Exchange glitches hint at problems with sustainability of Affordable Care Act
Wednesday, October 23, 2013
The launch of the online health insurance marketplace, considered to be the cornerstone of the Affordable Care Act, was marred with reports of long delays, websites crashing and consumers being unable to complete their insurance-purchasing transactions.
President Barack Obama said there were "no excuses" for the problems people are experiencing with the federal insurance exchange website, healthcare.gov. But the true impact of the problems could go well beyond people simply being upset by having a less-than-user-friendly experience.
On Oct. 21, Obama made a public address saying the government was calling in experts from both the private and public sectors to help resolve the issues. He was not specific about the problems, but reports indicate that more serious errors, such as incorrect data about applicants being sent to insurers, were occurring that could cause ongoing problems if not resolved.
Reports indicate that among the experts called in to help was telecommunications giant Verizon, which developed a cloud-based health information exchange platform three years ago. Technology industry analyst Jeff Kagan was happy to hear Verizon was called but questioned why the company wasn't involved during the design and testing phases of the project.
Kagan said the best solution would be to scrap the current website and start over from scratch with the industry experts leading the charge as opposed to tackling each problem with the existing, flawed system. Either way, he said, a delay is needed.
"I think if we take egos out of the equation, the smartest thing to do would be to postpone rollout," Kagan said. "Look to start it in six months or maybe a year from now. Take time and fix the problems, then after testing, roll out the new version."
Others, such as Barry Sloane, CEO of Newtek Business Services, thinks the project was an impossible feat from the start. Newtek is a business services company that offers health benefit plans to small- and medium-sized businesses and their employees.
"Despite the politics ... operationally, I don’t believe this can be done," Sloane said. "We deal with health insurance carriers all day long. They are not set up to pass and transfer data," he said, adding that the need for these sites to tie in to Medicare, Medicaid, the IRS and multiple carriers, complicates things even further.
Twenty-seven states have a federally-run exchange, while there are 17 state-run sites and seven with a partnership marketplace. A Pew Research survey conducted Oct. 9-13 among 1,504 adults shows those using state-run exchanges are having a slightly better experience than those using the federally-run site. In states with state-run exchanges, 32 percent said the websites are working well compared with 26 percent in states with federally-run exchanges.
But there have still been reported glitches on state-run sites. Oregon is processing applications for private insurance manually due to the system's inability to determine who qualifies for subsidies. Several other states including New York, Maryland and Hawaii also experienced delays getting their sites fully functional.
Elizabeth Schneider, an independent contractor in Washington, D.C., said after long delays accessing the D.C. Health Link insurance exchange site on Oct. 1, she went back to the site two days later and successfully created a profile. She was able to compare plans and found options cheaper than the COBRA plan she had been on. She stopped before submitting the application, however, when she realized her profile listed her as a smoker.
Schneider spoke with a customer service representative who confirmed there was a glitch but said the smoking status would not affect her rate. Regardless, Schneider thought about possible implications of being on file as a smoker, including future premium rates or inappropriate treatment plans.
But mostly, it was a matter of pride. She had a hard time quitting nine years ago, but has remained a nonsmoker since then. The thought of being on record as a smoker didn't sit well with her. After a few days, the glitch was fixed, but Schneider still has not completed the application process.
The Pew survey found 46 percent of those surveyed said the exchanges were not working well, but only 14 percent reported actually visiting an exchange site. Of those who used the sites, 56 percent said they found the site they visited very or fairly easy to use.
Some are speculating that the glitches, if not resolved, could lead to delays to the mandates or hamper the administration’s goal of having 7 million people signed up by March 31 when the open enrollment period closes. But others believe the glitches don’t jeopardize the intent of the law being fulfilled.
"Regardless of whether 7 million or 700,000 people sign up by March, what is important is that Americans now have a clear pathway to more affordable and accessible health care," said Summer McGee, associate professor of public management at the University of New Haven. "This was the goal of the law, not meeting arbitrary deadlines for enrollment."
Some are hopeful there’s still time to fix the problems and leave ample opportunity for people to purchase their plans by Dec. 15 to start coverage Jan. 1, 2014, or purchase a plan by the end of the open enrollment period, March 31, 2014, to avoid fines. The Dept. of Health and Human Services is expected to release data in November showing how many plans have already been purchased through the exchanges, a number many are expecting to be low.
"Even if the federal marketplace were operating perfectly, it is unlikely large numbers of consumers would be willing to make their first premium payment now (the final step required before enrollment is confirmed) for coverage that doesn't begin until January," said Jacqueline Garry Lampert, founder of Lake Street Strategies, a public policy strategy and consulting firm in New Bremen, Ohio.
Lampert represented Senate Majority Leader Harry Reid, D-Nev., in negotiations to draft and pass the Affordable Care Act and consulted the University of Pittsburgh Medical Center on the launch of its Health Care Reform Simplified website meant to help patients understand the ACA.
If the problems aren't fixed in a timely manner, Lampert is concerned that those who will persevere through the technical challenges will be those who need insurance the most: older, chronically ill patients. If the young and healthy, who will be needed to diversify the risk pool, put off getting coverage due to the technical challenges, premiums could rise, putting the sustainability of the law at risk, she said.
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