Perhaps the Obamacare system can best be summed up by this epigram from 19th-century French novelist Jean-Baptiste Alphonse Karr. Plus ça change, plus c'est la même chose, Karr observed – the more things change, the more they stay the same. No other government program in recent memory has had more problems, fewer solutions, and the amplification of the issues that legislators intended to resolve than the Affordable Care Act and HHS’ management of the system.
Two developments in recent days make that more apparent than ever. The first involves the troubled federal exchange system, and the continuing incompetence of HHS in providing effective management. The General Accountability Office (GAO) conducted a “secret shopper” study of Healthcare.gov. The agency enrolled 12 fake identities in health care plans through the exchange, either on line or by phone. Eleven of the fake identities qualified for subsidies, with the system unable to detect fictitious or fraudulent documentation submitted to HHS to substantiate eligibility for seven of the eleven.
If this sounds familiar, it should. GAO actually started this test in early 2014 for the 2014 cycle. The agency reported the results to Congress almost exactly a year ago. The other part of the secret-shopper test could not be completed at that time, GAO reported, because when their investigators made six attempts at registering new fake enrollees, they could not get in-person assistance.
Congress demanded answers at the time, and HHS pledged to do better. "We are examining this report carefully and will work with GAO to identify additional strategies to strengthen our verification processes," administration spokesperson Aaron Albright told Fox News.
Not only did HHS fail to make any progress, they didn’t do anything to suss out any of the GAO’s fraudulent accounts that had been opened a year earlier. The Obamacare system automatically renewed all eleven enrollments. The story gets even stranger at this point. Even though the GAO had done nothing with its phony enrollments, Healthcare.gov reported that six of the enrollees had submitted new applications, and canceled their insurance based on a lack of documentation. The GAO investigators supplied new documentation for all six accounts, succeeding in restoring five of them – and getting more subsidies than they previously received.
Furthermore, HHS still does not require its contractors to detect fraud – a year after the GAO exposed the ease in which it takes place. “We found that the CMS document-processing contractor is not required to seek to detect fraud,” the report states. The executives at contracting agencies told GAO that all they are required to do is “determine if the document image is legible and appears unaltered by visually inspecting it.”
Sen. Orrin Hatch pronounced himself “appalled” at the easy way the GAO defrauded HHS, in amounts of approximately $30,000 a year per account. “Bad actors can game the system,” Hatch told ABC News. “It’s an example of gross mismanagement.”
So much for the expertise of government in creating and running an enrollment system. The Obama administration hasn’t done any better in its other goal of driving the cost of care down for American families. Even Slate wondered last week just when the Democrats would start taking ownership of “skyrocketing premiums” in the third enrollment year of the Affordable Care Act. Oregon approved a 25 percent increase from its largest health insurer, and a 33 percent increase from the next largest. BlueCross BlueShield in Tennessee needs a 36 percent increase after getting a 19 percent increase the year before. In my state of Minnesota, BCBS wants to hike rates 54 percent, and 51.6 percent in New Mexico.
At the same time, deductibles have also skyrocketed, leaving people with higher monthly payments and even less ability to access the insurance that those premiums provide. Slate’s Helaine Olen heaps scorn on Obamacare opponents and fails to admit that their predictions of spiraling costs have come true, but she does admit that the system does not work at controlling costs – the most significant reason to have government overhaul the health-insurance system in the first place.
What have we accomplished in the last five years since the passage of Obamacare? We still have roughly the same number of uninsured, estimated to be roughly 30 million people, although the rate of uninsured has dropped significantly. Costs for the insured are skyrocketing, however, and many of the newly insured will find that high deductibles mean they will still have to fund their routine care out of pocket. Provider networks have narrowed considerably, making access even more difficult than before. Emergency room visits for routine care have actually increased. The bureaucracy that runs all of this cannot fix its fraud problem, not even after having it specifically pointed out to them by the GAO and given a year to resolve.
Those who pointed out all of the impossibilities of central planning and control over one-sixth of the nation’s economy may not want to say I told you so. We will just stick with plus ça change, plus c'est la même chose.