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Wednesday, March 26, 2014

Cruising the Web

Another day, another delay. With the deadline for signing up for health care coming next week and Kathleen Sebelius's testimony last week that there was absolutely no way that they would delay that deadline, now we're getting word that they are indeed going to extend the deadline. The Washington Post reports now that they're planning to give extensions until mid-April.
Under the new rules, people will be able to qualify for an extension by checking a blue box on to indicate that they tried to enroll before the deadline. This method will rely on an honor system; the government will not try to determine whether the person is telling the truth.

The rules, which will apply to the federal exchanges operating in three dozen states, will essentially create a large loophole even as White House officials have repeatedly said that the March 31 deadline was firm. The extra time will not technically alter the deadline but will create a broad new category of people eligible for what’s known as a special enrollment period.
Isn't that special? They have a deadline that will be extended on an honor system. What part of this law is actually being enforced as written? Is any of it?

The Post also had this fascinating story this past weekend about how the Office of Personnel Management processes retirement papers for employees of the federal government. Their office is in an old mine in Pennsylvania where they process the pension papers for retirees. Amazingly, they do all this on paper because, even now, they can't manage to get this process done on computers. The federal government just has a lot of trouble with putting their records into computer systems. And lots of regulations and outdated laws make everything unnecessarily complicated and cumbersome.
In New Jersey, for instance, one researcher found that the approval process for a bridge project dragged on for years, in part because officials were required to do a historic survey of all buildings within two miles and to seek comment from Indian tribes as far away as Oklahoma.

In other places, what breaks is the government’s technology.

The rollout of, of course, was ruined by glitches in the Web site, but there are other examples: The Census Bureau had a failed experiment with hand-held computers, then reverted to paper, which cost up to $3 billion extra. The Department of Veterans Affairs had trouble with an online records system and, while they struggled with it, accumulated so much paperwork in one office that auditors feared the floor might collapse.
Reading how the all sorts of federal laws have made the process for retirement unbelievably complicated. And they've tried to place the process online. They tried back in the 1980s and then again in the last decade, but they just couldn't do it.
“Every time we would do what I would call a stress test, we would come up with abysmal numbers — like an 18 percent success rate,” said Robert Danbeck, who was overseeing the project. The root of the problem, he said, was that the system had trouble synthesizing information from so many sources and calculations based on so many laws. “We would go back and look at what caused it, and it was always just so many pieces, trying to tie things together.”

Danbeck quit. In early 2008, the system went live.

Then it broke and was eventually scrapped, after more than $106 million had been spent. In the mine, the files continued to move on paper.

Contained in all those failures, experts say, is a very brief history of the federal government’s recent troubles with information technology.

A recent study by the Standish Group, a firm in Boston that researches failures, found that only 5 percent of large federal IT projects in the last decade fully succeeded.
Well, haven't we seen this play out before our lives with Obamacare. It makes one wonder how well the site is working now despite their claims to the contrary.

And we're not done with stories of technology disasters associated with Obamacare. Stephen Hayes reported a couple of weeks ago about the looming chaos this October when doctors across the land are supposed to have to implement new codes for reporting what diseases or injuries that patients come to them about. The requirements have gone from 17,000 to 155,000 code numbers. This will become crucial because doctors and their officeworkers are going to have to devote a lot of time making sure that they code in the correct code.
It will affect almost every part of the U.S. health care system​—​providers and payers, physicians and researchers, hospitals and clinics, the government and the private sector. That system​—​already stressed with doctor shortages, electronic medical records mandates, and the broader chaos of Obamacare​—​is nowhere near ready. And that has lots of people worried.

Health care professionals use ICD codes to talk to one another. The codes record diagnoses and services provided, and third-party payers​—​government, insurance companies​—​use the codes to determine reimbursements and to deter fraud. Coding errors can mean unpaid claims or costly audits​—​or both.

Virtually everyone agrees that the transition will mean decreased productivity and lost revenue, at least for a time. Some experts, dismissed as alarmists by ICD-10 enthusiasts, are predicting widespread chaos in a sector of the economy that can little afford it.
And doesn't this sound familiar? They haven't tested the system.
But nobody really knows just what to expect. And remarkably, despite the embarrassing failures of, until recently the federal government had no plans to conduct end-to-end testing of the system before the launch this fall.

In a letter to CMS administrator Marilyn Tavenner on February 18, 2014, four Republican senators pressed for comprehensive testing. The senators​—​Tom Coburn, Rand Paul, John Barrasso, and John Boozman​—​are all physicians and expressed deep concern that CMS is planning only one week of “front-end” testing. After receiving the letter, CMS hastily announced that it will offer limited end-to-end testing to “a small group of providers” at some point in “summer 2014” and promised that “details about the end-to-end testing process will be disseminated at a later date.”

That’s hardly reassuring. One health care consultant, a longtime ICD-10 proponent, put it this way: “This is probably going to be the most painful year we’ve seen in the history of U.S. health care.”
Hayes has some fun looking at specificity of these codes. There is even a code for someone who has gotten injured due to "falling or jumping from burning water-skis," even though there is no history of anyone ever having gotten injured from burning water skis. But the government has a code for that.
But woe betide a patient whose doctor's office uses the wrong code.
The introduction of a system with exponentially more codes, and far more complicated codes, will inevitably mean many more coding errors. The default position of payers, whether government or the private sector, will be to deny all claims that are not coded correctly. In many cases, providers will be left with a lose-lose choice: forgo payment altogether or dedicate valuable time and resources to appealing the denied claims. Hospitals, large physician practices, and other big institutions can absorb some of the losses and have the workforce at their disposal to challenge the denials. Small practices do not.

“When you have a provider who hasn’t prepared, who doesn’t know the codes, ​and they have every claim rejected because of improper coding for three months, that’s going to put people out of business,” Boynton tells me over breakfast before the second day of training.

“Most practices in the United States are small businesses,” says Senator Coburn, an obstetrician and family practice doctor from Muskogee, Oklahoma. “This could ruin them.”
So just wait for these stories to come out after October. Of course, the Democrats will tell us that any such anecdotes are all Republican lies.

a new poll out shows that the great majority of Americans have no idea who the Koch brothers are.
A George Washington University Battleground poll conducted March 20-24 and released this morning at a breakfast hosted by The Christian Science Monitor reveals that a majority of likely voters, 52%, have never heard of the Kochs.

One in four respondents, 25%, had a strong or somewhat negative view of the brothers, while 13% had a strong or somewhat favorable view.
As Ed Morrissey points out, this is not surprising. People who aren't political junkies and just don't pay attention.
In other words, this is red meat for the base. Most everyone else could care less, mainly because the “look — billionaires!” scare tactic is so blatantly hypocritical. Republicans used it with George Soros after the trader made public his desire to spend his fortune to keep George W. Bush from winning a second term. Reid and Senate Democrats just hijacked the Senate chamber for an all-night stunt on behalf of billionaire Thomas Steyer’s global-warming agenda without bothering to even propose a single piece of legislation … even though Democrats control the Senate. Republicans haven’t done anything remotely close to that to advance any particular agenda item for the Kochs.
And I would be suspicious of that even 38$ of respondents have any idea of who the Kochs are. Think of all those comedic videos that groups have been doing in recent years when they go around and ask people on the street basic questions about current news whether it be about which movies won the Oscars or who serves in the federal government. For example, check out this video of students at American University right in Washington, D.C. who can't name a single senator or even how many senators there are in the U.S. Senate.

Of course, the media is happy to jump on the "Koch is evil" bandwagon, but, as Mark Hemingway points out, they never seem to be as upset about labor unions spending substantially more than the Kochs.

Of course, all the attacks on the Koch brothers aren't really about persuading the public, but about ginning up donations from supporters.
Of course, the point of the attacks is to raise money for Democrats, and on that score there is some evidence that they have been effective. David Weigel of Slate reports that fundraising emails that bash the Kochs can bring in three-times as much money as solicitations that don't. "The Democratic base, which has been hearing about and fearing the Kochs for nearly four years, responds to this stuff," writes Mr. Weigel.

While most eyes seem focused on the Supreme Court argument in the Hobby Lobby case, there is another case that was heard yesterday in the D.C. Circuit that could be even more damaging to the health care law. Philip Klein summarizes the issue.
At issue in the case are the subsidies that the federal government provides for individuals purchasing insurance through Obamacare. Though the text of the law says the subsidies were to go to individuals obtaining insurance through an “exchange established by the state,” a rule released by the Internal Revenue Service subsequently concluded that subsidies would also apply to exchanges set up on behalf of states by the federal government.
The three-judge panel seemed to be quite divided, as Jonathan Keim reports, but what is amazing is how the Carter-appointed judge seems to think it is no big deal if the administration just ignores the text of the law.
There were plenty of fireworks on the merits. Right at the beginning, Judge Edwards (a Carter appointee) began an aggressive line of questioning pressing appellant’s counsel, Michael Carvin, to explain where the legislative history showed that one of the purposes of Obamacare was to incentivize states to start state-based health-care exchanges. Judge Edwards’s point was apparently that “no one” who voted for the Affordable Care Act intended to encourage states to create health-insurance exchanges. (Which is an odd thing to say, since Congress explicitly created a mechanism to do so.) Carvin could barely get his answers out because of repeated interruptions by Judge Edwards, prompting Judge Randolph to suggest specific examples of the legislative history that Judge Edwards was seeking.

The two other judges, Judges Griffith and Randolph, both Republican appointees, seemed genuinely puzzled by the basis for the government’s interpretation of the phrase, and spent most of the government’s argument trying to divine a coherent interpretive methodology underlying the IRS’s position. Judge Griffith was most pointed in his skepticism, at one point asking the DOJ attorney to parse the phrase “established by the State under [Section] 1311,” which he more or less couldn’t accomplish without compromising his litigation position. DOJ counsel also conceded that the exchange in West Virginia (where one of the appellants lives) was “established by” the Secretary of Health and Human Services, not the State of West Virginia, but refused to concede defeat on those grounds.

Today’s argument acutely demonstrated the dangers (and even absurdity) of broadly purposive statutory interpretation, which is readily susceptible to manipulation of the generality of the purpose. At one point, Judge Edwards claimed that because the statute was entitled the “Affordable” Care Act, the court should construe it so care would be affordable. This problem was even more evident in Judge Edwards’s repeated arguments that amounted to: “Nobody understood Obamacare to create a preference for state-run exchanges, so there is no reason why we should construe the text this way.” But it’s not surprising that there is relatively little legislative history or publicity devoted to the mechanics of a single technical provision of a hulking statute like Obamacare. Members of Congress and its staff are unlikely to generate legislative history interpreting a statute they haven’t read. As we all remember, Congress had to pass the law to find out what was in it.

The more important point, though, is what an “everybody-knew-it-but-nobody-says-it” canon of construction suggests about the law, the courts, and the Constitution. It implies that the role of the judge is to, as Michael Carvin put it, “psychoanalyze” Congress to find out what they did or didn’t know or think. This is especially true for a long, complicated statute like the Affordable Care Act, which typifies congressional sausage-making. There are so many cross-cutting purposes, gambles, tradeoffs, and compromises that for a court to pick a single, broad “purpose” and use it to construe the statute simply ignores all other possible “purposes” that Congress nevertheless enacted into the text of the law.
I love this interpretation that the law is called "Affordable Care Act" so that means its supporters wanted it to be affordable so forget about what is in the text of the law. Think of all those silly names that Congress comes up with. If all we paid attention to was the fluffy name of some law, then expect to get a whole lot more of those meaningless names for bills. In fact, the law in question in the Hobby Lobby hearing yesterday is the Religious Freedom Restoration Act. If you follow Judge Edwards' argument, Congress mentioned religious freedom in the name of the law so of course they wanted religious freedom and that should be enough. End of story. Yeah, sure.

1 comment:

Pat Patterson said...

The WH and enablers are engaging in a game of "...I dare you to cross this line..." and then three or four feet back "Well, I double dare you to cross this line." Truly a moveable feast.