Reality Check

Reality Check

Vets the truthfulness of claims and measures the efficacy of public policy

Reality Check: Obamacare Promise Kept?

By Sam Brock
|  Tuesday, Dec 3, 2013  |  Updated 8:10 PM PDT
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In this edition of Reality Check, Sam Brock examines whether the president's statement to get an operational website up by Dec. 1 held true.

In this edition of Reality Check, Sam Brock examines whether the president's statement to get an operational website up by Dec. 1 held true.

Plagued by technical issues from the very outset, the federal health care insurance exchange, healthcare.gov, has been a sore spot for champions of the Affordable Care Act and an albatross around the neck of President Obama.

The president assured Americans after the failed launch in October that the site would be fixed. ASAP.

He gave December 1st as a deadline for a functional web site, and now that we’ve passed that date has he kept his promise?

On the “front end,” meaning the ability to access and use the site, the early results appear positive.

The federal government’s Centers for Medicare and Medicaid Services, or CMS, says more than 50,000 users can now browse the website simultaneously, crash rates are down and wait times are slashed to mere seconds.

“Overall, it appears to be working well for people enrolling,” said Ken Jacobs, Chair of UC Berkeley’s Labor Center who has been studying the impact of the new law on California’s marketplace. “There are some little problems here and there, but huge
improvement over where they were.”

It should be noted, Jacobs has been modeling the marketplace for Covered California, a separate exchange from the federal platform used in 36 states (the other states, like California, run their own exchanges).

But Jacobs added the real “proof will be in the pudding” for the federal exchange, namely that many of the complaints about “back end” issues have yet to be resolved.

The insurance companies participating in the federal marketplace have complained that the enrollment forms, called 834 transaction forms, they receive when an individual signs up have been riddled with errors.

There’s also a major concern the federal government has yet to set up a system to pay insurers for subsidized plans.

“It is my understanding that that has not been set up yet,” said Jacobs. “They’ve got another month to get that in place.”

On January 1st, health care coverage purchased on the exchange can take effect.

Health plan providers, for their part, are not as optimistic as the president that these issues have been fixed and the website made functional. Because after all, what good is an exchange that can be used for sign up but not enrollment?

“Healthcare.gov and the overall enrollment process continue to improve but there are significant issues that still need to be addressed,” declared America’s Health Insurance Plans President and CEO Karen Ignagni in a public statement.

The group, also known as AHIP, is a national trade association representing the health insurance industry.

“Until the enrollment process is working from end-to-end, many consumers will not be able to enroll in coverage,” Ignagni added.

A CMS spokesperson told reporters this week that the reporting problems had largely been fixed, attributing the issue to a social security number coding glitch.

“More than 80 percent of the 834 production errors were actually due to one bug that prevented a social security number from being included in the application,” said Julie Bataille, the agency’s director of office communications. “The lack of that number caused the system not to generate an 834. The bug has been fixed and is now working properly.”

But Bataille could not provide any details on the scope of the problem - namely how many people were and continue to be affected.

AHIP did not buy the explanation, telling NBC Bay Area that health plans “are still seeing problems with the 834 enrollment files.” The group does not expect to know if the changes are working for at least another couple of days.

So who’s telling the truth here, the government or the insurance industry? Is the web site only semi-functional or can it relay accurate enrollment information to insurers?

“I don’t think that there’s objective data to say one way or the other,” said Marian Mulkey, a health reform expert at the California Healthcare Foundation, a philanthropic and research-based organization that strives for better health care outcomes in California.

“I think that there are questions about the technical handoff of information from healthcare.gov to the insurers, as well as the accuracy of that information,” Mulkey continued. “And again, I’m not in a position to state definitively one way or the other.”

Mulkey was able to assess the potential fallout, however, if enrollment reporting errors continue to occur.

“It will have real implications for consumers in terms of their access to care,” she said. “If there’s a glitch in that process, anywhere along the line - a handoff that isn’t made or an inaccurate piece of data- then that consumer potentially will show up at the doctor and it won’t be known how much they owe, or the plan will pay and it will turn out that the consumer really wasn’t eligible in the first place.”

Will consumers experience these nightmare scenarios? And just as importantly, how many people are impacted by the reporting problems?

Until those questions are answered, it will be difficult for the president to claim an operational web site….or that his promise has been kept.

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