Obamacare woes put pressure on requirement to buy insurance

Washington — President Obama may have to do what congressional Republicans who hate the Affordable Care Act were unable to accomplish during the bitter fight that led to a government shutdown: postpone the law’s provision that nearly every American have health insurance next year.

After three weeks of massive troubles with the 36-state insurance exchange websites run by the federal government, Obama said Monday, “Nobody is madder than me that the website is not working as it should be, which means it’s going to get fixed.”

But he also lowered expectations, saying the Affordable Care Act is “more than a website,” and he urged people to sign up “the old-fashioned way,” by telephoning call centers that the president said have increased staff.

The president said, “The best IT specialists” are working 24/7 to fix www.HealthCare.gov, but insurers and supporters of the Affordable Care Act worry the problems won’t be fixed by Dec. 15, the latest day someone can sign up for coverage beginning Jan. 1.

Although Americans can wait until Feb. 15 to sign up for insurance without penalty, the longer malfunctioning websites keep people from buying insurance, the better the bet that those who do sign up will be sick and older because they are more likely to be persistent in their efforts.

Obama tried to tamp down those fears Monday by saying nearly a third of the people who signed up in exchanges in Connecticut and Maryland are 35 years old or younger.

But Connecticut and Maryland run their own exchanges, and state exchanges have not, for the most part, suffered as many problems as those plaguing the federal exchange.

White House spokesman Jay Carney said Monday there are not plans today to postpone the individual mandate, but said  “the law makes clear that people who do not have access to affordable care due to a state not expanding Medicaid or other factors will not be penalized.”

The administration says that nearly 20 million people have visited HeathCare.gov. But it steadfastly refuses to say how many Americans have signed up for health care through the site.

“If these computer glitches are as bad as they seem, the president will have to postpone the individual mandate,” said Mickey Hebert, a consultant to the Massachusetts health care company Harvard Pilgrim who served on the board of Connecticut’s exchange, Access Health CT.

Hebert said long-term problems with the system “would be a death knell for the exchanges.”

Susan Millerick, spokeswoman for Aetna, said the Hartford-based company hopes the existing sign-up schedule remains, even as the exchanges “are unfortunately off to a slow and bumpier-than anticipated start.”

“The consumer experience is critical to the success of the exchanges, and further delays may result in individuals’ losing interest,” Millerick said.

Robert Zirkelbach, spokesman for America’s Health Insurance Plans, said  insurance company computer experts are doing everything they can to help get the federal web site on track. But he said there will be more pressure soon to roll back Obamacare’s schedule because Dec. 15 is the last day one can enroll for a policy that starts Jan. 1.

“If we are not seeing improvement, it will be a much different story than right now,” Zirkelbach said.

He also said a pushback of the individual mandate would force insurers to increase premiums.

Even before the disastrous rollout of the exchanges Oct. 1, 55 percent of health care investors surveyed by Citi Research said they expected the Obama administration to extend the open enrollment date beyond March 31 to give consumers more time to purchase coverage.

Timothy Jost, a law professor and health care reform expert at Washington & Lee University in Lexington, Va., said there is still time to get the system fully operational before the president is forced to make a decision on the mandate.

“It’s not like shooting a man to Mars,” he said.

But Jost said if the federal exchanges aren’t up and running by February, “it may be reasonable” to push the individual mandate deadline back.

Jost, however, said he is more worried about people who will lose coverage on Dec. 31, when the state and federal high-risk pools are closed.

“These are people with high medical needs,” Jost said. “They really need to be able to sign up for coverage.”

A delay in the mandate would be a huge blow to the insurance industry that hoped young healthy people will be forced to buy insurance and balance the numbers of older, sicker people who will now take advantage of Obamacare’s end to a ban on pre-existing condition and cap on how much older Americans can be charged for coverage.

The individual mandate is a flashpoint in the fight over the ACA; opponents who questioned its constitutionality took their case to the Supreme Court – and lost.

When Obama said he would delay a mandate that companies with more than 50 employees cover their full-time workers, Obamacare opponents insisted the individual mandate should be postponed for a year, too. They attached legislation that would do that to a short-term spending bill the Senate and Obama rejected, speeding the way to a 16-day government shutdown.

Obama said Affordable Care Act opponents will seize the massive technical problems as another reason to repeal the law.

“Given the problems with the website, they are going to go at this further,” he said.

House Republicans have scheduled a hearing Thursday on the problems with HealthCare.gov.

One thing that might have helped to crash the system initially, was the requirement to key in a lot of personal information and create an account before an individual can shop for a policy on an exchange. That, some say, caused the computer to malfunction because that information must be checked against information in other agencies and is unable to do so.

Critics of Obamacare say the system was created that so people eligible for subsidies would see discounted premiums and be more apt to purchase a policy because they avoided “sticker shock.”

Many consumers may have been surprised by that exchanges require personal information before plans can be compared.

Two nationwide polls by HealthPocket had found that one in four adults had not expected health insurance exchanges to require personal information.

The exchanges were fixed last week to allow people to shop without creating an account, said Jennifer Tolbert, director of state health reform at the Kaiser Family Foundation.

Tolbert said the system still has time to work, but she agreed that if it’s not operational by Feb. 15, the administration may have to postpone penalties on those who haven’t bought insurance.

“If people can’t sign up by then, they have to rethink imposing the mandate,” she said.

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