Health Industry Expert Offers Obamacare Status Report


It isn’t only politicians and pundits who are making their opinions known about the Affordable Care Act — health industry experts are sharing their views on the health care law, as well. Robert Laszewski is the president of Health Policy and Strategy Associates Inc., a health consultancy that assists its clients understand changes in policy. Laszewski recently discussed the issues of Obamacare with the Washington Post’s Ezra Klein.

First, Laszewski identified a few technical problems that remain with the exchange website.  The front-end of is finally where it should have been in October, Laszewski said, but the back-end remains a cause for concern. “Clearly the administration put its emphasis on the consumer side,” he told Klein. “Insurers are still seeing errors in probably 5 percent of the files coming through.”

This is a problem that has grown, as enrollment swelled in the final days of December, and it will probably not be sorted out completely until the end of January. Another issue, Laszewski said, is that there is “no computerized check between who thinks is enrolled and who the insurance industry’s computer systems think is enrolled.” This means that officials in the government, and the insurance industry need to manually reconcile the files.

However, all of that will not matter if people do not start paying. ”I was surprised today calling around to people to find only about 50 percent have paid,” Laszewski said, per the Washington Post. He does not believe that this is “a reason to panic yet,” because of the fluidity of due dates recently. It is important though, because Secretary of Health and Human Services Kathleen Sebelius said in her December testimony that reports about coverage cannot start until payments are processed.

When asked about who had enrolled so far, Laszewski confirmed the idea that so far, sicker Americans have enrolled. “It’s not positive,” he said to Klein. “I don’t want to say people have given up on the notion they’ll get a good mix. They know the administration will make a big push. The insurance companies will spend big on advertising and outreach. So no one has given up. But it doesn’t look good right now.”

He added that the notion of young people signing up for coverage will make or break the law needs to be dispelled. It isn’t about young people — it’s about healthy people, Laszewski said. But even more so than healthy people, enrollment generally needs to increase. “We only have about 10 percent of the uninsured in here,” he told the Post’s Klein. ”Insurers think you need more like 70 percent of a pool of people to sign up.”

Laszewski’s overarching concern is that people will not see the worth of the Affordable Care Act. The high deductibles and media attention that surrounded the debut have contributed to a negative view of the law. “I am really concerned that the uninsured who are healthy are not finding Obamacare the value they hoped it will be. That’s the real risk for Obamacare,” Laszewski said, per the Washington Post.

This concern impacts how many people sign up, whether the penalty is paid by those who do not, and a host of other issues, but it is not  the fundamental problem with Obamacare; according Laszewski, that is the fact that the health care reform law is “product driven and not market driven.”

Laszewski discussed with Klein that if an entrepreneur had created Obamacare, that person would have consulted an average, middle-class family to see what was desired in an insurance plan. The points he made are related to other recent calls for private sector solutions. In December, Reuters reported that some in the Democratic Party wanted a CEO to be in charge of the marketplace. Prior to that, Ezekiel J. Emanuel penned a column for The New York Times in which he called for “a new position: an independent chief executive of the federal exchange.”

“They didn’t ask the customer what they wanted. And I think that’s the fundamental problem with Obamacare,” Laszewski said in his interview with Klein. “It meets the needs of very poor people because you’re giving them health insurance for free. But it doesn’t really meet the needs of healthy people and middle-class people.”

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