Workplace

Glitches persist in Health Insurance Marketplace mandated by Obamacare

Updated: 2013-10-22T07:05:55Z

By DIANE STAFFORD

The Kansas City Star

Would-be health insurance buyers and the merely curious continue to be frustrated by the rocky rollout of the federal Health Insurance Marketplace.

Nearly three weeks into the planned launch of this centerpiece of the Affordable Care Act, Kansas City area residents, as well as millions nationally, are unable to get enough policy details to make purchase decisions.

“We’ve never successfully enrolled anyone,” said Joyce White, a trained site “navigator” working through a grant to the Shepherd’s Center in Kansas City. “I’ve never been able to see the actual insurance products, the real details about the plans.”

White is frustrated, but her frustrations pale compared with those of the Health and Human Services officials charged with making Obamacare work. Republican opponents of the health industry overhaul are calling for the resignation of HHS Secretary Kathleen Sebelius.

The White House said last week that Sebelius retains the administration’s confidence, but President Barack Obama is frustrated, too. He is expected to address the problems today during a health care event at the White House.

On Sunday, in a blog post that said the health insurance market “has not lived up to the expectations of the American people,” the Obama administration promised a “tech surge” to fix the problems.

“Our team is bringing in some of the best and brightest from both inside and outside government to scrub in with the team and help improve healthcare.gov,” according to the unsigned post, which went up on the Health and Human Services website. “We’re also putting in place tools and processes to aggressively monitor and identify parts of healthcare.gov where individuals are encountering errors or having difficulty using the site.”

Details about just how poorly the federal health insurance website is performing are hard to come by. Government officials won’t reveal until November how many people have successfully bought insurance through the program. But Obama administration officials who spoke on condition of anonymity said about 476,000 Americans have submitted applications for health insurance through the online exchanges being run by the federal government and 14 states. However, the officials continue to refuse to say how many people have actually enrolled in the insurance markets.

Aetna, which owns Coventry, one of two insurers offering plans on the federal marketplace that serves Kansas City area residents, has decided that “we believe it is too premature to release enrollment numbers at this time,” said spokesman Matthew Wiggin.

Blue Cross and Blue Shield of Kansas City, the other insurer offering plans for Kansas City area residents on the federal marketplace, also “preferred not to share specific enrollment numbers,” said spokeswoman Kelly Cannon. She added that “enrollment is currently slow” but emphasized that it extends to March 31.

The federal marketplace is the vehicle in most states, including Kansas and Missouri, for consumers to buy Obamacare health insurance plans and, depending on household income, be eligible for federal tax credits to subsidize the cost.

The site has been stumbling since it went online Oct. 1. Some technology experts believe that the $400 million site used outdated software and that a major overhaul is needed — not just remedies for “glitches” caused by heavy traffic to the site.

“They may be using 1990s technology in a 2.0 world,” Jeff Kim, president of CDNetworks, a content-delivery network, told USAToday.

One unnamed person “familiar with the system’s development” told The New York Times that the site was “70 percent of the way toward operating properly” but had no precise estimate about when the remaining fixes would be done.

“We are seeing progress,” said Joanne Peters, an HHS spokeswoman, in an email on Friday. “Wait times to begin the online process have been virtually eliminated, and more consumers are creating accounts, completing applications and ultimately enrolling in coverage.”

Privacy controls prevent outside computer experts from seeing the whole healthcare.gov system. For people concerned about consumer privacy, that’s a good thing. But it also contributes to a lack of precise information if HHS doesn’t choose to release it.

CGI Federal, the biggest government contractor to work on the healthcare.gov site, won a $93.7 million contract in December 2011 to build the site, but sources told The Times that it didn’t get the software specifications and begin writing code until earlier this year, and crucial software decisions about the enrollment process weren’t made until the end of September.

CGI, which bills itself as the world’s fifth-largest independent information technology and business process services company, does business with more than 100 U.S. federal agencies.

Other contractors, including Development Seed and Oracle, have said their parts of healthcare.gov are working correctly.

Heavy traffic

As of Thursday, federal officials said the site had received about 17 million unique visitors. That doesn’t count multiple attempts by the same person.

Independent companies that track Internet traffic have estimated that one-fourth of site users were able to enroll — not necessarily purchase policies — by the end of last week, up from about one-tenth in the earlier going.

HHS spokesmen have declined to be specific about the nature of the site’s problems, and outsiders are only able to speculate that the site’s complexity — perhaps including the need to integrate with the Internal Revenue Service’s site for tax credit reasons — is part of the problem.

The system requires personal information about income, family size and some health facts for users to find policy prices relevant for them. That enrollment step, which precedes the ability to shop for cost-specific plans, is another barrier.

Though many HHS employees were able to continue working on the Obamacare rollout because of a different funding stream, the partial government shutdown did send home some crucial IRS workers and others who could have been helping fix the healthcare.gov problems.

Federal officials ask for patience. Consumers have until Dec. 15 to enroll for full-year coverage beginning Jan. 1 and be eligible for the premium subsidies starting in January.

Users have until Feb. 15 to avoid being hit with tax penalties for failing to have health coverage next year, according to the ACA mandate. And they have until March 31 to obtain 2014 coverage through the program.

The federal tax credits, which may defray the cost of the insurance premiums for eligible buyers, are available only for policies bought on the marketplaces, also known as exchanges.

Another problem discovered by participating insurers is that some of the enrollment information is flawed. The Wall Street Journal reported Friday that about a dozen insurance companies nationally have discovered duplicate policy purchases, missing data fields and other errors by users.

In contrast, some state-operated insurance exchanges are faring better. Fourteen states chose to create and run their own exchanges that, for the most part, have had fewer computer problems or, because of the smaller size, have been better able to remedy them.

The state of Washington, for example, reported more than 46,700 successful enrollments on its state-operated site by week’s end. Kentucky, with another successful state site, reported nearly 14,000 successfully chosen insurance plans.

Specific enrollment numbers also have been reported by the state exchanges in Minnesota, Connecticut, Rhode Island, Nevada, Massachusetts, Maryland, Colorado and Washington, D.C.

The state site in California, which reported 95,000 enrollment starts in the first two weeks, shut down a part of its site temporarily to fix a search function that allows users to find out which doctors and hospitals participate in specific insurance plans.

Some of the state exchanges also allow consumers to browse policy prices before submitting personal information. Colorado, for example, said its site launch was fairly easy because of that consumer friendliness.

“All of us should have been doing state exchanges,” Kansas Insurance Commissioner Sandy Praeger said. “It wasn’t intended to be done this way. It was intended to be state-based. Insurance commissioners advocated for that. We know how to do these things. We have that experience. We could deal with the smaller capacity needed to deal with just a state exchange rather than the massive system that has to interface with multiple states’ Medicaid programs.”

Strong anti-Obamacare reaction in Kansas, Missouri and other Republican-dominate legislatures rejected any participation in the effort to get millions more Americans insured, including declining to accept federal funds to expand state Medicaid programs and make more people eligible for subsidized coverage.

In Missouri, the legislature prohibited state officials from assisting Affordable Care Act implementation in any way. A call to the Missouri state insurance commissioner’s office — to ask what kind of consumer reaction it’s hearing — produced this response:

“Any consumer calls the department has received regarding enrollment on the federal health insurance exchange were referred to CMS,” a reference to the Centers for Medicare & Medicaid Services, an HHS arm.

The longer it takes to streamline the federal enrollment process, the more worried Obamacare backers are about the success of the program that was designed to provide coverage for uninsured Americans.

They fear that young, healthier people — who haven’t been health insurance consumers anyway — will give up trying and that the only persistent shoppers will be the older, sicker people who desperately need the insurance they haven’t been able to get before. If the pool of insured is composed mostly of older, sicker people, the affordability of their insurance plans will be seriously jeopardized, undercutting a prime aim of Obamacare.

One independent online activity tracker said last week that traffic to healthcare.gov had dropped 88 percent since the first day. The analysis from Millward Brown Digital estimated that about 36,000 Americans successfully had signed up for an insurance plan online during the first week of enrollment.

Administration officials challenged those figures but didn’t provide alternatives.

“Time is critical,” Praeger said. “They have just a few weeks.”

Meanwhile, she said, “We’ll just keep plugging along.… They have to fix it. You can’t go to a paper system with something this big. It’d be so much easier if the states were doing it themselves. It’s just a shame that politics got in the way. This was an attempt to provide a private insurance-based marketplace. This was a conservative approach.”

Medicare enrollment is separate

Insurance brokers and navigators who are helping people shop for insurance on the healthcare.gov website say they are encountering confusion among Medicare recipients.

The message to Medicare recipients: You do not have to sign up for coverage at healthcare.gov.

Confusion is occurring because this is the annual enrollment period for Medicare’s prescription drug coverage and the private Medicare Advantage plans. But officials emphasize that Medicare enrollment has nothing to do with the Affordable Care Act or the new Health Insurance Marketplace.

A glimpse at Obamacare policies

Here’s a Web address to see basic information about the policies being offered to Kansas City area consumers under the Affordable Care Act: https://www.healthcare.gov/find-premium-estimates/

This site provides policy names and premium costs before calculating possible price breaks through tax credits.

The state of Kansas also provides this informational site: http://insureks.org/rates.php. It includes a tax credit calculator that gets an eligible buyer close to what subsidized premium costs would be.

Bloomberg News and The Associated Press contributed to this report. To reach Diane Stafford, call 816-234-4359 or send email to stafford@kcstar.com.

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