, Texas, Utah and their cronies, all of whom are failing the Obamacare rollout.

Peter Lee, Covered California executive director, emphasized to the Times that numbers will be updated weekly in an effort to defeat the “continued drumbeat of doubters and misinformation.”

3 Main Obstruction Tactics Blocking Obamacare Enrollment

In that recent New Yorker articled penned by that ultra-impressive surgeon-journalist-multitasker Atul Gawande, M.D. (@AtulGawande), three main methods of obstruction to the Affordable Care Act (aka Obamacare) law were highlighted:

1. Thanks, but no thanks. We don’t want and won’t take your stinkin’ Medicaid assistance money: 26 states (as in half the nation) have refused federal funds to expand Medicaid and help millions of Americans who need and want health insurance, despite the savings to state budgets.

2. Refusal to cooperate. Certain states refused to build, operate and run their own marketplace exchange website to display health insurance options and take enrollments, depending instead on the federal government to reach their citizens through the fed-operated Healthcare.gov, the site pummeled by demand and severe tech malfunctions. The site Congress had initially tied up funding to.

3. Trickery, sabotage and delay tactics. Several states have put into effect odd rulings that prevent people who need assistance to understand health-insurance information and options from getting it. Under the Affordable Care Act, states must establish “navigator” programs to help people understand their health-insurance options and enroll. To counter this, 12 states passed measures forcing strict requirements on health exchange “navigators,” including licensing exams, heavy licensing fees and insurance bonds. Tennessee created and enacted an emergency rule that any person described as an “enrollment assistor” has to be fingerprinted and complete 12 hours of coursework as well as a criminal background check.

Florida’s Foibles

Now, let’s look at one of the main obstructor states: Florida. We need to talk. You have some 3.5 million uninsured citizens in your state — you’re number two in the country for most uninsured citizens. Yet, it seems you are putting policies into effect that are obstructing health insurance enrollment via the marketplace exchanges.

You opted to reject the law and not build your own marketplace exchange site, forcing instead the federal government to reach and assist your citizens through Healthcare.gov.

We all know the tech troubles and glitches the fed-run exchange continues to have (CGI, here’s looking at you) — so much so that Kathleen Sebelius, secretary of the Department of Health and Human Services, is being pressured by some Republicans to resign though she’s holding strong. (Interesting tactic, no? Have them, as in the federal government, build and operate your health-care exchange site so you can reserve your energies for attacking it). Still, something did go terribly wrong because Massachusetts’ exchange, which Obamacare is based on, has been making its site work successfully some seven years. People going to Healthcare.gov to enroll, or even to scroll options, have too often been unable to complete even step one, which is to create an account. They have been plagued with annoyingly long waits and patronizing “please wait” messages. Even when info is diligently typed into online forms, it can vanish in a flash, not to be found again (poof! Better luck next time). 1-800 support phone numbers have failed. Online chat sessions do not work.


Many who most desperately need health insurance have had to take time off work to see health counselors (found at community health centers) who can explain coverage options — when they can find them, but they too ran into the same discouraging roadblocks trying the site, the help line, the online support chats. So frustrating are these delays that many stop going back and trying; some simply won’t have time to keep making attempts and counselor appointments. The state would not be sad about those dropouts one bit.

Florida, like 25 other states including Alabama, Louisiana, Mississippi, South Carolina and Texas, has also refused federal funds (in Florida’s case, $51 billion) to expand Medicaid for the state’s poor over the next decade. According to the law, federal funds would have paid all costs for three years, but then would have cut back to 90 percent, leaving the state to pick up the rest of the tab. No thanks, said Florida legislators and their pal rejector states.

For the record, the government is not off the hook here. Among those uninsured in Florida, 35 percent are Hispanic. And yet, launch of the Spanish version of Healthcare.gov was postponed until Oct. 21 (but CuidadoSalud.gov did go live today, so, Andale, mis hermanas y hermanos!).

Floridians who hold on and are persistent should be rewarded. Floridians should have some 100 options to choose from and, according to a Times estimate, more than half of Florida residents eligible for health insurance through the federal exchange should be eligible for subsidies that will reduce out-of-pocket costs (this Kaiser subsidy calculator estimates eligibility). On an article from Kaiser Health News a reporter wrote that it took 17 days and 63 attempts to create an account — which is, atrociously, step one of the four-step enrollment process. Fail. A commenter on that site, did however leave this silver-lining note of encouragement for the frustrated: “Account #5 worked like a charm. When I finally could see the plans, I was pleased to see the low prices here in Florida.”


The big question now is whether a nonprofit serving all Americans, such as a ProPublica, will be able to step in to help people in non-cooperative states get the information and navigation support they need to understand and weigh health insurance options. Will these groups even be able to infiltrate the obstructions themselves in order to reach people who need help?

If you know a family member or friend in an obstructive state, encourage them to be persistent and to not give up — to keep going back to their exchange (be it state-run or federal-run) until they can successfully enroll. Remind them that they have until Dec. 15 to enroll for health insurance starting in January 2014. Two and many more can play at these games.

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