To alleviate health care mess, turning to insurers

Juliet Eilperin and Amy Goldstein / The Washington Post /


Published Nov 10, 2013 at 04:00AM / Updated Nov 19, 2013 at 12:31AM

The White House is increasing its reliance on insurers by accepting their technical help in efforts to repair the problem-ridden online health exchange and prioritizing consumers’ ability to buy plans directly from the carriers.

The administration’s broader cooperation with insurers is a tacit acknowledgment that the federal insurance exchange — fraught with software and hardware flaws that have frustrated Americans trying to buy coverage — might not be working smoothly by the target date of Nov. 30, according to several health experts familiar with the administration’s thinking.

White House officials reject the idea that the strategy represents a contingency plan if the online system continues to falter. “We are working 24-7 to ensure that the site is working smoothly for the vast majority of users by the end of November,” said Chris Jennings, an aide to the president on health policy.

He said the administration remains confident that the site, HealthCare.gov, will be ready by the end of the month and that the White House always envisioned insurers’ direct enrollment of customers would be important to the law’s success.

The government has said for months that consumers would be able to go directly to insurance companies to buy the health plans offered on the exchange. But this was always imagined as a secondary route, along with call centers and in-person enrollment assistants.

If insurers’ sites became a main way to buy coverage, it would undermine the side-by-side comparison shopping — as is used on travel websites such Kayak — that HealthCare.gov is meant to promote. That’s because individual insurers are not obligated to tell their customers about competing health plans available. They are required only to advise consumers that other plans exist.

Insurers are eager to take on a larger role. But they, like consumers, have been stymied by the online system’s technical problems. During one step in enrolling customers — determining whether their income qualifies them for government help with paying for health plans — insurers must connect to part of the federal online system, and that part does not work. White House officials and insurance industry leaders have been talking about how to solve this problem, perhaps on a temporary basis, and insurers are insisting that they be allowed to keep any extra subsidy money they might accidentally be paid, said people familiar with these discussions who, like others interviewed, spoke on the condition of anonymity because of the topic’s sensitive nature.

The Affordable Care Act requires most Americans to have health insurance, and December is a vital period. Those who are uninsured must buy plans by Dec. 15 to be covered by Jan. 1, the date the requirement begins. Those who do not buy coverage by March 31 will face financial penalties. The question is whether everyone will be able to meet those requirements if the website’s problems persist.

The possibility of using health plans to directly sign up large numbers of uninsured Americans is a strategy by the administration and the insurance industry to try to deflect growing pressure from Capitol Hill. Even some Democratic lawmakers want to give people more time to buy coverage.

Such delays are anathema to the insurance industry, whose leaders have warned that companies would end up with mainly sicker people signing up early on.

Although potentially enabling more people to buy health plans promptly, a greater reliance on the industry to sign up new customers could have other ripple effects, such as prompting ads that might run counter to the administration’s messaging.

“One key question is whether insurance company advertising will accurately reflect the benefits people can get from the Affordable Care Act or if they will attempt to use fear and uncertainty to push people into a particular plan to increase their profits at customers’ expense,” said Eddie Vale, a strategist with Protect Your Care, an advocacy group that promotes the law.

In recent days, several people familiar with work on the website — all of whom spoke on the condition of anonymity — said the system is improving but that they cannot say definitively that all of the problems will be fixed by the 30th.

Analysis:

For Obama and his legacy, it’s crunch time

President Barack Obama likes to say he will never again be running for office, but every Democrat knows he will be on the ballot figuratively in 2014 and 2016. Right now they are rightly nervous about that prospect.

Obama faces two urgent problems. The first is to make the Affordable Care Act work. That begins, but does not end, with fixing HealthCare.gov. He and Health and Human Services Secretary Kathleen Sebelius have promised the site will be running smoothly by the end of this month.

But fixing the website is only one of the repairs that are now needed. The viability of the new program has been undermined as people learn about the real-life changes being forced by the law’s implementation.

A law as complex as the Affordable Care Act will continue to bring surprises as new regulations go into effect. A shortfall in sign-ups, particularly by young and healthy uninsured Americans, would present major problems. Absent buy-in by the public, the new law could end up being blamed for almost anything that goes wrong with people’s health care coverage, whether justified or not.

The second and broader challenge the president faces is restoring his credibility, not only on health care but also on his overall leadership. It could take years for the public to reach a full judgment on the Affordable Care Act. With talk already turning to the contest to succeed him, the president knows he has only a limited amount of time in which to get back on top of things.

The latest report cards on the president’s performance chart the decline in his standing in the year since he was re-elected. The Pew Research Center, in a poll released late last week, pegs his approval rating at 41 percent. That is 14 points lower than it was at the end of last year.

— Dan Balz, The Washington Post