On the Third Hand: The 3 Rs

That's a set of HHS regulations that, among other things, affects what happens if some health insurers end up with a lot of sick people and some with a lot of healthy people. The insurers with the healthy people are supposed to somehow send cash to the insurers that end up with a lot of sick people (or successfully pretend that they insured a lot of sick people).

This could affect the flow of a lot of money, and whether the exchange plans really kind of work or don't work at all.

I did my best, figured out one toenail on one leg of that complicated elephant, and wrote about that toenail, to try to at least give readers an idea about whether they ought to read the regs. But my editors look at me funny when I try to write about the risk program elephant, and I know they'd really prefer that I write about some new funny problem with HealthCare.gov. (Maybe some problem with the questions about whether you or your relatives have been in jail lately.)

On the one hand, if PPACA World really starts up in 2014 and operates more or less as required by PPACA, layfolks, and people in the insurance community will depend on people at HHS and other federal agencies to run that complicated risk management programs in good faith, with some reasonable level of disclosure, and not just make risk program payments flow in a way that looks pretty on a PowerPoint slide.

If we can't count on HHS to give us basic estimates of, say, how many people have tried to use HealthCare.gov to sign up for exchange plans in Texas or Florida — which is something we can at least start to figure out for ourselves — how can we count on HHS to be reasonably candid and competent when it comes to the much more abstract, much more contentious and, I suspect, much more complicated risk management programs?

On the other hand, Republican opponents of the exchange have certainly pounded HHS in an obnoxious way that's all but forced the department to lawyer up and defend itself by having lawyers do their best to remove any possible bit of information from any sentence that an HHS official utters.

But, on the third hand, if HHS officials would just be a little bit candid about what's going on with PPACA, maybe they could at least convey the idea that HHS officials are capable of having information in their heads. Maybe that by itself would elevate the level of discussion. 

See also:

• On the Third Hand: Make a deal
• On the Third Hand: California
• On the Third Hand: The doers