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Charles Ornstein: Six Questions About HealthCare.gov’s Future

December 4, 2013

Will the improvements to the site be enough to ensure consumers can get coverage before the December 23 deadline?

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Image from Flickr via Mike Licht.

By Charles Ornstein
By arrangement with ProPublica

D-Day for HealthCare.gov is upon us.

The federal health insurance marketplace for 36 states has undergone round-the-clock fixes during the past eight weeks after what could only be characterized as a disastrous launch. Obama administration officials have promised that it will work better by month’s end (read: now) for the “vast majority of users.”

There’s little doubt the site is working better today. Users report that it’s faster and has fewer errors. Practically every day, the Obama administration reports progress.

But it’s unclear whether the improvements are enough to salvage the Affordable Care Act’s central element and ensure consumers can get coverage before Dec. 23, the deadline to sign up for benefits that begin on New Year’s Day.

Here are six big questions:

1. Can the website handle the expected crush of traffic? Media reports about problems with HealthCare.gov surely kept some consumers away. But as the deadline for signing up for coverage looms, they are likely to come back. The New York Times reported today that administration officials “have urged their allies to hold back enrollment efforts so the insurance marketplace does not collapse under a crush of new users. At the same time, administration officials said Tuesday that they had decided not to inaugurate a big health care marketing campaign planned for December out of concern that it might drive too many people to the still-fragile HealthCare.gov.” The trepidation is well-founded, and a dose of it could have gone a long way on Oct. 1, when the site debuted.

Some consumers are getting stuck in “no man’s land” in which they sign up for accounts on HealthCare.gov but are prevented from selecting plans because their identities cannot be verified by an outside contractor.

2. Are the site’s back-end problems fixed? One of the biggest issues — out of public view — is that information being transmitted from the administration to insurance companies has been riddled with errors, hampering the smooth enrollment of consumers. Sarah Kliff at The Washington Post drew attention to this major problem last month, and while the administration has made fixing the problem a top priority, the error rate remains too high, experts say. Philip Klein of the Washington Examiner reports, “Insurers still haven’t reached the point where they can feel confident that the data is reliable. As a result, though they have been able to process some payments from individuals, they’ve only been able to do so on a piecemeal basis in cases where they are fully confident in the data, often because it’s been verified by hand.”

3. Can individuals verify their identities so that they can enroll in plans? The New York Times reported Monday that some consumers are getting stuck in “no man’s land” in which they sign up for accounts on HealthCare.gov but are prevented from selecting plans because their identities cannot be verified by an outside contractor. “Many users of the website have had their applications cast into limbo after they uploaded copies of documents like driver’s licenses, Social Security cards and voter registration cards, or sent them to the office of the federal insurance marketplace in London, Ky. Administration officials said the government had established strict procedures to verify that people applying for insurance were who they said they were, in order to prevent fraud and identity theft. But a breakdown in the process instead is causing concern among some consumers about the handling of their personal information.”

Will enough people sign up for coverage — and are they the right people?

4. Will the delayed Spanish language sign-up site work? CuidadoDeSalud.gov has been repeatedly delayed because of the issues plaguing its sister site, HealthCare.gov. The administration initially said it would be ready by mid-October, then the end of November. Now Talking Points Memo says it will have a soft launch in early December. That doesn’t give much time at all for Spanish speakers to sign up online before the Dec. 23 deadline for coverage that begins on Jan. 1. Of course, those consumers can fill out paper applications or call the toll-free number for assistance, but the online option cuts it very close. “The administration projects 10.2 million uninsured Latinos will be eligible to sign up for coverage. Federal call centers have so far fielded about 107,000 Spanish-language calls, according to the official, three percent of their total volume. Though national Latino advocacy groups have been generally supportive of the health care reform law, they have begun to voice frustration about the delays to the Spanish-language website,” Dylan Scott reports for TPM.

5. Will enough people sign up for coverage—and are they the right people? Ultimately the Affordable Care Act’s marketplaces will be judged by how many people enroll in coverage. The Congressional Budget Office projected 7 million people would sign up in 2014 (in the federal and state-run exchanges), but best I can tell that doesn’t really take into account the millions of people canceled by their existing insurance plans who may replace their coverage on the exchange. Beyond that, insurance companies need a balance of old and young, healthy and sick to balance their costs and avoid a “death spiral” in which costs keep going up and only the old and sick who must have coverage choose to stay in. Ezra Klein at The Washington Post says Obamacare enrollment won’t hit 7 million, but that will be OK if the mix of consumers is acceptable. “No one will ever look back on Obamacare’s launch and call it a success. The question is whether they’ll look back and say that Obamacare subsequently became a success. And that’s why the bottom-line goal for the White House is still the ratio of people who sign up for 2014 rather than the raw number of who sign up for 2014,” he writes.

6. Will all the state-run exchanges get it together? While some states, including California, Kentucky and Washington state, have won praise for a relatively smooth rollout of their marketplaces, other states are still having more trouble. Covered Oregon has been plagued by so many problems that its online sign-up isn’t working yet. Maryland likewise is struggling. And the head of Hawaii’s exchange stepped down last week amid problems there. Even if HealthCare.gov is up and running, residents of these states have to rely on the pathways set up where they live.

Charles Ornstein, in collaboration with Tracy Weber, was a lead reporter on a series of articles in the Los Angeles Times titled “The Troubles at King/Drew” hospital that won the Pulitzer Prize for Public Service, the Robert F. Kennedy Journalism Award and the Sigma Delta Chi Award for public service in 2005. His ProPublica series, with Tracy Weber, “When Caregivers Harm: California’s Unwatched Nurses” was a finalist for a 2010 Pulitzer Prize for Public Service.

Ornstein reported for the Times starting in 2001, in the last five years largely in partnership with Weber. Earlier, Ornstein spent five years as a reporter for the Dallas Morning News. He is a past president of the Association of Health Care Journalists and a former Kaiser Family Foundation media fellow.

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