HealthCare.gov working better, but insurance data problems linger

Healthcare reform supporters shifted from defense to offense last week as President Barack Obama and his administration boasted that the HealthCare.gov website has been repaired and most consumers now are able to sign up for health plan coverage with relative ease. But danger looms as the White House confirmed Friday that the federal website has sent faulty enrollment data to insurers for a significant number of applications.

Nevertheless, the president and congressional Democrats are sounding more confident that Americans will like the coverage they find on the exchanges and won't hold the rollout debacle against them come the 2014 elections. That's a big change from a few weeks ago, when the Patient Protection and Affordable Care Act looked imperiled. In a speech last week in Washington, Obama urged people to spread the word about the benefits of the law.

“Now that the website is working for the vast majority of people, we need to make sure that folks refocus on what's at stake here, which is the capacity for you or your families to be able to have the security of decent health insurance at reasonable cost,” he said.

According to the Washington Post, more than 50,000 individuals signed up for coverage in the first three days of December—more than twice as many as in the entire month of October. HHS has not confirmed that figure, but is expected to release November enrollment figures for the federal website this week. A Modern Healthcare survey of private-plan enrollment in 13 states and the District of Columbia that are running their own exchanges found that 174,000 people had enrolled as of Dec. 3.

The turnaround in the federal website for now has quelled a budding revolt by congressional Democrats fearful that the Obamacare launch problems would jeopardize their 2014 re-election prospects.

But congressional Republicans are continuing their attacks. They generally have shifted their emphasis from the federal website woes to the concerns of some people who have to pay more for coverage or who can't continue to use their old doctors or hospitals in the new exchange plans.

Rep. Michael Burgess (R-Texas), vice chairman of the House Energy and Commerce Health Subcommittee, continued to hammer on the bungled rollout of the federal website, questioning the credibility of HHS Secretary Kathleen Sebelius. “We've been lied to by this secretary so many times that it's almost a farce,” Burgess said in an interview. Sebelius is scheduled to testify about the law before his subcommittee this week.

The stiffest test for the federally run and state-run exchanges is the functionality of their back-end interactions with insurers. Issues remain with the accuracy of information being conveyed. Even the more successful state exchanges, including those of New York and Kentucky, reportedly are having trouble transmitting 834 enrollment forms to insurers.

On Friday, CMS spokeswoman Julie Bataille said there were problems with roughly one-quarter of such forms generated by the federal exchange in October and November, including incorrect or duplicative information and forms that were never sent to insurers. And there continue to be problems with 834 forms for about 10% of individuals seeking coverage through the exchange.

Bataille indicated that CMS officials are holding daily conference calls with insurance officials to update them on progress and generate feedback.

Last Wednesday, the CMS, American's Health Insurance Plans and the Blue Cross and Blue Shield Association took the unusual step of releasing a joint statement saying they are working together to resolve back-end issues.

“A lot of work still needs to be done to get us where we need to be Jan 1,” said an insurance official who did not want to be identified. Of particular concern are so-called orphans, where insurers received no record of individuals who supposedly signed up for coverage.

The biggest fear is that patients will show up after Jan. 1 seeking care under their new plans and learn that insurers have no record of their coverage. “There is a risk of chaos once people start to use services,” said Paul Ginsburg, president of the Center for Studying Health System Change.

While most of the current attention has focused on the 834 forms, there also are believed to be problems with 820 forms through which insurers will receive enrollees' premium subsidies from the federal government. If that information is inaccurate, insurers might not get those subsidy payments on a timely basis. That could be particularly problematic for smaller insurers and start-up organizations such as the 23 not-for-profit, consumer-governed health plans that were established under the ACA.

The success of the ACA also will hinge on the young “invincibles” ages 18-35. A new poll by the Harvard Institute of Politics found that among the 22% of Millennials surveyed who did not have health insurance, less than a third said they will sign up for coverage. In states that have released preliminary statistics, the customer base is skewing disproportionately older.

Ginsburg said that could prove a bigger problem for insurers than the data glitches or the total number of enrollees. “Will the risk profile be somewhat in the range of what the insurers were projecting and what they set their rates on?” he asked. “Or will it be very different?”

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