Obamacare Enrollment Problems Might Be Blessing in Disguise

If front-end problems are fixed quickly, back-end issues will be more apparent.

US President Barack Obama speaks about immigration reform in the East Room of the White House in Washington, DC, October 24, 2013. The President renewed his call for Congress to pass sweeping immigration reform.
National Journal
Sam Baker
Add to Briefcase
See more stories about...
Sam Baker
Oct. 24, 2013, 1:49 p.m.

Quickly fix­ing Obama­care’s most vis­ible prob­lems could be a dis­aster for the health care law.

By now, pretty much every­one knows that Health­Care.gov, the main portal to ac­cess the law’s new in­sur­ance ex­changes, doesn’t work. When the site first launched, hardly any­one could cre­ate an ac­count to be­gin shop­ping for cov­er­age. And though the re­gis­tra­tion prob­lems have got­ten bet­ter, en­roll­ment is still an up­hill climb.

The site’s dis­astrous front end has over­shad­owed an­oth­er set of ser­i­ous prob­lems on the back end. In­sur­ance com­pan­ies say they’re see­ing wide­spread er­rors in the trickle of ap­plic­a­tions they do re­ceive through the ex­changes.

And un­til those er­rors can be fixed, it might be best to leave en­roll­ment at a trickle.

“Is CMS stu­pid enough to fix the front end of this thing be­fore they fix the back end?” asked Bob Laszewski, a health care con­sult­ant who works closely with in­surers.

In Laszewski’s view—and he’s hardly alone—the fact that users can’t eas­ily log in to Health­Care.gov is a bless­ing in dis­guise. Sure, it’s a polit­ic­al and pub­lic-re­la­tions head­ache for the White House, but leav­ing the back-end prob­lems un­checked could be a big­ger one.

In­sur­ance com­pan­ies are see­ing a range of er­rors in the ap­plic­a­tions they re­ceive through Health­Care.gov. One an­ec­dot­al re­port said a man showed up as hav­ing three spouses, two of whom were ac­tu­ally his de­pend­ents.

In­surers also say they’ve got­ten an en­roll­ment, fol­lowed by a can­cel­la­tion, fol­lowed by an­oth­er en­roll­ment. They don’t know why, and in some cases, the vari­ous doc­u­ments don’t have time stamps—so the in­sur­ance com­pany doesn’t know which is the most re­cent and, pre­sum­ably, the ac­cur­ate trans­ac­tion to pro­cess.

CGI, the con­tract­or that built most of Health­Care.gov, down­played the back-end er­rors dur­ing a con­gres­sion­al hear­ing Thursday.

“We have un­covered a num­ber of those scen­ari­os—not sig­ni­fic­ant—but a num­ber of them. “¦ Most of them are isol­ated, not across the board for all in­surers,” CGI’s Cheryl Camp­bell said.

But an in­sur­ance in­dustry of­fi­cial said the prob­lems are ac­tu­ally much more wide­spread than Camp­bell in­dic­ated. In­surers simply don’t have much con­fid­ence in the data they’re get­ting, even the ap­plic­a­tions that don’t con­tain ob­vi­ous er­rors.

Laszewski ques­tioned wheth­er CMS is truly work­ing over­time to fix the site’s front-end prob­lems, in which case “they’re about to flood the in­sur­ance com­pan­ies with crummy data,” or quietly let­ting the sign-up prob­lems linger to help identi­fy and fix back-end er­rors.

The lat­ter would be the smarter move, he said, but it would also be an ac­know­ledge­ment of ser­i­ous prob­lems in the en­roll­ment pro­cess.

“They’re either really stu­pid or they’re smart. And if they’re smart, this is de facto shut down,” he said.

Right now, the flow of new en­rollees from Health­Care.gov is so slow that in­sur­ance com­pan­ies can mon­it­or ap­plic­a­tions by hand, track­ing down in­con­sist­en­cies one by one. But if hun­dreds or thou­sands of people start to come through the sys­tem, in­surers won’t be able to keep up—and they could end up get­ting the blame from angry cus­tom­ers for prob­lems they didn’t cause.

In­surers also don’t yet know the ex­tent of the ex­changes’ bad-data prob­lems.

Health­Care.gov batches and sends over all of its en­roll­ments every night. But only two of the state-run ex­changes (which total 14, plus the Dis­trict of Columbia) are sub­mit­ting en­roll­ments to in­sur­ance com­pan­ies; the rest are hold­ing off un­til at least Nov. 1, while they con­tin­ue to test their own sys­tems.

States are giv­ing each in­surer a sense of how many people signed up for each plan, but the com­pan­ies don’t know who their new cus­tom­ers are—wheth­er they’re the young, healthy con­sumers in­surers cov­et, or older, sick­er en­rollees who are more likely to file ex­pens­ive claims.

Chris Clark, the tech­no­logy pro­gram man­ager for Ken­tucky’s state-based ex­change—widely con­sidered one of the best in the coun­try—said the state and in­sur­ance com­pan­ies agreed early on to a delayed sub­mis­sion pro­cess. Ken­tucky is still test­ing the ac­cur­acy of the en­roll­ment forms it will sub­mit to in­surers.

“We’re very con­fid­ent that that pro­cess is go­ing to work smoothly,” Clark said.

What We're Following See More »
APPEALS COURT RULED TRUMP EXCEEDED HIS AUTHORITY
Supreme Court Takes Up Trump Travel Ban
5 hours ago
THE LATEST

The Supreme Court announced "that it would consider a challenge to President Trump’s latest effort to limit travel from countries said to pose a threat to the nation’s security." The case concerns Trump's most recent attempt to make good on a campaign promise "tainted by religious animus" and only questionably justified by national security concerns. The decision to take the case, called Trump v. Hawaii, comes almost exactly a year after Trump issued the first travel ban. The ban under consideration affects Iran, Libya, Syria, Yemen, Somalia, Chad and North Korea.

Source:
FACES STIFF OPPOSITION FROM BOTH PARTIES
Trump Proposes 95 Percent Cut To Office of Drug Control Budget
7 hours ago
THE LATEST

Trump wants to move the two grants, the High Intensity Drug Trafficking Areas grant and the Drug Free Communities Act, to the Justice and Health and Human Services departments, respectively. This would result in a $300 million plus reduction in funding, about 95 percent of the cost of the Office of National Drug Control Policy. "'I’m baffled at the idea of cutting the office or reducing it significantly and taking away its programs in the middle of an epidemic,'" said Regina LaBelle, who served as ONDCP chief of staff during the Obama administration. This is the second time the Trump Administration has proposed gutting the agency.

Source:
HOPES A DEAL CAN GET DONE
Schumer Meeting with Trump for Last-Ditch Meeting
8 hours ago
THE LATEST
BLURRY LINE BETWEEN BUSINESS/PRESIDENCY
New CREW Report Identifies 500 Conflicts of Interest in Trump’s First Year
9 hours ago
THE DETAILS

A new report assembled by the watchdog group Citizens for Responsibility and Ethics in Washington has identified more than 500 potential conflicts of interest in President Trump's first year. First, the report notes, Trump spent 122 days at his properties during his first year. He has been accompanied by 70 federal officials and 30 members of Congress. "Second, far from this signaled access to power being an empty promise, those who patronize President Trump’s businesses have, in fact, gained access to the president and his inner circle." Lastly, about 40 special interest groups and 11 foreign governments have held events at Trump properties.

Source:
BY SCALISE
House Told to “Stay Flexible”
10 hours ago
THE DETAILS
×
×

Welcome to National Journal!

You are currently accessing National Journal from IP access. Please login to access this feature. If you have any questions, please contact your Dedicated Advisor.

Login