The New York Times provided numbers yesterday on Medicaid enrollment compared to Obamacare enrollment during the month of October. Those of us who follow health policy are not really surprised by the numbers; we expected more people were signing up for Medicaid for some time. Here’s part of the article:
The Obama administration said Tuesday that 1.46 million people had applied and been found eligible for Medicaid or the Children’s Health Insurance Program in October, far more than had selected a private health plan in the new insurance marketplaces…
…By contrast, in October, just 26,800 people selected private health plans in the new federal exchange, and 79,400 chose private plans through exchanges run by states.
Of course, enrollment in Medicaid is not a good thing. Medicaid is a notoriously bad insurance program and many physicians refuse to see Medicaid patients because of its low reimbursement rates and its horrific bureaucracy. Medicaid consumes about 23 percent of a state’s budget and with the expansion, will consume even more.
And while the Obama administration has been claiming since December 1 that the healthcare.gov is fixed, it really is not. There have been lots of reports that while the front end is now more consumer friendly, it is the back end, where information is transmitted to an insurer, that is not fixed. In fact, this part of the system is still being built.
Again, here is what the New York Times says about the second Obamacare rollout.
Weeks of frantic technical work appear to have made the government’s health care website easier for consumers to use. But that does not mean everyone who signs up for insurance can enroll in a health plan.
The problem is that the systems that are supposed to deliver consumer information to insurers still have not been fixed. And with coverage for many people scheduled to begin in just 30 days, insurers are worried the repairs may not be completed in time.
‘Until the enrollment process is working from end to end, many consumers will not be able to enroll in coverage,’ said Karen M. Ignagni, president of America’s Health Insurance Plans, a trade group.
And that is why this McClathchy News report is important today:
With the automated payment system for the federal health insurance marketplace still under construction, the Obama administration will temporarily require insurers to manually submit their payment requests beginning in January.
The marketplace was supposed to calculate the amount of premium tax credits and cost-sharing benefits that low- and middle-income enrollees were eligible for after they sign up for marketplace coverage. The financial assistance would then be sent electronically to insurers to help pay for coverage.
But that payment delivery system is still under construction and will not be ready for use when insurers are due to receive the federal subsidies in January. If the subsidy payments aren’t received on time, consumers’ health coverage could be jeopardized.
To avoid that possibility, insurers will submit their subsidy payment requests to the U.S. Department of Health and Human Services, which will verify the amounts and pay them electronically using the Medicare automated payment system.
Consumers will not be impacted by the change, administration officials say. As long as they sign up for a marketplace plan by December 23 and make their first premium payment by December 31, their coverage will begin on January 1.
Staff at HHS will be contacting insurers to educate them about the new process.
Does anyone believe the insurance companies will get payment in a timely manner? Does anyone believe the insurance companies will even get the correct information about their customers?
Furthermore, the president said the following in his remarks yesterday concerning Obamacare:
And today, the website is working well for the vast majority of users. More problems may pop up, as they always do when you’re launching something new. And when they do, we’ll fix those, too. But what we also know is that after just the first month, despite all the problems in the rollout, about half a million people across the country are poised to gain health care coverage through marketplaces and Medicaid beginning on January 1st — some for the very first time.
Poised? About a half a million people are poised? What does that mean exactly? Either they have purchased insurance or they have not.
Perhaps the answer can be found in the exchange between White House Press Secretary Jay Carney and reporters during Monday’s press briefing when he was asked about the back-end of the healthcare.gov website – the part that transmits the information about the purchaser to their respective insurance company.
Q. Insurers are saying that there’s a problem still on the back end where, for those folks that are actually able to enroll, the information that the insurance companies are getting is garbled, incomplete, in some cases totally unusable. Can the administration assure people who have been able to enroll that they will, in fact, have coverage beginning on January 1st?
MR. CARNEY: Well, I’m glad you asked me that question. There’s a couple of things I want to say about that. First of all, we are very mindful of making sure that consumers who want coverage starting in January are able to get it. And CMS is reaching out directly to consumers who have already selected a plan to let them know to be in touch with their plan to pay their first premium to ensure that coverage kicks in and know that plans are working hard to make sure their new customers are covered as well. So this is a joint effort to reach out to those who have enrolled to make sure that every step is being — that they know they need to take all the necessary steps to ensure that that coverage kicks in.
Furthermore, CMS is having daily conversations with issuers to get feedback from them. We have instituted a number of significant fixes to the so-called 834 forms, which are these — that’s the vehicle by which information is transmitted to the issuers. And we believe that the majority of fixes to 834 forms have been made, including significant ones that were made over the weekend. We expect the info now sent to insurers to be vastly improved. But we’re going to continue to work with issuers to make sure that whatever remaining problems exist are addressed and fixed.
Q So you can assure folks that have signed up or will sign up through December 23rd that they will definitely have coverage beginning on January 1st?
MR. CARNEY: Well, I think what I would say is that CMS is reaching out to those who have enrolled to make sure that they know the steps that they need to take to ensure that coverage kicks in. If a consumer enrolls in a plan by December 23rd and makes their first payment by the date set by their insurer, they are covered beginning January 1st. And if consumers are not sure if they are enrolled, they should call our customer call center or the insurer of their choice so that they can be sure they’re covered by January 1st.
So we’re making — this is a high priority, making sure that those who are enrolled are aware of the steps that they need to take, including that they need to pay their premiums on time for coverage. We’re working with insurers to make sure that those who are enrolled know this information. And we’re reaching out — or we’re telling consumers that if they’re not sure that they’re enrolled, they should call the call center or their insurer directly.
If you were purchasing a plan via an Obamacare exchange, do you feel confident that the government is on top of the entire procedure and making sure you are covered? Are you confident everyone who thinks they have enrolled in an insurance plan actually have enrolled?
Then we got the news about the lack of security of the website. Here is what Chairman Mike Rogers (R-Mich) of the House Permanent Select Committee on Intelligence said this week and reported in National Review Online about the website:
“They [the White House] could not even provide someone — CMS and HHS, the two folks responsible for the HealthCare.gov website — in a classified setting to come up and talk about the breaches that they know have happened,” Rogers said on Fox News on Monday. “That’s just unconscionable.”
He warned that there is currently no coordinated effort within the administration to test the website’s newly-written code which was completed over the past two months of repairs, leaving it vulnerable to breaches. “You’re encouraging people to go to a site that our own government knows doesn’t meet safety standards when it comes to security of private information,” Rogers said.
Would you want to put your social security number and other private information into a website that John McAfee, founder of McAfee security software, said was a “hacker’s wet dream?”
Whew. What next?