Another Unilateral Obamacare Implementation Glitch: Delay On Reporting Insurer Consumer Data . . .

by William Warren

. . .  NYT: Healthcare.gov Back End 'Remains Unfinished'

As this year’s open enrollment period approaches, The New York Times again highlights problems that persist in the Obamacare exchanges and reports on yet another Obama administration-initiated delay in implementing the law.

The Times writes, “Federal and state officials say that the online health care marketplaces that performed so badly last fall have been upgraded to ensure smoother service when they reopen Nov. 15. But both new and old customers are expected to flood onto the exchanges, testing their capacities, and the ‘back end’ of the federal system, where insurers receive applications and bill the government for subsidy payments, is not completed. . . .

“President Obama promised that buying health insurance on the online health care exchanges would be as easy as buying plane tickets on Kayak. Instead, most Americans were essentially locked out of HealthCare.gov, the federal online insurance marketplace that served 36 states, for two crucial months last fall. Many of the 14 state-run marketplaces also malfunctioned, and millions of tax dollars have been spent fixing all the defects. Now a question looms over the second enrollment period, which starts Nov. 15: Will the system work better this time around?”

The Times notes, “several significant new challenges will test the exchanges this time.” For one, “the ‘back end’ of the federal exchange, which the government uses to enroll consumers in health plans and to send subsidy payments to insurers, remains unfinished.”

And at the state level, the NYT points out, “Nevada and Oregon have also given up on their botched state-run websites, which are now targets of lawsuits and investigations, and will use the federal marketplace instead. And Maryland and Massachusetts are scrambling to rebuild their sites with new software before open enrollment. . . . In Maryland, where at least $40 million has been spent rebuilding the exchange using technology from Connecticut’s more successful version, tens of thousands of people who signed up for private coverage during the first enrollment period will have to re-enroll by mid-December if they want to keep their subsidy. The state will introduce its revamped website in phases, not opening it for general use until the fifth day of open enrollment. In Massachusetts, where the state and federal government are spending at least $80 million to fix its website with new software, officials promise it will work this fall.

“The future of troubled exchanges in Hawaii and Vermont is also in question. Vermont took its exchange offline last month to complete a number of repairs, although state officials say it will be working by Nov. 15. The Hawaii exchange, which just hired its third director, still has operational problems and is struggling more than most to stay afloat financially.”

Meanwhile, another New York Times piece notices the Obama administration again unilaterally choosing which parts of the unpopular health care law to enforce and which not to.

According to the NYT, “With health insurance marketplaces about to open for 2015 enrollment, the Obama administration has told insurance companies that it will delay requirements for them to disclose data on the number of people enrolled, the number of claims denied and the costs to consumers for specific services. For months, insurers have been asking the administration if they had to comply with two sections of the Affordable Care Act that require ‘transparency in coverage.’ In a bulletin sent to insurers last week, the administration said, ‘We do not intend to enforce the transparency requirements until we provide further guidance.’ . . .

“The law says each exchange shall require insurers to disclose their claims payment policies, “data on enrollment, data on disenrollment, data on the number of claims that are denied, data on rating practices” and information on the use of doctors and hospitals outside a health plan’s network.

Moreover, the law says, insurers must allow consumers to ‘learn the amount of cost-sharing (including deductibles, co-payments and co-insurance) under the individual’s plan or coverage that the individual would be responsible for paying with respect to the furnishing of a specific item or service.’ ‘At a minimum,’ the law says, ‘such information shall be made available to such individuals through an Internet website’ and by other means for people without access to the web. . . .

“Many people obtaining coverage under the Affordable Care Act have never had commercial insurance, and even experienced consumers are sometimes baffled by the intricacies of insurance policies, including provider networks and deductibles.”

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