More Hidden Costs of Obamacare

I was reading over the list of “Essential Health Benefits” mandated by Obamacare. I found myself looking at the extensive requirements through my old systems analyst/programmer eyes. A question arose that I don’t know the answer to – can the insurance companies capture and retain all of the data that will be required by Obamacare with their current software – or will changes to their systems be required?

Obamacare requires that health plans offered in the individual and small group markets, both inside and outside of the new Health Insurance Exchanges, cover a core package of health care services known as Essential Health Benefits (EHB).

Since the insurance carriers accept the responsibility for approving or denying each claim and paying the doctors, hospitals, etc., they must retain the data in their systems. I can foresee lots of modifications and new database elements that are necessary to capture and retain the data to support reimbursement decisions, dispute resolution, reporting history, and actuarial calculations.

Let’s hope that the insurance companies use in-house staff or do their due diligence when contracting for software services and don’t use the same “experts” who gave us the Obamacare signup software.

Here’s one small example: Obamacare requires that each child under the age of 19 be allowed two routine dental exams, an eye exam, and corrective lenses, each year.

Some of the insurance carriers were selling plans that didn’t accommodate dental and vision at all, much less cover multiple dental exams each year. That means that the insurer’s software now will be required to retain the occurrence of multiple exams and when each occurred. The same holds true for the vision exam and the coverage of corrective lenses (once each year). The company has to retain proof that guaranteed procedures did, in fact, occur and that they were covered and, if approved, paid.

There are many other examples of data elements that became required under Obamacare and that an insurance company will now have to capture and retain.

My point is: I’ve not heard any discussion about the cost to the insurance companies of complying with the requirements mandated by Obamacare.

And that prompts the question: who will be paying for that additional software programming and modifications? It’s got to be multi-millions.

Answer: We’ll pay it – as the insurance companies will pass along the expense in their premiums.

And this is one more additional cost (mandated by the government) that wasn’t required until we were blessed with Obamacare.

Ain’t we lucky?

Maybe this is a “JOBS” program in disguise. It certainly will be a boon for contract programmers (hired guns) who’ll be called in to modify current systems. Especially legacy systems that haven’t had the benefit of modernizing for a decade or more. If an insurance company wants to “play” in this market, they’ll have to immediately update their software. Some won’t make it in time and we’ll see “glitches” like Obamacare. We’re in for a bumpy ride, folks.


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25 Responses to More Hidden Costs of Obamacare

  1. Saltwater says:

    The problem you address may prove even more “Gordian” depending on the wording of enacting regulations.
    What is a ‘year’ for use in computation of repeat and/or limited benefits? Does it encompass a Jan 1 – Dec 31 period? Or, is a ‘year’ 365 days from a date certain in one calender year? Or is a ‘year’ the time from a date certain in one calendar year to that date certain in the following year?
    Say I have an eye exam May 15, 2015. Will I be able to have another exam in December 2015? Using that same exam date, will I be authorized for another on May 15, 2016, or have to wait an extra day, because 2016 is a Leap Year?
    Collecting and retaining the data may prove to be the least of insurance companies woes. Computing which benefits are authorized by law for whom, and when, has real potential to all the worms – without the bag.

    • Garnet92 says:

      Thanks for the comment Salty! While ordinary conversations don’t usually deal with dates like legal documents are required to do, insurance policies do cover the way a “year” is calculated – mostly “plan year” and sometimes “calendar year” but all policies will define what a “year” consists of for a specific purpose.

      You’re right that the insurance companies will have to rely on the Obamacare’s definition of “year” for purposes of writing their plans, but it won’t be left up to interpretation, it’ll be legally defined.

      • Saltwater says:

        Point taken Garnett. However, I have some reservations about how ‘well defined’ a term might be across that 12 million pages of regulations. They are being written by bureaucrats, not insurance specialists.

        As a defense contractor, I got to see many ‘definitions’ that defied basic common sense. One example was the specification our equipment pass fully operational, and manned. acceptance testing – including one called “EMP Survivability”.

        Our lead engineer, a brilliant programmer, was about to sign off on the specification, when the project physicist explained the test parameters dictated an EMP surge that could only be attained by setting off a tactical nuke just over one kilometer from our system containers.

        The technical support pool said they could test if they wanted – but WE would ALL be on the other side of the State having beers and burgers when it happened.

        • Garnet92 says:

          I can dig it. I’ve done some research on EMPs and they’re not something to be toyed with – if that physicist decides to test, let me know when and where and I’ll be a fur piece away. BTW, I’d be interested in chatting with you relative to your EMP-protection knowledge.

          • Saltwater says:

            Actually, it was the physicist who talked the programmer out of accepting that particular demand. We (company and DoD) finally compromised on substitute testing involving high-power RF generators INSIDE the shelters, with remote monitoring for leakage across multiple spectrums using sensors OUTSIDE the shelters.

            Although not a ‘true’ test, it did provide enough data to show the system had sufficient protection against electro-magnetic effects. Radiation exposure for the system and operators was another matter, but specifications for shelter materials indicated dosage would be within “acceptable” levels (whatever THAT meant).

            My personal knowledge of EMP protective protocols is really quite limited to basic understanding of power dissipation over distance from source, and calculating wavelengths used to determine what type of ‘antenna’ to use for capturing and grounding specific frequency ranges.

            Why do you ask? Are you planning on moving into some type of gigantic Faraday cage?

            • garnet92 says:

              Not exactly Salty, I occasionally interact on a couple of prepper/survivalist blogs and one of the questions that has yet to be definitively answered (and many have tried) is whether a garbage can-sized Faraday cage MUST be grounded. Since we’re worried most about the E1 pulses (from high altitude blast), there are two different camps on grounding – just wondered where you come down.

              • Saltwater says:

                A ground is not required to achieve the Faraday cage effect – witness the protection offered passengers and equipment by an airplane in flight, or an automobile on rubber tires, when struck by lightning.

                Another everyday example of an ungrounded cage are the “traps” police use to contain transmitters banks often include with ‘bait’ money surrendered during robberies. Once PD has tracked down and arrested the bad guy, they pop the RF emitting tag into a little box so it can no longer ping the system.

                The discussion to which you refer entails protection from a very aggressive EMP (natural or man made). A pulse, or pulses, of that magnitude would charge the surface of a container through electromagnetic induction, just like more benign sources. However, such a charge would surely overwhelm even the best insulating scheme and materials available to the home prepper.

                “Leakage” of that charge to surrounding environment is inevitable. Once the difference in potential between the induced EMF on the surface of the cage and the local environment has dropped sufficiently, the insulation properties would cause that leakage will stop. What you have left is a container at some potential other than the surrounding area – effectively a capacitor in search of a circuit through which it can attain balance.

                Touching that charged container, say while attempting retrieval of those items initially placed inside for protection, may prove to be a VERY exciting enterprise – from a small shock, to a knock you on you aft quarters arc of electricity. So, in the name of safety, unrelated to functional design concept, put me down on the “ground it” side of the argument.

                At least that’s my view.

  2. Well, aren’t YOU the Joyous Joker~! Mein Gott, Garnet,,, that’s going to add tons of costs, on top of the increase that “everyone” is already seeing.

    To be honest, Garnet, I never thought of the IT Upgrades that all the insurance companies would have to undergo. And I’m afraid that such upgrades are only a small part of it – How many thousands of Doctor’s offices and hospitals, clinics, you name it, are going through the same process???

    (O) Care has got to go.

    • Garnet92 says:

      I know Grouchy, and the costs to the insurance companies pale when compared to all of the other financial impact caused by the Obamanation, it’s just that it occurred to me as I was writing another piece and thought that I’d do a short post noting it.

      And when you mention the doctor’s offices, don’t forget the Electronic Health Records (EHR) which all doctor’s offices are required to implement – separate and apart from Obamacare. Costly to buy, implement, and train for the physicians – just another reason for doctors to be thinking of changing professions – and becoming a wood-whittler or glass blower, etc. Doctors will become an endangered species soon.

  3. Kathy says:

    You make some great points, Garnet, and that will only multiply with other options and conditions. This will go from a mere train wreck to a nationwide nightmare.

    • Garnet92 says:

      Thanks Kathy. The problems associated with Omammycare continue to explode – just about daily, a new turd shows up in the punchbowl. It’s getting worser and worser.

  4. Clyde says:

    Garnet, good post, BUT I’m surprised. You can’t see the end result here ? The WHOLE point of Obamacare is to FORCE private insurers OUT of the marketplace, by ANY means possible, through onerous policy requirements, costly software upgrades, etc etc,leading to the democrats’ REAL wet dream, a single-payer system run TOTALLY by THEM. Has ZERO to do with whether or not insurers can cover their costs.

  5. Garnet92 says:

    Sure Clyde, they’ve been getting aroused by the thought of “single-payer” for some time now, but I no longer think that single-payer is a done deal. Are the insurance companies going to fold their cards and accept elimination? The big ones, with deep pockets and wealthy benefactors for the dems? The sentiment just beginning to boil right now can be damaging to the dems and, at least, delay any push for single-payer and Omaumau is losing his “mantle of invincibility” and folks may not be so eager to accept any politician’s promises based on the exposure of his many lies – which has now become the “topic of the day.”

    As he gets hit more and more often over this Omaumaucare debacle, he is becoming tarnished and I hope, losing credibility.

    We’ll see.

  6. Hardnox says:

    Good post. I’m beginning to think that this is such a mess that one day everyone will just say “screw it” and then let the government handle the whole thing.

    A horrible scenario to contemplate for sure. There are hundreds if not thousands of “the secretary will decide”. The law can change in an instant. How would anyone stay in business with that crap going on?

    • And China and Hong Kong thought THEY had / have a “Black Market Economy”?
      Taking your scenario, Hardnox, We’ll have an underground black market that will be surreal~!

    • garnet92 says:

      I’m glad you mentioned that, Nox. The sheer number of “the secretary will decide” statements (I don’t remember an exact number either) ought to have been enough, on its face, to disqualify this piece of crap from becoming law. A POS Secretary of HHS has our health care completely under her(his) thumb – much too much power in the hands of an unelected bureaucrat.

  7. Bullright says:

    Good points Garnet. I assume its a lot like Hipaa which needed software etc. That’s what is so egregious about ObamaCare failures in view of that. Yea a bumpy ride to hell.

    • garnet92 says:

      Right Bull, in my company, we had to make sure that our HR software complied with HIPAA and all of its privacy and security aspects – those “features” of HIPAA are the reason that we all must sign a HIPAA release whenever we’re treated at a doctor’s office or a hospital or clinic. It was enacted to prevent “unauthorized” access to our health information and keep it from falling into the “wrong” hands. Now Obamacare is creating another depository of our private health information and, we’re told, without proper security provisions. Thanks Obama.

  8. Bill Baldwin says:

    This is just my opinion and edumicated guess, but I doubt the insurance industry is the least bit concerned about the cost of implementing the ACA. Under the ACA, the profits of insurance companies is limited. They must spend 80% of their income on medical care, that leaves 20% for profit and operation costs. Let’s use simple numbers for the inbred progressives that might be reading.

    Suppose an insurance company has an income of $120 a year from all of it’s insured. Suppose they only spent $80 on medical care for their insured. That means that have to refund $20 and can keep $20. Now suppose, the insurance company figures, it should also pay for additional medical procedures that it would ordinarily not pay for, and those procedures costs an additional $20 per year. That would bring their total annual payments to $96 (80%) and their slice is increased to $24, or a 20% increase in profit.

    Now that we’ve covered the simple numbers, multiply that by tens of billions of dollars. In 2010, healthcare expenditures was $2.6 TRILLION, or 17.9% of the Gross Domestic Product.

    SHORTER ANSWER HERE: yeah, consumers will be paying for it.

    Earlier this year, my mom was diagnosed with breast cancer. Total costs so far, without treatment, other than diagnosis and removal of the tumor, is $120,000. Her out of pocket expenses was about $600. She and my step dad are on his employer provided insurance with an annual cap on out of pocket expenses at $2,000 or $2,500. Her coverage is getting canceled on Jan. 1, 2014. Although she’s not old enough to retire, next year she’ll be eligible for medicare, because of her diagnosis. A few years ago, my biological father was diagnosed with brain cancer (stage IV GBM). He had just retired and had medicare and that other insurance that pays for part of what medicare doesn’t pay for. I wrote checks for about $1,500 to $2,000 per month for his share of medical costs for his treatment. In his final two months, he was put on a Hail Mary chemo med (Avastin, I think) which was $20,000 per dose, once a week. If I recall correctly, I wrote checks for $1,200 for a few weeks, until a charity picked up the tab.

    Because of ACA, my mom is being forced into medicare, where there is no cap on what the ensured have to pay out of pocket, or, to enlist in an ACA approved program which will still cost thousands more than her current insurance. All of her remaining surgeries have been fast forwarded by months so that she can be covered under her current insurance policy.

    If the current Piece Of Shit, president stompy feet, really wanted to address the costs of health care, there would have been legislation targeting the costs of healthcare, not the cost of insurance. What he did, was paved the road to socialized healthcare. Expect mandatory “healthcare” taxes to be taken out of paychecks in a year or two.

    • garnet92 says:

      Sorry, forgot to add that you also correctly forecast that when it’s found that the revenue isn’t covering the costs of Obummercare, the next step will be withholding of premiums.

  9. garnet92 says:

    Thanks for your input Bill. I can’t imagine having to depend on a “miracle drug” costing $20,000 per dose to prolong life, but a situation like that is what we all hope to be spared.

  10. CW says:

    This is great work, Garnet. More proof of why we had to pass the bill before we were allowed to see what was in it. Obamacare is a gold mine of unintended (and some intended but unwelcome) consequences.

    • Garnet92 says:

      Gold mine is right, CW and it’s the gift that keeps on giving – seems like each week we find some new “feature” that will take away more rights and cost us more money. This shitpile HAS to go – somehow, don’t matter how, it has got to be KILT.

  11. bullright says:

    So Garnet, here’s an example in kind. Say you have a little small town, every year they have to spend upwards of 20,000 dollars for update maintenance for their police computer system. Do the math for the number of vendors hooked into ObamaCare and those connected to the medical system.(not to mention the millions spent for the initial programming…fixing so far. It never ends. Its a bonanza for someone.

    • Garnet92 says:

      Right bull. I used to make a living just updating computer systems for governmentally mandated tax changes – this will be WORSE. Yup, some folks will buy (big) houses and put kids through college making modifications to this Frankenstein of a monster.