Health Insurance Report™ helps you track and analyze legal, legislative, and regulatory developments affecting the health-insurance industry throughout implementation of the Affordable Care Act...
By Sara Hansard
Oct. 7 --Work done to increase access to the federally facilitated health insurance marketplace website, HealthCare.gov, is beginning to show results, a Department of Health and Human Services spokeswoman told Bloomberg BNA in an e-mail Oct. 7.
“Our work to expand the site's capacity has led to more people successfully applying for and enrolling in affordable health coverage online, with wait times being shortened by approximately 50 percent” since Oct. 4, HHS spokeswoman Joanne Peters said. The administration has not provided any information on the number of people who have enrolled in plans through the online marketplaces, also known as exchanges.
“But we won't stop until the doors to HealthCare.gov are wide open, and at the end of the six-month open enrollment, millions of Americans gain affordable coverage,” she said.
Connections to HealthCare.gov's sites for the 36 states in which the HHS is operating marketplaces for individual coverage continued to display messages Oct. 7 intermittently saying, “We have a lot of visitors on the site right now. Please stay on this page.” The page referred visitors to a 24-hour call center. “Call center wait times are seconds, not minutes,” Peters said in the e-mail.
Late Oct. 4 the HHS said in an e-mail that HealthCare.gov received 8.6 million visitors at the finish of its first week in operation and 225,000 requests for online chats. The HHS took down the application part of the website for scheduled maintenance during off-peak hours over the weekend, it said.
In an e-mail statement to Bloomberg BNA Oct. 7, the HHS said that “an extraordinary number of people are coming to check out HealthCare.gov,” suggesting a strong interest by consumers in getting information about health coverage. In a telephone briefing with reporters Oct. 1, when the marketplaces opened, Centers for Medicare & Medicaid Services Administrator Marilyn Tavenner said traffic on the site was more than seven times what Medicare.gov has ever experienced, which led to the disruptions (see previous article).
In the Oct. 7 statement, the HHS said it is undertaking a threefold operation to improve the system:
• continuing to add more server capacity, enabling the system to carry bigger loads;
• moving the specific component of the system that became overstressed from virtual machine technology to powerful dedicated hardware; and
• making software changes to enable the system to perform more efficiently and handle higher volumes.
More than 560,000 calls have been made to the call center, and people can apply over the phone 24 hours a day, seven days a week, the statement said.
“While we are increasingly moving more users through the system, we are not satisfied with the performance,” the HHS said. “We can do better.”
The HHS said Oct. 4 that it plans to issue regular updates on implementation, including enrollment statistics. Updates will likely be released in the middle of the following month “to ensure accuracy,” it said. The HHS must coordinate enrollment from different sources, including paper applications, online data and call centers; verify the information with insurers; and collect data from states, it said. Frequent releases of enrollment data in small states risk violating individuals' privacy, it said.
States have discretion in the frequency and types of data that they release but generally will release enrollment data monthly as well, it said.
Open enrollment in the first year of implementation of the Affordable Care Act lasts until March 31, 2014, and applications must be received by Dec. 15 for coverage to begin Jan. 1, 2014.
The Blue Cross and Blue Shield Association, which represents plans that are offering products in 47 states and the District of Columbia as well as a multistate plan in 30 states, issued a statement Oct. 4 saying it is “pleased that enrollment for healthcare coverage through the new insurance marketplaces is picking up, and that consumers around the country are choosing Blue Cross and Blue Shield coverage. We expect enrollment to continue to increase.”
The system problems generated criticism from opponents of the ACA. House Speaker John A. Boehner (R-Ohio) issued a statement Oct. 4 saying the news that the enrollment system was going offline for the weekend “confirms that the launch of the president's health care law has been an unmitigated disaster. What the administration wanted to dismiss as simple glitches have turned out to be a system-wide failure.”
Implementation of the law needs to be delayed, as Republicans have called for, Boehner said. Referring to the tax penalty that is to be assessed against people who do not have health insurance, he said, “How can this administration tax individuals for not purchasing a product from a website that doesn't even work?”
Brian Haile, senior vice president for health policy with Jackson Hewitt Tax Service Inc., told Bloomberg BNA that the fact that Medicare open enrollment is scheduled to begin Oct. 15 could create problems with HealthCare.gov's open enrollment period.
“The concern is if you're promoting HealthCare.gov in the middle of the Medicare open enrollment period it will inevitably produce a lot more traffic, and frankly, confusion,” Haile said.
The volume of traffic HealthCare.gov is experiencing “should not have been particularly surprising” to the administration, Haile said. “I'm caught a little off guard by their representations that they were surprised by the volume.” The Congressional Budget Office estimated that about 7 million people would enroll through the marketplaces for 2014.
Haile also said that from working with clients, Jackson Hewitt has found that call center representatives have given out erroneous information to callers.
Many problems are “plaguing both the federal and state exchanges,” John Gorman, chief executive officer of Gorman Health Group LLC, told Bloomberg BNA.
In the state marketplaces, “It appears the ones having the most trouble are the ones that made the strategic decision to require the consumer to open an account before they could go shopping,” Gorman said, citing Maryland's exchange as an example. States that let people shop before setting up an account, such as Connecticut, “are moving them through at a relatively rapid pace,” he said.
In the federal marketplaces, “predictably, with vendor contracts signed just weeks ago and then launched on a shoestring in the middle of a shutdown, nothing's working,” Gorman said. Little was tested before the system was launched, “and the volume is rubbing raw all of the holes in the coding,” he said.
That means the federal government will have to rely on paper applications initially, Gorman said. That will cause “a host of issues for the plans,” since they will not receive confirmation of enrollment, which could lead to errors, he said.
However, “Despite these technical barriers I don't think uninsured people are going away,” Gorman said. “They're going to come back until they are successful. This is not like a discretionary item. This is health insurance.”
On Oct. 7 House Energy and Commerce Committee ranking member Henry A. Waxman (D-Calif.) sent a letter to committee Chairman Fred Upton (R-Mich.) asking him “to correct a series of inaccurate statements that you released last week on the Affordable Care Act Navigator program.”
On Oct. 2 a committee press release claimed that navigators, groups hired to conduct outreach on the ACA and help people get enrolled in coverage, “go door to door,” presenting consumer protection concerns, Waxman said in the letter. The release cited a Fox News story as the source, he said.
“This assertion was not correct,” Waxman said. Neither of the two groups cited in the Fox News report--the United Way affiliate serving Coral Gables, Fla., and Enroll America--are part of the federal navigator grant program, he said. An Oct. 4 release saying that residents in Florida received visits at home from United Way and Enroll America identifying themselves as navigators also “appears to be inaccurate,” he said.
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Waxman's letter to Upton is at http://democrats.energycommerce.house.gov/sites/default/files/documents/Upton-Florida-ACA-Navigators-2013-10-7.pdf.
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