D-Day for HealthCare.gov is
upon us.
The federal health insurance marketplace for 36 states has
undergone round-the-clock fixes during the past eight weeks after what could
only be characterized as a disastrous launch. Obama administration officials
have promised that it will work better by month’s end (read: now) for the “vast
majority of users.”
There’s little doubt the site
is working better today. Users report that it’s faster and has fewer
errors. Practically every day, the Obama administration reports progress.
But it’s unclear whether the improvements are enough to
salvage the Affordable Care Act’s central element and ensure consumers can get
coverage before Dec. 23, the deadline to sign up for benefits that begin on New
Year’s Day.
Here are six big questions:
- Can
the website handle the expected crush of traffic? Media reports
about problems with HealthCare.gov surely kept some consumers away. But as
the deadline for signing up for coverage looms, they are likely to come
back. The
New York Times reported today that administration officials “have
urged their allies to hold back enrollment efforts so the insurance
marketplace does not collapse under a crush of new users. At the same
time, administration officials said Tuesday that they had decided not to
inaugurate a big health care marketing campaign planned for December out
of concern that it might drive too many people to the still-fragile
HealthCare.gov.” The trepidation is well-founded, and a dose of it could
have gone a long way on Oct. 1, when the site debuted. - Are
the site’s back-end problems fixed? One of the biggest issues —
out of public view — is that information being transmitted from the
administration to insurance companies has been riddled with errors,
hampering the smooth enrollment of consumers. Sarah Kliff
at The Washington Post drew
attention to this major problem last month, and while the
administration has made fixing the problem a top priority, the error rate
remains too high, experts say. Philip Klein of the Washington
Examiner reports, “Insurers still haven’t reached the point where they
can feel confident that the data is reliable. As a result, though they
have been able to process some payments from individuals, they’ve only
been able to do so on a piecemeal basis in cases where they are fully
confident in the data, often because it’s been verified by hand.” - Can
individuals verify their identities so that they can enroll in
plans? The New
York Times reported Monday that some consumers are getting stuck
in “no man’s land” in which they sign up for accounts on HealthCare.gov
but are prevented from selecting plans because their identities cannot be
verified by an outside contractor. “Many users of the website have had
their applications cast into limbo after they uploaded copies of documents
like driver’s licenses, Social Security cards
and voter registration cards, or sent them to the office of the federal
insurance marketplace in London, Ky. Administration officials said the
government had established strict procedures to verify that people
applying for insurance were who they said they were, in order to prevent
fraud and identity theft. But a breakdown in the process instead is
causing concern among some consumers about the handling of their personal
information.” - Will
the delayed Spanish language sign-up site work? CuidadoDeSalud.gov has been
repeatedly delayed because of the issues plaguing its sister site,
HealthCare.gov. The administration initially said it would be ready by
mid-October, then the end of November. Now Talking Points Memo says it
will have
a soft launch in early December. That doesn’t give much time at
all for Spanish speakers to sign up online before the Dec. 23 deadline for
coverage that begins on Jan. 1. Of course, those consumers can fill out
paper applications or call the toll-free number for assistance, but the
online option cuts it very close. “The administration projects
10.2 million uninsured Latinos will be eligible to sign up for coverage.
Federal call centers have so far fielded about 107,000 Spanish-language
calls, according to the official, three percent of their total volume.
Though national Latino advocacy groups have been generally supportive of
the health care reform law, they have begun to voice frustration about the
delays to the Spanish-language website,” Dylan Scott reports for TPM. - Will
enough people sign up for coverage—and are they the right people? Ultimately
the Affordable Care Act’s marketplaces will be judged by how many people
enroll in coverage. The Congressional Budget Office projected 7 million
people would sign up in 2014 (in the federal and state-run exchanges), but
best I can tell that doesn’t really take into account the millions of
people canceled by their existing insurance plans who may replace their
coverage on the exchange. Beyond that, insurance companies need a balance
of old and young, healthy and sick to balance their costs and avoid a
“death spiral” in which costs keep going up and only the old and sick who
must have coverage choose to stay in. Ezra Klein at The Washington
Post says
Obamacare enrollment won’t hit 7
million, but that will be OK if the mix of consumers is acceptable. “No
one will ever look back on Obamacare’s launch
and call it a success. The question is whether they’ll look back and say
that Obamacare subsequently became a success.
And that’s why the bottom-line goal for the White House is still the ratio
of people who sign up for 2014 rather than the raw number of who sign up
for 2014,” he writes. - Will
all the state-run exchanges get it together? While some states,
including California, Kentucky and Washington state,
have won praise for a relatively smooth rollout of their marketplaces,
other states are still having more trouble. Covered Oregon has been
plagued by so
many problems that its online sign-up isn’t working yet. Maryland
likewise is struggling.
And the head of Hawaii’s exchange stepped
down last week amid problems there. Even if HealthCare.gov is up
and running, residents of these states have to rely on the pathways set up
where they live.
Editor’s Note:
This post is adapted from Ornstein’s “Healthy
buzz” blog. Has your insurance been canceled? Have you tried signing up for
coverage through the new exchanges? Help us cover the Affordable Care Act by
sharing your insurance story.
