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Understanding Obamacare is a lot harder than reading the law

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Remember when people used to boast about having read the entire Patient Protection and Affordable Care Act?

It was an impressive feat, but it pales beside what would now be required to get an accurate picture of what the law entails. These days, the law itself wouldn't do you much good; it has been almost entirely supplanted by the ongoing flood of regulation and administrative fiat. (In other words, I'm trying to think of some Obamacare detail that hasn't changed from law to implementation, and coming up with the medical device tax -- maybe. If the notable efforts to repeal it don't succeed.)

By "ongoing," I mean just that. Most of the press lately has been about the website and its woes, but that doesn't mean other important details have stopped changing. In case you missed it, on Nov. 26 I wrote about a regulatory proposal to change the reinsurance program payment parameters for 2014, partially because of President Obama's Nov. 14 announcement about the option to renew existing policies.

But that wasn't all the 255-page proposal issued on a holiday week included. There was also a plan to exempt some self-insured group health plans from the last two years of reinsurance fees. It didn't make it into my Nov. 26 article because -- confession alert -- although I read fast, the regulations' length and complexity far outstrip my ability to assess them for the news cycle. Although I do delve into them myself, I rely largely on getting a heads-up from some other poor soul whose job involves staying up all night scouring the Federal Register. And in this case, I didn't see anything on this angle until later.

And now, a short sentence in which I say only, "Here's the angle."

"We propose to modify the definition of a 'contributing entity' for the 2015 and 2016 benefit years to exclude self-insured group health plans that do not use a third party administrator in connection with claims processing or adjudication (including the management of appeals) or plan enrollment," the proposal says. The administration decided against exempting the specified plans from the 2014 fee because doing so without raising the rates on the remaining payers would disrupt the program, it says.

(Background interjection: The $25 billion reinsurance program is supposed to help stabilize premiums for coverage in the individual market from 2014 through 2016, as the implementation of Obamacare mandates significant change to the industry. A $63-per-person fee on major medical plans from health insurance issuers and third-party administrators on behalf of group plans will be assessed in 2014; the proposed rate for 2015 is $44 per person.)

That's the regulatory version. For the fighting words version, I would direct you to this editorial by U.S. Sen. John Thune, a Republican from South Dakota who chairs the Senate Republican Conference. It's titled "Unions Again Seeking Special Favors Under ObamaCare." He's not just railing; Thune has also introduced legislation on the subject.

Then, and I quote, "To circumvent the broken transfer process, the Obama administration agreed Friday to let states use an incomplete set of data — known as a 'flat file' — to enroll people in Medicaid, even though those files lack critical information that states normally use to verify eligibility."

I hope you're counting "thens," because here's another one. As you may have heard in the past two months, insurers reported problems with the 834 forms they were getting from -- what is generally referred to as the back end of the Obamacare website. The administration has said it's working on the problem and has put fixes in place and, in a conference call Monday, said about 80 percent of the problems with 834s was attributable to a single glitch, which has been fixed.

However, here's the thing: Despite concerted journalistic pressing, the administration has, as of this writing refused to provide details about those crucial errors -- how many there were or are, etc. Given that they felt able to quantify that one glitch was responsible for 80 percent of the problems, it seems ... well, let's dive lazily into my email account, where I get candid.

"Appearing to hold back on any info right now is a very dangerous game for the administration," I wrote in one email exchange. "And presumably they know that, which means the numbers must be really, really bad. And if the back end stays that bad, speeding up the front end is a recipe for disaster. I'm betting a lot of them have their fingers crossed right about now."

I should also mention at this juncture that last Friday, America's Health Insurance Plans' President and CEO Karen Ignagni said this: " and the overall enrollment process continue to improve but there are significant issues that still need to be addressed. Until the enrollment process is working from end-to-end, many consumers will not be able to enroll in coverage. In addition to fixing the technical problems with, the significant 'back-end' issues must also be resolved to ensure that coverage can begin on January 1, 2014. In particular, the ongoing problems with processing '834' enrollment files need to be fixed."

To be sure, I think the website is very likely working better today than it was last Friday. But without a more factual, less cagey response from the administration on the back end issues, it's hard to tell whether "better" is anywhere close to "good enough."

* * *

Addendum: Last night The Centers for Medicare & Medicaid Services, AHIP and the Blue Cross Blue Shield Association issued the following joint statement.

"Ensuring that all Americans who need coverage are properly enrolled is a top priority for all of us. We are working together closely to resolve back-end issues between health plans and This is a very focused effort that is being driven by a team of experts from CMS, key outside contractors working closely with health plan representatives and overseen by CMS's general contractor, Optum/QSSI. We will report on our progress."

Make of that what you will.

* * *

On a very different tenor, welcome to the new Surprised and Delighted section of my blog, which will probably appear extremely rarely.

I was impelled to create it because, on Monday, the administration announced that the window shopping feature had been greatly improved, and lo and behold, it was true.

It may have even been an understatement.

You can now go to the site and -- without signing in or creating an account or entering anything more sensitive than your age and county of residence -- see a plan's approximate deductible, co-payment and co-insurance and access a provider directory and covered drug list.

We've been waiting so long, I almost can't believe it. But there it is.

Now I get to start waiting to hear what the nation thinks of all these newly available details.

* * *

That first segment was such a morass that I feel like even the Surprised and Delighted entry was not enough to counterbalance it. Therefore, allow me to offer up this perhaps unintentional gem from the National Association of Insurance Commissioners.

Its title and subtitle are "Research Uncovers Disconnects Between What Newlyweds Say and Do Regarding Tough Insurance Conversations: New Insurance Survival Guide and Interactive Game from the NAIC Help Couples Initiate 'The Talk.'"

I dare you to read its gaspingly earnest expressions of concern without giggling.

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