Insurers Worry About Big Gaps in Obamacare Site


This December 2, 2013 photo shows a woman in Washington, DC reading a message indicating that the insurance marketplace internet site has too much traffic to continue enrollment. The troubleshooter appointed by President Barack Obama to overhaul a bungled health care website rollout said Sunday that improvements had made a 'night and day' difference in handling online traffic. The White House has admitted previously that the launch of, where people can sign up for health insurance, was a debacle and the Obama administration pledged that the vast majority of potential customers would be able to enroll online by the end of November.
National Journal
Sam Baker
Dec. 2, 2013, 3:55 p.m.

In­sur­ance com­pan­ies are still wait­ing for key parts of Health­ to be built — and still hav­ing trouble with the parts that are in place.

Im­port­ant pieces of the Obama­care site are still glitchy, or miss­ing al­to­geth­er. And the site’s botched rol­lout is hardly boost­ing con­fid­ence in the vi­tal com­pon­ents that still need to be built, in­clud­ing the sys­tems for pro­cessing pay­ments to in­surers and squar­ing away the de­tails of who has en­rolled in which plans.

Both sys­tems are cru­cial to the in­sur­ance in­dustry, which needs to col­lect premi­ums so it can pay out claims. And car­ri­ers are still wait­ing for the delayed pro­cess of re­con­cil­ing their en­roll­ment in­form­a­tion with the fed­er­al gov­ern­ment’s data. As the rest of Health­ struggles to get off the ground, people in and near the in­sur­ance in­dustry are nervous about the delays and about how well those sys­tems will work once they’re in place.

“They don’t have a very good track re­cord of build­ing and test­ing sys­tems, giv­en what we’ve seen so far, so that is cause for con­cern,” an in­dustry of­fi­cial said.

An­oth­er cause for in­surers’ anxi­ety: CGI Fed­er­al — the con­tract­or that has come un­der fire for its work build­ing the bulk of Health­ — is also in charge of build­ing the pay­ment and re­con­cili­ation sys­tems.

Re­con­cili­ation is the pro­cess by which in­sur­ance com­pan­ies and the fed­er­ally run in­sur­ance ex­change iron out any dis­crep­an­cies in en­roll­ment in­form­a­tion — mak­ing sure, for ex­ample, that the same per­son isn’t ac­ci­dent­ally en­rolled in two policies, and that the con­sumer and the in­sur­ance com­pany got the same in­form­a­tion about the size of any sub­sidies.

Con­sumers have to pay their first month’s premi­um by the end of Decem­ber for their cov­er­age to take ef­fect on Jan. 1. And to make sure that the right people are pay­ing the right amount for the right policy, in­surers and the gov­ern­ment need to re­con­cile their in­form­a­tion. The pro­cess was sup­posed to start this month, but in­surers are now skep­tic­al that will hap­pen. And they haven’t got­ten word of any backup plan.

Gaps in en­roll­ment in­form­a­tion seem likely, giv­en the myri­ad prob­lems Health­ has had in sub­mit­ting com­plete, ac­cur­ate re­ports to in­sur­ance com­pan­ies about the few people who have man­aged to sign up through the web­site.

In­surers say the re­cords — known as “834” trans­mis­sions — are im­prov­ing but have been rife with in­ac­curacies or miss­ing ne­ces­sary in­form­a­tion.

The Cen­ters for Medi­care and Medi­caid Ser­vices said Monday that it had iden­ti­fied — and fixed — a single glitch re­spons­ible for the vast ma­jor­ity of the site’s back-end er­rors. A soft­ware bug that pre­ven­ted So­cial Se­cur­ity num­bers from ac­com­pa­ny­ing the re­ports was re­spons­ible for about 80 per­cent of the prob­lems, CMS Com­mu­nic­a­tions Dir­ect­or Ju­lie Ba­taille told re­port­ers.

She could not spe­cify the over­all er­ror rate for sub­mis­sions to in­sur­ance com­pan­ies, even though CMS would have to know that to as­sert that it had solved 80 per­cent of them.

Even as en­roll­ment sub­mis­sions are im­prov­ing, however, in­surers are still wait­ing for an­oth­er big part of the sys­tem: the part that pays them. Most people who buy in­sur­ance through Health­ will be eli­gible for a sub­sidy to help cov­er the cost of their premi­ums. But CMS hasn’t yet built the sys­tem that trans­mits sub­sidy pay­ments to in­sur­ance com­pan­ies.

In­surers are sup­posed to re­ceive their first pay­ments in Janu­ary, and they’re count­ing on the money to be there. Oth­er­wise, they’ll be pay­ing out claims for cus­tom­ers whose premi­ums haven’t been fully paid.

In­surers will be paid on time, Ba­taille said. CMS is piggy­back­ing off Medi­care’s pay­ment sys­tem to pro­cess pay­ments in Janu­ary while it “builds out” the auto­mated sys­tem that’s sup­posed to handle sub­sidy pay­ments un­der the Af­ford­able Care Act, she said.

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