• Part D lends perspective to the exchange rollout

    I’ve generally refrained from joining the rampant speculation about the launch—and attendant glitches—of healthcare.gov. I know my limitations: I mostly stopped toying with web development when I was about thirteen and decided CSS was hard. I have zero expertise to judge the quality of IT infrastructure, and it looks like critiques to date may not be especially substantive. What’s more, HHS probably won’t offer actual enrollment numbers (for federally-facilitated exchanges) until next month, which just leaves us with tedious and clumsy traffic stats to pick apart. That’s hardly fun, and it’s not a particularly productive use of time.

    But Jack Hoadley, a health policy analyst at Georgetown, asked a question that warrants attention: how did the rollout of exchanges compare to the rollout of Medicare Part D? As Sarah Kliff reported in June, the Medicare program was even less popular  than Obamacare when in went live in 2005. People don’t still talk about Part D’s glitches—but they happened. Hoadley quotes a critical news story from its launch, then adds:

    Based on the Medicare Part D experience, we can experience some decline in interest in the health insurance marketplaces after this first week.  But there should be steady volume of website use, phone calls, and visits with counselors throughout the fall.  Medicare Part D then experienced another surge of interest as the December enrollment deadline for coverage to begin on the first of the year.

    Glitches continued with the Part D website and call center throughout the open enrollment period.  But the program added both phone lines and customer service representatives and implemented other upgrades over the weeks.  The website – both its functionality and the accuracy of its information – was the source of ongoing frustration for its users, but it did get better over time.

    By the end of open enrollment in May 2006, over 16 million successfully enrolled for drug benefits in Part D (not counting another 6 million automatically enrolled as a result of participation in both Medicare and Medicaid).  Initial glitches did not deter their enrollment.  And today, Part D enjoys widespread popularity.

    The exchanges’ rocky first week doesn’t set me on edge. The infrastructure itself is a pretty ambitious technological feat and October 1 was a “wholly arbitrary” date selected by HHS for launch (not a legal deadline). It’s a good sign that they have scheduled a bit of downtime this weekend—that means there’s a game plan to fix the problems.

    If the kinks haven’t been ironed out substantially in the next couple weeks, I’ll start worrying. Until then, I’m going to keep calm and remember Part D.

    Adrianna (@onceuponA)

    • One major difference between the two roll-outs, however, was the ability to view available Part D plans without requiring registration, i.e., entering one’s zip code and seeing available Part D plans was and remains an option with the medicare.gov website. I’m not seeing that same functionality on either the Federal Marketplace or the one state (KY) where I’m trying to secure information for a family member.
      I’d propose that this option be added to at least the Federal site and also that HHS consider extending open enrollment by whatever period of time it takes for the Marketplace to be fully functional. For the latter, I’d point to one “fix” that HHS employed; I know of several individuals whose Medicaid drug coverage was extended in spite of the Part D provisions prohibiting Medicaid from paying for medications.

    • California’s web site doesn’t require registration to see information.
      You do have to enter your zip code so they can show you plans in your area. You can also enter income information to see if you’re eligible for subsidies.

    • The nattering about the health exchange flaws reminds me of that quote from the master Yogi Berra: “”Nobody goes there anymore. It’s too crowded.”

    • Hate to quibble – but Part D was 7 years ago…

      Technology HAS advanced a lot since then and there was a LOT of time to get this done – and right…

      And I am not sure if Part D is as popular as you suggest…

      But then maybe that makes me the Lonely Contrarian 😉

      One thing I think we will see fairly soon is some third party survey data on enrollment….

      Did you enroll?
      Did you try?
      Reaction to rate?
      Rate compared to prior insurance – if any
      Rate compared to expectations

      I would guess Gallup is already working on something like this…

      • Yeah, and if it was “done right” with ample staff, time, resources, etc., then you’d have people complaining that too much taxpayer money was spent to fix it up all fancy or whatever.
        There really wasn’t a way to win here, I’d say.

        Take a look at the Pennsylvania Career Link job search site, if you really want to see an EPIC FAIL.
        You’re probably more likely to find a job by sending your resume out into the supermassive black hole at the center of the galaxy. And the effort would at least have a chance of indirect technological advancements.
        And that’s been like that for 5 years at least.
        Probably for the best PA didn’t set up their own exchange.

        Anyway, in regards to rates…
        I’ve looked at the rates for my county/state, listed on the link provided here.
        Yes, they look to be better than I would’ve expected, based on what I know of the individual market in recent years, as well as what I have known small businesses to pay in recent years.
        With subsidies for those of modest income (like myself)… I would say that a lot of people may find it affordable to get insurance.

        A few months ago I was not so sanguine.
        Since seeing the premiums listed, I’m more cautiously optimistic than I was a few months ago.

        Though I should mention that PA is supposed to be among the top 10 most affordable rates in the exchanges, from what I read.
        As it happens, there are quite a few regions of PA that have a fairly low cost of living, so I imagine that’s why. To balance it out, said regions also offer low wages and high unemployment.

        As for the popularity of Plan D… maybe “popular” is not an accurate word. But “better than nothing” comes to mind.

    • “And today, Part D enjoys widespread popularity.”

      Why shouldn’t Part D be popular? How is Part D paid for?

      13% monthly premiums
      73% from general federal revenue
      14% from state patents and interest


      I would be exceptionally happy if the bank got me such a deal on my home.