LTCI Watch: Public option

I figured out a Rube Goldberg method to get early 2017 Patient Protection and Affordable Care Act (PPACA) public health insurance exchange plan filings for many states out of government databases.

At least, this year, I can get some of the early flings, but the process takes a long time. I'd need to give up all my other work to go through all of the databases every day. Even the thought of it makes me tired.

Meanwhile, I've been reading public comments under some of U.S. long-term care (LTC) system reform articles that I've done and other articles I have written.

Commenters who love the government have converged on the hope that Bernie Sanders will get us single-payer everything for everyone. Single-payer health care? Yes. Single-payer long-term care? Sure. Single-payer bowling? Why the heck not? (But maybe the shoes will still be bad.)

Commenters who hate the idea of government involvement, just hate it! (Although, interestingly, the remaining private stand-alone LTCI issuers seem to be noticeably warm toward the idea of public-private partnerships.)

Meanwhile, over in PPACA land, we have the usual stadiums full of people who sputter at the mention of Obamacare, either because it's "Communism," or because it's not "Communism," darn it.

The moderately Democratic supporters in the middle point shyly to the dramatic improvement in the uninsured rate between 2013 and today, especially in the states that took that "free" PPACA Medicaid expansion money from the federal government.

Fair enough.

Even in the states that did everything they could to support PPACA, the improvement in the uninsured rate may not be what some had hoped, but it's big. That's something. Plenty of people will buy major medical coverage with a low out-of-pocket premium, if it's marketed heavily.

But what's noticeable, beside the random dribble of 2017 filing information, is the lack of any effort whatsoever by anyone to tell me how much the PPACA coverage expansion programs have cost per newly insured enrollee.

Is the government really, truly – when you include all of the subsidies for individuals and exchange programs — spending an extra $1,000 per new enrollee? Or perhaps $5,000? Or maybe $20,000?

Maybe the number is buried in a Congressional Budget Office (CBO) report, but I haven't been able to find it. Even if the CBO can give me that number: Can it tell me how much PPACA mandates are costing individuals and employers per enrollee?

And, to be fair, will the CBO, or some other entity, analyze how much society is saving per enrollee – or per newly insured enrollee – on the improvement of their access to health coverage and health care? Getting good numbers on any monetary savings and improvements in quality of life resulting from coverage expansion will take time, of course, but those numbers are as interesting as the cost numbers.

Perhaps just as important: Will the Centers for Medicare & Medicaid Services (CMS) or other entities at the U.S. Department of Health and Human Services (HHS) ever get in the habit of presenting information, of any kind, in such a way that a "lay reader" — without a data scientist on retainer — can easily compare how indicators changed between the latest available data year and the previous year?

One of the roots of the current world retirement preparation crisis, including the U.S. long-term care (LTC) planning crisis, is people's failure to look hard at key numbers, look at how numbers were changing over time, and understand what might happen if the optimistic assumptions embedded in forecasts turned out to be wrong.

We as a society flunked the Common Core math analysis standards.

Given what an opaque mess of information PPACA World is, and how unwieldy the major Medicare program databases are, the idea of letting CMS try to set up a Medicare Part E Long-Term Care program seems absurd. CMS would just deflect our questions about, "Is that program solvent?" with 10-megabyte spreadsheet files that look classy but don't really answer the question.

If Covered California or Connect for Health Colorado wanted to try to start a Medicare LTC program: Well, who knows if they can do it, but at least they know how to post board meeting minutes, and spreadsheets that show how interesting indicators have changed between 2015 and 2016. That's something.

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LTCI Watch: Public option

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