Insurance companies selling through the health law鈥檚 troubled online marketplaces are scrambling to provide coverage by Jan. 1 even as swarms of customers are still enrolling and making their first payments.
Federal officials and state regulators have repeatedly altered rules to allow the Affordable Care Act鈥檚 computers to enroll as many as possible before 2014 begins. The combination of problem software, changing deadlines and shifting regulations over the last two months is unprecedented, insurers say.
鈥淕oing into this, knowing things weren鈥檛 going to go swimmingly, we did a lot of scenario planning so the health plans could build out contingency plans,鈥� said Paul Lambdin of Deloitte Consulting, which advises insurers. 鈥淎nd thank goodness we did. But no one thought up the scenario we鈥檙e living in.鈥�
Medical plans, with potentially billions in revenue at stake in the health law鈥檚 expansion of private coverage, have hired extra workers to run phone banks and tangle with paper applications that were supposed to be processed online.
They鈥檝e assigned staff to pore through electronic enrollments that might be inaccurate or incomplete, or to remind customers to pay. They鈥檙e guiding applicants who were expected to sign up on the federal healthcare.gov site or portals run by the states.
鈥淲hen you look at the problems associated with healthcare.gov and how long it took to be fixed, it seems unfair to ask insurance companies to have their systems incorporate these changes within a few weeks,鈥� said Stephen Zaharuk, an insurance industry analyst for Moody鈥檚 Investors Service, which rates bonds.
Implementing the health law involved countless deadlines, but one that can鈥檛 budge is coverage for Jan. 1.
On Thursday the administration disclosed another change, exempting those whose policies have been cancelled from next year鈥檚 coverage requirements and allowing them to buy high-deductible聽鈥渃atastrophic鈥� plans. Fewer than 500,000 people face losing insurance because of cancellation, administration officials told reporters.
Although marketplace enrollment for 2014 doesn鈥檛 end until March 31, many consumers are counting on insurance in January to replace expiring 2013 plans. Others without coverage, many with existing illness, have been promised for years that Jan. 1 is when they can have affordable, subsidized, comprehensive coverage for the first time.
鈥淚 can tell you they鈥檙e going to have people working through New Year鈥檚 Eve,鈥� Lambdin said of the insurers. 鈥淚f someone wants to see how hard the health plans are working, they can join them at their party.鈥�
The Congressional Budget Office that 7 million would buy policies in 2014 issued by private insurers through the subsidized marketplaces, or exchanges. (That鈥檚 in addition to millions more low-income consumers expected to gain new Medicaid coverage in states that chose to expand it.)
But thanks largely to computer problems that surfaced after the exchanges opened in October, fewer than half a million had signed up through November.
The Phones Are Ringing
Since then insurers and marketplace administrators have enrollment surges and substantially improved software.
鈥淲e have definitely staffed up,鈥� said Jon Urbanek, a senior vice president at Florida Blue, the Blue Cross affiliate in that state. 鈥淲e鈥檙e looking at extremely high volumes coming in during the holidays.鈥�
Call volume to Blue Cross and Blue Shield of Minnesota 鈥渟ort of ebbs and flows with the wait times on MNsure,鈥� the Minnesota portal that sometimes keeps people waiting an hour or more, said Scott Keefer, the insurer鈥檚 vice president of policy.
Blue Cross Blue Shield of Michigan to let applicants learn their eligibility for subsidies via phone text.
Health Care Service Corp. got a flood of calls related to President Barack Obama鈥檚 request last month that insurers allow customers to renew 2013 plans that don鈥檛 include required benefits under the Affordable Care Act, said Jeff Tikkanen, the company鈥檚 president of retail markets. HCSC runs Blues plans in New Mexico, Texas, Oklahoma, Illinois and Montana.
That, too, required more staff, he said.
The original signup deadline for January coverage was Dec. 15. In November, the Obama administration extended it to Dec. 23. This month it ordered insurers to accept payment even later 鈥� up to Dec. 31. Then insurers to take payment until Jan. 10.聽
Insurers have said little about the administration鈥檚 request that they provide Jan. 1 coverage for those who sign up and pay after that.
Taking Preventive Steps
In any case, nobody expects everything to be done on time.
The health maintenance organization Kaiser Permanente expects some new subscribers to walk into clinics without yet having received their membership cards.
鈥淲e already have established mechanisms in place for handling people who show up at the medical centers but are not in our systems as members,鈥� said Kaiser spokesman Chris Stenrud. 鈥淲e trust the member and provide any immediate care needs. If the person turns out not to be a member, we will bill them for those services.鈥�
(Kaiser Health News is not affiliated with Kaiser Permanente.)
Cigna, selling exchange plans in Florida, Texas and elsewhere, has set up 24-hour hotlines, and a team to deal with new members and 鈥減ost-enrollment snafus,鈥� said spokesman Joe Mondy. New subscribers should expect a welcome package, but 鈥渋f they don鈥檛 get a binder within a week鈥檚 time, they need to call us and make sure everything is in place,鈥� he said.
Blue Cross Minnesota assigned people to double check electronic applications from MNsure.
鈥淪ometimes the addresses don鈥檛 match. The date of birth may not match,鈥� Keefer said. 鈥淲e鈥檝e had cases showing the dependents are the parents, and the parents are actually the children. Weird stuff like that.鈥�
Another concern is that insurers might not聽 get any enrollment file, flawed or not, from the federal healthcare.gov site run by the Centers for Medicare & Medicaid Services. Insurers have reported in data handoffs.
鈥淭hat鈥檚 the problem most of us are worried about 鈥� people who have selected a health plan and we haven鈥檛 heard from CMS on,鈥� said HCSC鈥檚 Tikkanen. 鈥淚f I don鈥檛 have a record of them I don鈥檛 know who they are.鈥�
Florida Blue advises new customers to print a screen shot of the enrollment confirmation on healthcare.gov just in case related emails and data submissions don鈥檛 get sent.
鈥淭hat gives them something to keep in hand,鈥� Urbanek said.