Insurers Working With Administration to Fix Enrollment File Errors, Industry Exec Says

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By Sara Hansard  

Dec. 3 --A health insurance executive Dec. 3 said the industry is working with the Obama administration to correct errors in enrollment files from the insurance marketplace website.

Referring to a report in the Washington Post that about a third of enrollment files transmitted to insurers by have errors in them, Daniel Durham, executive vice president, policy and regulatory affairs at America's Health Insurance Plans (AHIP), said, “That's what our plans are experiencing, and that's what our plans are working with the administration to fix.”

Durham spoke at a public policy forum on Affordable Care Act implementation, sponsored by Arent Fox LLP and the Georgetown University McCourt School of Public Policy. “An enrollment file comes over and it doesn't have complete information, or it's a duplicate, or if the file never arrives at the health plan, then we have problems enrolling individuals,” he said.

Although the Obama administration has improved the operation of, which has experienced major problems since the marketplaces opened Oct. 1, “There's still significant progress that needs to be made,” Durham said.

“In addition to fixing all the front-end problems that the health-care site has been experiencing, there has to be a focus on the back end,” Durham said. Work has been done to solve problems involving creating accounts, applying for premium tax credits and cost-sharing subsidies and shopping for and choosing plans, he said. But transmission of the “834” files that contain details plans need to enroll people is “where we're having trouble today,” he said.

Higher Volume Hard to Handle

“So far we've been able to deal with these issues because there's been a relatively low volume,” Durham said. “It's been a heavy-duty manual process to make these fixes. But now that the floodgates are open, the front end has largely been fixed, we're going to see a lot more volume, and health plans just don't have the personnel to do all this manually. So we need to have clean 834 enrollment files coming over so we can process them quickly and ensure that individuals have coverage on Jan. 1.”

Durham said the health insurance industry has been “working very closely with the administration to make those fixes.” But, he added, “time is short.”

The administration announced Dec. 1 that corrections made to mean the website is ready to sign up 800,000 people a day (232 HCDR, 12/3/13). But health insurers said there are still problems with the system for them (232 HCDR, 12/3/13).

For the marketplaces to work, “Coverage needs to be affordable and there needs to be broad participation by everyone,” including younger, healthier people, who are needed to balance the risk pool and keep premiums down, Durham said. He reiterated AHIP's position that the health insurance tax on premiums, slated to raise $100 billion over 10 years under the ACA, should be repealed--or at least delayed--for two years.

The tax will result in higher premiums in 2014 of $110 for an individual and $360 for a family in small group coverage, he said. A majority of members in the House are co-sponsoring H.R. 763, the proposed Jobs and Premium Protection Act, which would repeal the tax, and companion legislation (S. 603) has been introduced in the Senate.

Delaying Individual Mandate a Problem

But Durham said delaying the individual mandate, as some ACA opponents have suggested, would be “highly problematic.” Plans are “locked in” for premiums and benefits for 2014, which were put in place assuming the mandate is in place. “To delay or repeal that individual mandate at this point would simply make the current premiums not sustainable, and we would see a significant spike in premiums come 2015,” he said.

In the keynote address at the policy forum, White House Chief of Staff Denis McDonough said the ACA provides security to American families and improves the economy. “We're doing all we can to implement the law the right way, fairly and flexibly, and that includes learning from our experiences with,” he said.

A majority of uninsured people will be able to buy health insurance for less than $100 a month, McDonough said. Under the law, uninsured people now have responsibility to get covered, “so that it's their coverage that covers them, not the rest of us that cover them when they're forced to get treated in the emergency room,” he said.

If all states expand Medicaid, another 5 million people will be covered in 2014, McDonough said. He referred to a Centers for Medicaid& Medicaid Services report released Dec. 3 finding that 1.4 million people gained eligibility for Medicaid and the Children's Health Insurance Program in October, a 15 percent increase from previous months, he said (see related article).

'Signing Up in Droves' in Some States

In states where governors and legislators and others are working to make the ACA work, “people are signing up in droves,” McDonough said. The federal website is working better than it has, although it didn't work the way it should have initially, he said. “That's on us. That's on me,” he said. He said the site will continue to improve, and the number of people enrolling in plans is climbing.

The website had more than 1 million new visits Dec. 2, and the administration will “also make it a special priority to reach out to those users who have already submitted applications but have yet to actually enroll in a plan,” McDonough said. “We'll make sure that those customers who have selected a plan do everything they need to do to ensure they're covered on Jan. 1.”

“Ultimately we believe that will be the easiest way for Americans to compare and buy quality, affordable health insurance, having brought transparency and competition to a market that heretofore has been closed and opaque,” McDonough said.

Provider Consolidation May Raise Costs

AHIP's Durham warned that, despite the fact that health-care cost growth has slowed in recent years, provider consolidation may result in higher costs in the future. In highly concentrated markets, such as Boston, hospital costs are higher, he said.

“Unfortunately we're seeing tremendous growth in provider consolidation throughout the nation. That means higher premiums,” Durham said. “We have to find a way to ensure that the provider marketplace is competitive.”

Kevin Lucia, senior research fellow at the Center on Health Insurance Reforms at Georgetown University's Health Policy Institute, said that a “positive” development is enhanced health insurance rate review brought about by the ACA in Rhode Island, Oregon and Pennsylvania. This allows insurance regulators for the first time to examine “some of the issues that I think insurers face when they're held over the barrel by providers.”

Lucia said state-based marketplaces are likely to look for ways to encourage payment reform practices that “potentially could be helpful to maintaining issuer premiums over the long term.”

Narrow Networks

Durham said the “private marketplace is already moving in that direction.” He said that “high-value networks,” narrower networks of providers, that are offered in the ACA marketplaces are a “direct reaction from health plans focusing on quality, affordable care.”

To offer affordable premiums, insurers provided incentives to providers that meet quality metrics to be included in the plan networks, Durham said. “The incentive for individuals is that they have a lower premium. If they stay in network their cost sharing is much lower,” he said.

Lucia also said that it will be crucial that the federal government get a payment system built quickly, so that insurers can receive subsidies for which many enrollees are eligible. The system hasn't yet been built, and insurers will initially be reimbursed based on estimates they provide to the government, Durham said.

“You probably have some large carriers that can cushion it for a short period of time, but we also have a number of smaller carriers that have entered the market,” including smaller Medicaid plans and cooperatives, Lucia said. “They cannot survive if they don't get paid,” he said. “We're talking about a month to deal with this.”


To contact the reporter on this story: Sara Hansard in Washington at

To contact the editor responsible for this story: Janey Cohen at

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