Health Insurance To Start Jan. 1

With three weeks left in the year, not one of the thousands of Massachusetts residents who need to enroll in new health insurance plans by Jan. 1 has been able to do so through the state insurance marketplace that was revamped to comply with the national Affordable Care Act.

About 126,000 people enrolled in health plans subsidized by the state have until March to choose a new plan and can keep their current coverage until then. But thousands of others are depending on a new plan to start on the first of the year, and some worry that their coverage will not be ready in time. Their anxiety has only been heightened by stubborn technical problems, such as a snag this week that blocked many people from signing in to the website.

Gina Kamentsky of Somerville has been trying to enroll through the Massachusetts Health Connector for weeks. Her insurance plan, bought through her partner’s former employer, expires this month. Because of expensive medications and a doctor’s appointment she cannot miss, the 54-year-old artist from Somerville said she needs coverage in January. Plus, the landmark 2006 state health insurance law, the model for the national law, requires her and most others to have coverage.

Kamentsky was first stymied by the widespread technological problems. At the end of October, she filed a paper application. She has been stuck since then in a shuffle of documents and on long calls with customer support staff, but she feels no closer to being enrolled.

“There’s no feedback,” she said. “There’s no way to tell if anything has been processed. Time is ticking away.”

More than 32,000 people have been able to complete an application. Only about 1,700 have selected a health plan.

A small number have been able to submit payment information online, bringing them near full enrollment, but the state will not process those payments until Dec. 23.

The Connector Authority will mail invoices starting next week, said executive director Jean Yang. That leaves little time for customers to return a check or credit card information and for the Connector Authority to deliver payments to insurers, with all information needed to create accounts and finalize enrollment.

“Obviously time is tight,” Yang said. “At the same time, we are working extremely closely with the carriers, so that they know what’s coming.”

The $69 million website was built by CGI, which helped develop the much-maligned federal health insurance site, HealthCare.gov. The Health Connector website, by communicating with federal databases and the state Medicaid program, was meant to give users a place where they could find out which insurance subsidies they qualify for. But that function of the website has not worked.

Many people who applied for a subsidy are in a holding pattern, waiting for the Connector Authority to verify their eligibility so they can shop for a plan. Yang said Health Connector staff and contractors are working to find the fixes necessary to make online verification possible and, in the meantime, to identify applicants who need coverage starting Jan. 1.

Many people already receiving state insurance subsidies — through Commonwealth Care, the Medical Security Program for people who are unemployed, and the Insurance Partnership for small business employees — must re-enroll in a new plan, but the state extended the deadline for that group from Dec. 23 until March 24, giving them three more months on their current plans.

As many as 15,000 people who have completed applications do not fall into that category, and an unknown number of them could be uninsured on Jan. 1 if they are not enrolled through the Health Connector.

Yang said CGI has increased the number of people working on the website, and the Connector Authority plans to boost the number of customer service representatives to as many as 190 by the end of December, up from about 65 last month.

“We are not happy with the situation; there’s no question about it,” Yang said. “We look at the vendors critically. We look at ourselves critically. We ask ourselves every day how fast can we make things better.”

Nationally, insurers have expressed frustration that the enrollment records sent by the federal website have been inaccurate. Yang said the state is preparing a back-up plan to deliver data in a spreadsheet or a similar format if the state’s website fails on that front, too.

Typically, insurers need seven to 10 days to set up an account and get insurance cards and an enrollment packet to new customers, said Eric Linzer, spokesman for the Massachusetts Association of Health Plans. But the carriers sometimes receive information about new enrollments up to the last day of the month. The state has not approached carriers about any possibility of missing its deadline for January enrollees, Linzer said.

“The plans are going to be working very hard to make sure that members have what they need for coverage that’s effective Jan. 1,” he said.

But the state may already be short on time, said Bill Fields, a business consultant who works with companies on insurance compliance. Insurers may process the occasional case on the last day of the month, but he figures that the bulk of enrollments must to be sent to carriers by about the end of next week to be processed in time.

“This is a mess,” Fields said. “The sad thing is that the people who are going to get hurt are the people that they’re trying to help.”

Carrie Murray of Abington completed the application process for her family of five on Tuesday. Murray has been buying unsubsidized coverage through the Health Connector since June, when her husband started his own architectural firm. That plan expires this month. After months of grappling with the Health Connector website, Murray finished applying over the phone. Now, she is waiting on an invoice and is still anxious.

“I don’t know if I’m going to get the paperwork in time,” she said. “And, then once I pay the check, will that go through in time.”

Connector administrators need to communicate more directly with the public to explain what challenges they are facing and what they are doing to fix them, said Brian Rosman, research director for Health Care for All, the Boston-based consumer group. But, he said, he is confident that the agency will find ways to keep people like Kamentsky and Murray from falling through the cracks.

“They’ve told us they will, and there’s no reason to think that they won’t,” he said. “They have to.”

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5 Inspiring Quotes From the Women A.R.E. Summit

What do you get when you cross 300 of the country's most driven women with a stage, a few microphones, and the common goal of advancing women's roles? An awe-inspiring first Women A.R.E. (Aspire. Respond. Engage) Summit. Thrown by Women A.R.E. founders Angella Nazarian and Beth Friedman, the one-day event in Los Angeles united trailblazers in the fields of art, entrepreneurship, health and wellness, and philanthropy in a series of panels featuring speakers such as Sharon Stone, Kathy Freston, Chelsea Handler, and Catherine Opie. With so many inspiring women in one room, it's no surprise that I left with some nuggets of wisdom. Here are my five favorite gems from the day.

"Women don't have to be jealous of other women." —Chelsea Handler
"I didn't want to be an actress; they're not fun to be around," said Handler, who discovered the competitive and jealous side of the entertainment world when she first began auditioning in Hollywood at age 19. "When you do stand-up, you're the center of your universe," she said. Handler went on to forge her own path, becoming the first female late-night television host, best-selling author, and one of 2011's Glamour Women of the Year to boot. Currently, Handler employs a 500-person staff across multiple shows, and 300 of those staff members are women. Her motto? "[Women] should lift each other up."

"Love others and lighten up!" —Marianne Williamson
Williamson, who just announced her first run for Congress in California, has impacted countless lives with her spiritual advice, 10 books, and the founding of Project Angel Food, which delivers meals in Los Angeles to homebound people affected by AIDS. And then she said this: "Being the best person you know how to be, living as heart-centered a life as possible is the key to success in work and everything else."

"Do what you are passionate about, and the dollars will follow." —Jane Wurwand
"You have to have fun," said Wurwand, founder of skin care line Dermalogica. Julie Clark, who launched Baby Einstein—and later sold it to Disney—shared similar sentiments as well as her own wisdom, also drawn from experience. "When you are passionate, you are afraid, because you are putting yourself on the line. It's difficult to take the first step, but that's what draws the good juju to you."

"You get to make this whole thing up as you go along." —Abigail Disney
"I wish I had known that anything is possible," said filmmaker and grassroots activist Abigail Disney of what she wishes she knew at the beginning of her career. "I thought there were lines, like in a coloring book, and I had to stay in them. There are no borders, and there are no limits. You get to make this whole thing up as you go along." And the proof is in the pudding: The pioneering women's rights documentarian is currently at work on her next project, highlighting the Arab Spring and its effect on women in the Middle East.

"Give of yourself whatever you can give, but don't put a judgment on it." —Wallis Annenberg
"Never explain to anybody, 'I can only afford this,'" said keynote speaker Annenberg, who recently bestowed the city of Beverly Hills with the Wallis Annenberg Center for the Performing Arts. In her speech, Annenberg emphasized being true to yourself and experimenting to find what you enjoy. A passionate philanthropist, Annenberg continues to reap the rewards of her work in culture and for her community. "You can't get that in a Neiman Marcus catalogue," she reminded the audience.

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Take a Road Trip in Australia

Travel Writer Fiona Harper explains why jumping in the car and taking a road trip in Australia makes for a fantastic holiday - and shares her favourite Aussie drives. 

Do you remember Jack Nicolson in the movie As Good as it Gets? Playing eccentric, obsessive-compulsive Melvin, he was rather nervous about an impromptu road trip with Carol whom he rather fancied and Simon whom he didn’t. He had prepared a carefully labelled playlist tagged to ‘get things going’ or for use as ‘icebreakers’ as the three of them settled into leather seats and drove out of New York bound for good times and noodle salad. I can’t watch that movie without wishing I too was heading off on an extended road trip.

Growing up in country West Australia, family holidays always included a road trip: we rarely flew anywhere. Three kids on the back seat, plus the dog (sometimes a hitchhiker too). Border collie crossbreed Poochie was always first in the car whenever it looked like Team Harper was hitting the road and was never left behind. Except for that one time, in Whyalla I think it was after crossing the Nullarbor Plain, when Dad somehow managed to drive off without her, creating buckets of hysterical tears from the back seat when we realised. We went back though and thankfully found her, welcoming her return into our back seat bunker with delirious delight.

Usually we’d have a caravan hitched behind us, which back then were all bubble-like curves with oversized windows. Actually the windows were so large I managed to roll right out of one, landing with a thud on the dirt one night while asleep on the top bunk. But that’s a story Mum would rather I not tell (sorry Mum, I have). Later, our family moved to the Pilbara and road trips became more adventurous as we ventured off road, billowing clouds of fine ochre dust coating us, the camper trailer and everything packed inside it. Poochie was still with us, her white coat tinted as red as our feet, swimming alongside us in freshwater streams, clamouring up cliffs, chasing lizards or sleeping exhausted beside the campfire while Mum prepared dinner on the camp stove.

Fast forward 30 years and despite open skies and low cost airlines encouraging us to fly hither and thither, I still love the thrill of hitting the road. Whether that road is paved with asphalt, dirt, gravel or bulldust, it’s the lure of the unknown that is so enticing. No matter whether the verge is bordered by architecturally miserable roadhouses or primeval rainforest, once in the car it’s kind of like having your own private ticket to ride, destination unknown. Sure maps, apps and guidebooks have quashed some of the mystery but they’ve also made driving off into the unknown a whole lot more fun (and safe) too.

So where are my favourite Australian drives? The Great Ocean Road in Victoria remains a firm favourite, so too Queensland’s Captain Cook Highway flanked by reef and rainforest between Cairns and Port Douglas. The Gold Coast Hinterland has the Scenic Rim, all craggy dormant volcanic peaks clad with rainforest, while further north and inland from the Sunshine Coast Steve Irwin Way winds through the Glasshouse Mountains. Out west the Cape to Cape route rambles through award winning vineyards, karri forest and small towns, hugging the coast in parts, rolling through farmland in others. In Tasmania, just about every outing is worthy of ‘road trip’ status the whole state is so damn pretty, but I am rather fond of the Huon Trail south of Hobart that meets up with the car-carrying barge to Bruny Island.

We’re awfully fortunate in Australia to have such splendid road infrastructure. Hitting the road, whether for a few weeks or a few hours really is as good as it gets.

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Paula Patton : Our Girl of the Month

Her career’s on fire. Her husband’s everywhere. Actress Paula Patton, it’s clear, has arrived. It started with her turn in the fourth Mission: Impossible as an agent who can kick ass and rock a ball gown. Then her husband, Robin Thicke—get this, they were high school sweethearts—crafted a song we’re still humming, “Blurred Lines.” (The video is stocked with nearly naked models, but in real life all that Thicke wants to talk about is how hot he is for his gorgeous wife.) Now Patton has a new movie, the romantic comedy Baggage Claim, in which the 37-year-old plays a flight attendant still looking for love. (Don’t feel too bad for her, though, because her search involves Taye Diggs and Djimon Hounsou.) We grabbed some time with Patton to discuss Hollywood style, first-kiss magic—and how many of her guy’s sexy lyrics are really true.

GLAMOUR: You’ve been getting so much red-carpet attention. What’s your style philosophy?

PAULA PATTON: I would really love to be a sixties movie star like Sophia Loren or Brigitte Bardot but with a bohemian twist—I have a little bit of hippie in me. I was the kid who would go climb trees in a dress.

GLAMOUR: How do you deal with the pressure to look a certain way?

PAULA PATTON: I’m an extremist. Either I’m being healthy and organic, or I want a big, juicy In-N-Out burger, you know? And I want it now! It’s certainly not gonna make me a runway model, but it sure makes me happy.

GLAMOUR: You met Robin as a teenager. Do you remember your first kiss?

PAULA PATTON: He sang Jodeci’s “Forever My Lady” to me. He did a full-out R&B onstage performance in his dad’s living room. Then he kissed me. It worked!

GLAMOUR: You guys still seem very passionate. He did say in an interview that he turned you into a bad girl.

PAULA PATTON: He ruined me! Gosh, I hope I’m still a good girl and a bad girl at the same time. And I think that every girl should know the bad girl inside her—and that doesn’t make her bad, you know?

GLAMOUR: So in the “Blurred Lines” video, there’s that balloon message—“Robin Thicke has a big d-ck”…

PAULA PATTON: It’s cool, it’s funny, it’s awesome!

GLAMOUR: Yes, it’s definitely all of those things. But we have to ask: Is it accurate?

PAULA PATTON: Robin’s like, “Listen, if I’m, you know, in the Miami Heat’s locker room, I don’t know where I stand, but.…” But I think that the statement is fairly accurate!

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Why I signed up for Obamacare

Late last week, I became one of the 189,000 New Yorkers to sign up on New York state's partner exchange, NY State of Health. New York is one of 14 states that elected to set up its own exchange rather than rely on the federal government to do so. It is also one of the states that have accepted the Medicaid expansion.

In other words, New York, led by a popular Democratic governor, Andrew Cuomo, is all-in on Obamacare, and I decided to go along for the ride. I did this despite being opposed to Obamacare, and I am increasingly convinced that it will eventually have to be either drastically reformed or replaced outright.

Hardly anyone denies that Obamacare is in trouble. Though enrollment in the new exchanges has increased in recent weeks, it has still fallen far short of expectations. Many households that had purchased individual insurance policies in the past have had their policies canceled, and it is widely expected that many small business will receive cancellation notices in the year to come.

Last year, the Obama administration argued before the Supreme Court that the individual mandate was so essential to the success of the Affordable Care Act that it was inseverable. Yet last week the Department of Health and Human Services announced that it would not enforce the mandate against the not inconsiderable number of Americans who've had their policies canceled.

The Medicaid expansion has succeeded in providing more low-income Americans with insurance coverage, though not in the more than 20 states that have so far refused to take part in it. President Barack Obama and his allies had expected that as Obamacare implementation demonstrated the benefits of the new health law, the public would come to embrace it.

A new CNN/ORC International survey instead finds that 62% oppose the law, an increase of 4 percentage points since November. So far, at least, it seems as though the more familiar people become with Obamacare and its consequences, the less they like it.

ike most Americans, I am an Obamacare critic, and I've been making the case against the President's approach to coverage expansion since it started to take shape. This isn't because I oppose government's role in helping people secure insurance coverage.

I'm convinced that we would be far better off as a country if all Americans had enough health insurance to protect themselves from financial disaster, and that government can and should provide a health safety net.

But Obamacare does both more and less than that. It limits innovation by insurers and providers that can help contain costs. It leaves many of the most dysfunctional aspects of America's health system, such as the monopoly power of big medical providers, largely untouched.

It treats different households with the same income levels very differently, depending on how they happen to buy insurance. Its sliding-scale subsidies provide at least some families on the exchanges with a strong disincentive against earning more income. And by raising the bar for what counts as acceptable private insurance, there's a real risk that it will lead to a net decrease in the number of people who have private insurance.

When I envision an ideal health system, I don't doubt that it would involve insurance marketplaces where consumers can compare different policies to make informed decisions. That is what the insurance exchanges are at their best. The big problem with the Obamacare exchanges is that they don't give insurers the option of offering consumers a wide range of products suited to their needs, and they don't offer enough flexibility on pricing.

Obamacare's defenders often claim that conservatives are hypocritical to oppose the law because it relies on the kind of insurance marketplaces that conservatives favor. What these critics miss is that the problem isn't having insurance marketplaces per se. Rather, Obamacare is narrowly constraining the kind of products available on the marketplaces, and in doing it is pricing a fair number of cost-conscious consumers out of the market, even after factoring in subsidies.

I should also note that I don't think Republicans have great solutions for America's health care woes either.

During the 2008 presidential campaign, Sen. John McCain introduced a controversial plan for coverage expansion that I greatly admired and which the Democrats fiercely attacked. Ever since then, Republicans have been extremely gun-shy about offering ambitious health reform proposals of their own.

I was sympathetic to the Massachusetts coverage expansion law that passed in 2006 under then-Gov. Mitt Romney, which struck me as a reasonable solution for an affluent state with a small uninsured population. (The Massachusetts experiment hasn't turned out as well as I had hoped, but that's a story for another day.)

And I've advocated a number of reforms designed to expand coverage, such as more federal funding for high-risk pools, federal and state reinsurance programs designed to make insurance more affordable and tax reforms designed to limit the health insurance tax subsidies that flow to high-income households while increasing those that flow to low- and middle-income households. None of these reforms is cheap, which is why they are opposed by the many of the same Republican lawmakers who oppose Obamacare.

Eventually, the GOP is going to have to recognize that any durable health care fix is going to cost money -- less than Obamacare, perhaps, but not nothing. For now, however, millions of Americans like me who don't believe that Obamacare is the right way forward for the country will have to learn to live with it.

For all my concerns about the Obamacare exchanges, I will say that as a healthy (knock on wood) New York City resident who is not eligible for subsidies, my experience with NY State of Health has been a good one. The reason is that New York state had already made a mess of its individual insurance market before Obamacare, and Obamacare might actually make it better, at least temporarily.

New York is one of relatively few states in which average premiums will be substantially lower in Obamacare's first year then they have been in the recent past, as Avik Roy of the Manhattan Institute observed in November. Roy estimates that average premiums in New York will decline by 40% under Obamacare, the biggest decline in the country. They will increase by 179 percent in Nevada, the state with the biggest increase.

So why are premiums going down in New York?

New York -- like Maine, New Jersey, Vermont, Washington and Massachusetts -- already has regulations on the books that impose community-rating and guaranteed issue on all insurers. That is, insurers have to accept all comers, regardless of health status, and they are strictly limited in the extent to which they can charge different consumers different amounts for insurance. But these states, with the exception of Massachusetts since its 2006 health law went into effect, don't impose a mandate.

The result has been that sick people have flocked to the individual insurance market while healthy people have avoided it at all cost, and this in turn has led to higher premiums.

By pushing healthy people to buy coverage, the individual mandate allowed insurers to lower premiums in the individual market in Massachusetts, and insurers are betting that it will do the same in New York. Indeed, some researchers have called New York state a "poster child" for the individual mandate.

The question for insurers and New Yorkers buying coverage on the exchanges is whether the relatively low premiums on the New York state exchange are sustainable.

If the individual mandate is never enforced (a very real possibility), insurers could find themselves losing enormous sums of money as the problems that plagued New York's individual insurance market in the past reassert themselves. (There are, to be sure, more attractive alternatives to the individual mandate that state governments might embrace, like default insurance.)

People often accuse conservatives of rooting for Obamacare to fail. I'm personally rooting for an outcome in which all Americans can have access to affordable health coverage. I'm just deeply skeptical that Obamacare is the best way to achieve that goal.

But if I'm wrong, if Obamacare and the new health insurance exchanges turn out to be a great success, I will be among the beneficiaries.

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