As Colorado’s health exchange managers sprint toward an October 1 launch, a top manager warned board members on Monday that a recent decision to build a new “eligibility” IT system poses the greatest risk of delay and could undermine the quality of the online health marketplace.

Adele Work, who is leading implementation for the exchange, made a presentation about “key implementation risks” during a technology update for the board.

More: ‘Risks’ loom for health exchange technology | Health Policy Solutions.

Kathleen Sebelius, the Secretary of HHS, thinks that catastrophic insurance isn’t really insurance at all.

At a White House briefing Tuesday, Health and Human Services Secretary Kathleen Sebelius said some of what passes for health insurance today is so skimpy it can’t be compared to the comprehensive coverage available under the law. “Some of these folks have very high catastrophic plans that don’t pay for anything unless you get hit by a bus,” she said. “They’re really mortgage protection, not health insurance.”

She said this in response to a report from the American Society of Actuaries arguing that premiums are going to rise by 32% when Obamacare kicks in, as coverage gets more generous and more sick people join the insurance market.  Sebelius’ response is apparently that catastrophic insurance isn’t really insurance at all–which is exactly backwards. Catastrophic coverage is “true insurance”.  Coverage of routine, predictable services is not insurance at all; it’s a spectacularly inefficient prepayment plan.

More: Health and Human Services Secretary Doesnt Understand What Insurance Is – The Daily Beast.

via. Heartland Institute, Consumer Power Report #366.

After all, a Ways and Means Committee report shows that Fortune 100 companies each save more than $400 million by not offering insurance and sending employers to exchanges.  Deloitte finds that at least nine percent of employers will drop coverage. McKinsey’s estimate is 30%.  The Congressional Budget Office estimates that seven million employees will lose employer-based coverage. The Economist reports on similar trends.

If you end up buying health coverage through a government-run exchange, worry about having a narrow provider network and long waits for appointments.  Also worry that the the policies will cater to healthy plan holders and under-provide to the sick.

The Patient Protection and Affordable Care Act, a.k.a. Obamacare,  turned three years old this week. But unlike fine wine, the ACA is not getting better with age. A torrent of recent studies and reports has provided new evidence — as if we needed more confirmation — that nearly everything we were told about this law was untrue.

Tanner takes on these promises:

If you like your doctor, you will be able to keep your doctor, period. If you like your health-care plan, you’ll be able to keep your health-care plan, period.

— President Obama, June 15, 2009

This law will cut costs and make coverage more affordable for families and small businesses.

— President Obama, June 22, 2010

This legislation will also lower costs for . . . the federal government, reducing our deficit by over $1 trillion in the next two decades. It is paid for. It is fiscally responsible.

— President Obama, on signing the Affordable Care Act

It’s about jobs. . . . In its life [health-care reform] will create 4 million jobs, [and] 400,000 jobs almost immediately

— Nancy Pelosi, February 25, 2010

Quality, Affordable Health Care for All Americans

– Title 1 of the Patient Protection and Affordable Care Act

Read more: Three Years of Broken Promises – National Review Online.

There’s an astute article in today’s edition of the Wall Street Journal by veteran healthcare reporter Anna Mathews. It outlines the scope of health plans that will be offered on the new exchanges taking shape this fall. And why Obamacare is looking more and more like Medicaid.

Mathews notes that hospitals are giving up discounts to the new exchange-based health plans. In turn, the hospitals plan to make up these discounts through the narrow networks of providers that consumers will be able to choose from. The bet that these hospitals are making is that they can offset the discounts by getting more volume. …

[Wi]th fewer out-of-pocket costs, consumers will also have far less skin in the game. In turn, they will have less incentive to constrain their demand for services.

That constraint will instead be applied by the providers themselves, through the limitations that they place on access. Not by outright denying care, but by funneling patients into overworked networks that make it much harder to actually get appointments and schedule needed services. This is exactly how rising demand is managed under Medicaid. It’s one more reason why Obamacare coverage is likely to resemble Medicaid over time.

More: The New Obamacare Insurance Is Looking More Like Medicaid – Forbes.

See also: Survey: Medicaid-Level Rates Could Cripple Health Insurance Exchanges.

Colorado’s health exchange is supposed to debut in just six months, but having the technology ready by Oct. 1 may be an impossible task.

Critical problems threaten the system, ranging from a lack of coordination with the state’s technology office and historic problems with state IT systems to poor oversight by exchange managers and contractors and the potential for serious conflicts of interest among those charged with creating the complex multi-million dollar exchange system.

More: Tech troubles could hobble health exchange | Health Policy Solutions.

See also Avik Roy at Forbes: “CMS on Obamacare’s Health Insurance Exchanges: ‘Let’s Just Make Sure It’s Not a Third-World Experience‘”

I have served as a volunteer range officer at a Colorado rifle range for over fifteen years. It is a passion of mine. A range officer is like an air traffic controller, and my first responsibility is safety. I also instruct and assist those who come out to shoot. I want everyone to have a safe and positive shooting experience. Under proposed HB13-1224, the magazine ban bill, I will not be able to continue to volunteer my services without becoming a criminal. Let me explain.

Read more: Mag Ban: A Range Officer’s Safety Perspective | Complete Colorado – Page Two.

Medicaid expansion would limit access to care for the significant fraction of the currently uninsured who would otherwise be eligible for federal premium subsidies under ObamaCare. It raises costs for state taxpayers, increases costs for people who are hospitalized, and prevents state insurers from collecting millions of dollars in federal subsidy money.

Read more: How Colorado’s Medicaid expansion harms patients | Complete Colorado – Page Two.