In article om,
bud-- wrote:


Interesting that no one from the Feds that I have found even
mentioned that. You would think that if they could shift the blame to
someone nefarious they would be trumpeting it to the heavens. Besides,
you could get to the site, then THEIR banner would say to wait. DOS
would normally be such that you wouldn't get that far and the website
certainly wouldn't have a banner up asking you to wait.

Not at all obvious to me that is true. DNS can crash a system. It can
make it too busy. It is, in any case, only one of the possible reasons
the fed exchange has problems.
Except even the Feds have said DNS wasn't a problem. While DNS can
trash *a* system there is not a shred of evidence that is has had any
effect on *this* system. It should be obvious given the lack of evidence
to the contrary (especially since you and I both know that HHS and the
President would love to have even a sniff of a DoS attack as an out) and
the fact that what happens ( such getting to the site and then having to
sit on it for extended periods of time) are not consistent with a DoS
attack. The Feds screwed the pooch on this one. Period.




to the states that don't want it being
responsible.

Some states that do not want ACA to be successful increased the work in
creating a fed exchange.
How? It is the Fed's program so why is it the responsibility of the
states to make sure it runs right?

It was still a move, at least in part, to make building the fed exchange
more difficult.
You mind reading? It was a move largely because the Dems pushed
this through with no GOP support and the GOP wasn't all that keen to
take even a part of the fall when it screwed up.

It was still a move, at least in part, to make building the fed exchange
more difficult.
Again without a shred of evidence. Even assuming you are correct.
This is something they knew from the getgo and were (or at least should
have) planning around. It isn't like the states said they were going to
and then changed their minds and pulled out at the last minute. Actually
it was other way around as some such as FL, said they weren't going to
the build their own and then did.



I have also heard a few more reported.

Interesting that my points were very specific and (yes I admit)
verbose. This is the best you can do as a comeback?

I didn't know we were sharing all the reasons that we have heard.
Rather pointless since they are largely guesses what the major sticking
points are.
I would have settled for one or two. If rather pointless why, then
did you make a point to point them out?

Amazon managed to do that from the get.

Amazon at the start was not as complex as Amazon now and was not as
complex as the exchanges.
Again, this was something that the Feds knew about from the start
and should have worked around. Although, it is hardly only a Fed thing
to dither around before making the original RFP and then changing their
minds multiple times (and probably from the programmer's standpoint,
random intervals) during the runup. These are the problems most of the
experts have talked about most often.



You have yet to give me anything remotely resembling an actual
fact (a few others, heard many times) and you suggest I get real?

Apparently you have not looked very hard.
Can't tell how hard you looked, or even IF you looked since you have
given nothing but nebulous "I have heard" responses.



Since the fed rules are the same it is not obvious to me why an insurer
would not want to be in a state. Could be because the state rules are
onerous, but the low-plan states don't seem to be ones that would have
much state regulation.

Mostly because they can't be all places at all times. The rules may
be the same, but the populations, markets, expenses, etc., aren't. Some
pulled out because of current penetration consideratinos that they
thought made it unlikely that they could get a big enough group of
patients to make any money. There are many things other than just the
structure of the plans that enter into it.

I don't understand how that explains how only 2 (for sake of argument)
companies put up plans for a state.
The big one is penetration. Especially with community rating (where
you can't underwrite for anything other than age, place, and smoking ),
you have to have a VERY big group to make any money. And that group has
to be made up a diverse group of people age and conditions. If you don't
have this diversity, say a concentration of us old farts with health
issues, then you can't balance the cheaper kids with the expensive old
farts and the policy gets very expensive and people leave. Unlike before
where just certain policies were in this death spiral, there is a
possibility that the whole system will go into a death spiral.
So, if you can't get enough people, they can't make any money and
you can lose great amounts.
For this alone, it is makes sense that companies pulled out of
marginal states and were hesitant to go into others. Add in the great
amount of uncertainty and resources that needed to be put in to get the
new policies up and functioning, and you have some states with only a
couple of insurance companies interested. As I mentioned, the
interesting thing will be if this changes after a couple of years of
experience and things have settled down.
Also, it should be noted that there is no requirement that a plan
work for the entire state. There is at least one group in Indiana that
is only available in Indy and the donut counties. So, even if a state
has some large number of providers, a given area is likely to have many
fewer.
--
America is at that awkward stage. It's too late
to work within the system, but too early to shoot
the *******s."-- Claire Wolfe