If You Like Your Insurance, Can You Keep It This Time Around?

The Affordable Care Act’s website is still facing challenges ahead of the second round of open enrollment.

Mercy Cabrera, an insurance agent with Sunshine Life and Health Advisors, speaks on the phone as she helps a person with information about an insurance policy under the Affordable Care Act at the store setup in the Westland Mall on November 14, 2013 in Hialeah, Florida.
National Journal
Oct. 14, 2014, 4 p.m.

People who already bought health in­sur­ance through Obama­care will likely face an­oth­er round of con­fus­ing tech­nic­al is­sues as they try to reen­roll for a second year.

The health care law’s second open-en­roll­ment peri­od be­gins Nov. 15. And by al­most all ac­counts, Health­Care.gov will prob­ably work much bet­ter this time, es­pe­cially con­sid­er­ing its dis­astrous de­but.

Health in­sur­ance com­pan­ies, at least so far, seem to think Health­Care.gov is on the right track to func­tion more smoothly for new cus­tom­ers. But in­surers still see gaps in the sys­tem for people who want to re­new their cov­er­age, in­clud­ing pit­falls that threaten con­sumers with du­plic­ate en­roll­ments, un­ex­pec­ted can­cel­la­tions, or sur­pris­ing tax bills.

In­surers aren’t ne­ces­sar­ily wor­ried about prob­lems as dra­mat­ic as last year’s Health­Care.gov fail­ure, but rather what one in­dustry of­fi­cial called “a soup of kind of icky things” that could make life dif­fi­cult for re­turn­ing en­rollees.

Some of the tech­nic­al prob­lems stem from the dif­fi­cult bal­ance between keep­ing people en­rolled and en­cour­aging them to shop for a bet­ter deal. Due to com­plic­ated be­hind-the-scenes changes in the way the law’s tax cred­its are cal­cu­lated, people who auto­mat­ic­ally re­new their policies, without tak­ing an­oth­er pass through the en­roll­ment sys­tem, are at risk for par­tic­u­larly large and of­ten sur­pris­ing cost in­creases.

To off­set the risk of wide­spread premi­um hikes, the ad­min­is­tra­tion will en­cour­age ex­ist­ing cus­tom­ers to go back through the sys­tem, up­date their per­son­al in­form­a­tion, and shop for a bet­ter deal. People who are will­ing to change plans can in­su­late them­selves from most premi­um hikes—but that’s where the tech­no­logy starts to get tricky.

For starters, re­turn­ing cus­tom­ers will have to use the old, 78-screen ap­plic­a­tion. New cus­tom­ers can use a sim­pler, faster, and more stream­lined 16-screen ver­sion.

Health and Hu­man Ser­vices of­fi­cials said the site will auto­mat­ic­ally fill in ex­ist­ing con­sumers’ in­form­a­tion, such as their ad­dress and in­come, to help speed them through the pro­cess even though they have to use a more cum­ber­some ap­plic­a­tion. That makes sense, as long as con­sumers take the time to change pre-pop­u­lated in­form­a­tion that has be­come out­dated.

“We don’t have great con­cern that people will be con­fused by the tech­no­logy,” said Andy Slavitt, the prin­cip­al deputy ad­min­is­trat­or at the Cen­ters for Medi­care and Medi­caid Ser­vices, at a re­cent brief­ing with re­port­ers.

The site won’t fill in a 14-di­git code that iden­ti­fies their ex­ist­ing policy; con­sumers will have to go find that code on a let­ter from their in­sur­ance com­pany and enter it them­selves. Adding that step might help prod con­sumers in­to shop­ping around, but the in­dustry of­fi­cial said there’s con­cern that it will simply con­fuse cus­tom­ers.

And while ma­jor im­prove­ments have been made to Health­Care.gov‘s user ex­per­i­ence, some parts of the sys­tem’s “back end” are still un­der con­struc­tion—in­clud­ing the mech­an­ism that re­con­ciles in­surers’ in­form­a­tion with the fed­er­al gov­ern­ment’s, to make sure both sys­tems ac­know­ledge they’ve en­rolled the same people.

As part of the re­con­cili­ation pro­cess, in­surers will get a list of every­one the gov­ern­ment has logged as reen­rolling in their plans. But they won’t get a list of people who have de­cided to drop their plans, the in­dustry of­fi­cial said.

This same in­form­a­tion was of­ten miss­ing, in­com­plete, or wrong dur­ing the first open-en­roll­ment peri­od—that was the fuss over “834” trans­mis­sions—and, partly be­cause of that ex­per­i­ence, in­surers are afraid some people will fall through the cracks.

Without a list of ter­min­ated policies, the in­sur­ance of­fi­cial said, in­surers don’t know whose cov­er­age they should cut off and who was simply lost in the shuffle but in­ten­ded to stay en­rolled.

Again, none of these are fatal prob­lems. In­surers man­aged to sign up nearly 8 mil­lion people largely by hand dur­ing the first open-en­roll­ment peri­od, and these tech­nic­al chal­lenges pale in com­par­is­on to last year’s.

But to whatever ex­tent these is­sues do trip up con­sumers, the short­er en­roll­ment win­dow might make the con­fu­sion harder to re­solve, at least quickly.

The second sign-up peri­od ends in Feb­ru­ary, soon after Obama­care en­rollees are sched­uled to re­ceive a no­tice out­lining the tax cred­its they re­ceived to help pay for their cov­er­age. If their sub­sidies were too big and they owe the IRS money, that doesn’t leave much time to go back and up­date their fin­an­cial in­form­a­tion for the next year, the in­dustry of­fi­cial warned.

Even so, the risks from a messy pro­cess aren’t nearly as great this year. Glitches will cause some bad head­lines for the ad­min­is­tra­tion, and will re­quire more tech­nic­al work, but un­like last year, Obama­care is already on its feet. Year one was about get­ting a crit­ic­al mass of people in­to the sys­tem so that the sys­tem could func­tion prop­erly—and the ad­min­is­tra­tion met that goal.

“If no one else ever signed up, it would func­tion fine,” said Jonath­an Gruber, a Mas­sachu­setts In­sti­tute of Tech­no­logy pro­fess­or who helped design Mas­sachu­setts’ health care law.

That doesn’t mean the law would suc­ceed at its most fun­da­ment­al goal—sub­stan­tially re­du­cing the num­ber of un­in­sured Amer­ic­ans. It’s too early for Obama­care’s sup­port­ers to de­clare the law a suc­cess, Gruber said, be­cause lackluster sign-ups in the second and third year could still pre­vent the law from cov­er­ing enough un­in­sured people.

“I think that if it cov­ers less than half [of the un­in­sured], I would be dis­ap­poin­ted,” Gruber said.

But in part be­cause there’s plenty of time to reach that goal, Gruber is bullish.

“I think right now on sub­stance there’s noth­ing to worry about,” he said.

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