We'll get to the latest on-the-fly changes in a bit, but what better way to mark Friday the 13th than to check in on the status of the website for America's least popular law? For that, we turn the floor over to Bob Laszewski -- a health insurance expert whose predictions about, and criticisms of, Obamacare have been remarkably accurate. Might this assessment be part of the reason why anxious Democrats are experiencing a relapse of the "fix" itch (emphasis mine)?
- As of this week, the 834 transaction error rates (enrollments sent from the government to the health plans) are better than they were in October and early November but are still running in the 5% to 10% range––a place they have been for a number of weeks now.
- The Obama administration has still not built the reconciliation computer system needed to clean up the remaining enrollment data issues between HealthCare.gov and the health plans. The health plans have been told to expect an electronic file in the next few days, containing what the feds think are the health plan's enrollments through November. The plans will then have to figure out how to reconcile the two lists and then fix the problems. Many plans will have thousands of enrollments to reconcile. There will be another such file coming in January for the December enrollments with likely tens of thousands of more names to reconcile. That means that any December errors will have to be fixed before people can be covered, thereby creating additional customer service issues until the files can be cleaned up.
- The feds can't pay the insurers their premium subsidy payments because a payment system has not yet been built. The government is asking the health plans to prepare their own bill and send it to the government for a preliminary payment until this is resolved.
Laszewski also points out the dual Medicaid snafus that continue to vex Obamacare officials. Click through for his synopsis of how unimpressive federal and state enrollment numbers have been so far. He also touches on a key point we've covered twice now -- namely, that only a small fraction of "enrollees" are actually covered because so few people have paid their first month's premiums (a requirement for coverage kicking in on January 1). In the surest sign yet that the White House is panicking over low enrollment figures and unsustainable risk pools, the administration is issuing a series of last-second extensions and "fixes," and "encouraging" insurance companies to pick up the pieces. Extension number one, aimed at horrific, deeply embarrassing cases like the family Dan highlighted yesterday:
The Obama administration moved Thursday to protect some of the sickest patients in the country from the possibility that they would lose health insurance on New Year’s Day. Medically needy patients enrolled in temporary high-risk pools now have an extra month to sign up for new coverage because of early enrollment struggles in Obamacare nationwide, the Centers for Medicare & Medicaid Services announced. The extension seems to be the Obama administration’s first tacit acknowledgement that it can’t guarantee that everybody who wants to obtain coverage starting Jan. 1 will be able to do so.
The acknowledgement isn't "tacit." It's pretty explicit. Here's another SOS:
BREAKING: HHS requiring insurers to take payments through Dec 31 for Jan 1 coverage; HHS says consumers must pick plan by 12/23 at midnight
— CNBC (@CNBC) December 12, 2013
This move is being coupled by many insurers granting "grace periods" in which people can send in their first payments without their enrollment being voided on New Year's Day -- which, again, is required within Obamacare's regulations. Beyond all that, Philip Klein surveys the brand new raft of -- ahem -- suggestions HHS is tossing at insurance companies, and he sees a program on the brink of collapse:
On a conference call, an HHS spokeswoman emphasized: “We are just proposing it as an option and we’re encouraging issuers. There is no requirement.” Translation: HHS has a huge mess on its hands and it hopes that by getting ahead of this news, it can foist the blame for the problems on insurers. Of course, for insurers who have spent years designing plans to comply with the law, this would present huge and unreasonable logistical hurdles. HHS also announced there would be a "special enrollment period" for people who tried to purchase insurance by Dec. 23 but couldn't because of a "system error."
Among these non-requirements, HHS urges insurers to count out-of-network doctors and hospitals as in-network, for the purposes of billing and deductibles. This is totally unworkable. The whole point of the pared-down Obamacare networks is to hold down premium costs as much as possible. If insurers are nudged toward opening up the floodgates, expect costs to respond accordingly. And that's on top of existing sticker shock. When deductible and doc shock start hitting in 2014, the White House will try to pawn these problems off on insurers. Phil is right about that. It won't work, but blamestorming is what they do. Bottom line: The Obama administration is terrified that too few people are signing up for Obamacare, that too many of those who have enrolled are older and sicker, and that millions of Americans will transition from being insured to uninsured in January directly because of the president's law. An absolute mess.