Enrollment up, docs get SGR respite

The year drew to a close in Washington with a bipartisan budget agreement that averts a drastic Medicaid payment cut to physicians in January, along with hopeful signs for the Obama administration that health plan enrollment is finally going well on the insurance exchanges. Just to be sure, the administration named an experienced technology expert to oversee the HealthCare.gov effort.

There's been a surge of enrollments through the health exchanges in recent weeks. Covered California reported it was signing up 15,000 individuals per day by the second week of December, double the pace during the first week of the month. President Barack Obama announced more than 500,000 enrollments through HealthCare.gov in the first three weeks of December. That would be roughly four times the number of enrollments in October and November combined, and would move toward the administration's goal of 3.3 million people enrolled by Dec. 31.

On the budget front, the Senate voted 64-36 last week to approve a House-passed budget bill that sets topline spending figures for 2014 and 2015 and continues the 2% mandatory Medicare sequester cuts for two more years, through 2023. The Bipartisan Budget Act, which Obama was expected to sign, also extends current Medicare physician payment levels and various expiring or expired health programs through the end of March.

The temporary solution to Medicare's troublesome sustainable growth-rate formula, which expires March 31, is meant to give Congress more time to pass a permanent SGR repeal bill. Three committees—Senate Finance, House Ways and Means and House Energy and Commerce—each have passed legislation this year to replace the SGR with a payment system that rewards value over volume. Committee members and staff will spend the first quarter of the year negotiating differences among the bills, though there is no indication so far of any consensus on how to pay the $116.5 billion cost over 10 years.

Ilisa Halpern Paul, managing government relations director at Drinker Biddle & Reath, said providers worry how lawmakers will pay for funding of the permanent SGR repeal. The SGR fix and the extension of the other programs will cost about $8.3 billion over 10 years, which Congress will pay for primarily by revamping how long-term acute-care hospitals are reimbursed.

“There's a momentary opportunity to exhale in terms of the three-month patch,” Halpern Paul said. “But I think providers are looking at April 1 and beyond at a possible 10-year fix with no real insight into the pay-fors.”

Also last week, HHS Secretary Kathleen Sebelius announced that former Microsoft executive Kurt DelBene will succeed Jeff Zients to oversee improvement efforts for HealthCare.gov, the federal website where consumers in 36 states can shop for private health plans. DelBene served as president of the Microsoft Office division and will stay on through at least the first half of 2014, Sebelius said. Zients came on board in October after the disastrous launch of the website and is credited with getting the website working relatively well as of Dec. 1. Zients will start in his new role as director of the National Economic Council in February.

Enrollment groups around the country say they're seeing heavy demand. Deb Holmgren, president of Portico Healthnet, a not-for-profit enrollment group in St. Paul, Minn., said her organization had to add six group-enrollment sessions for the final Saturday before the Dec. 23 deadline. “I'm not sure at all that everyone who needs to get on by Monday is going to get on,” Holmgren said. “There's just a limit to what we can do with the resources we've been given.”

The late surge has triggered concerns about a potential logistical mess as tens of thousands of enrollments pour in for coverage effective Jan. 1. In Maryland, where the state's exchange website has experienced severe technical problems, insurers agreed to give customers four extra days to choose a plan. Nationally, the Obama administration announced that enrollees would have until Dec. 31 to make their first payment. In addition, it announced that people whose individual health policies were canceled can sign up for high-deductible catastrophic coverage if the premium for their new Obamacare-compliant plan would be higher than what they previously paid. That “hardship exemption” already was available as an option.

America's Health Insurance Plans announced last week that its members would allow premium payments to come in as late as Jan. 10 for coverage taking effect Jan. 1.

There remained concerns about whether insurers were getting accurate information about enrollees from the federal and state exchanges through the 834 enrollment forms, as well as issues about the accuracy of Medicaid eligibility information sent by the federal exchange to state Medicaid agencies. Some experts fear that individuals who think they are signed up for a private plan or Medicaid and seek medical care after Jan. 1 will discover there is no record of their coverage. But both insurers and federal officials say the problems with those back-end communications have lessened in recent weeks.

Peter Lee, executive director of Covered California, said providing accurate customer information to insurers has not been an issue. “We've got a good-looking back end, so to speak,” he quipped.

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