Tuesday, November 5, 2013

The Obamacare Rollout––Week Five

Enrollments continue to trickle in. Health plans, with the kind of market share that would have to sign-up 100,000 to 200,000 people for the administration to hit its goal of 7 million people, are generally reporting they have enrolled only about 100 - 200 people over the first 35 days via Healthcare.gov.
Does this mean no one wants to sign-up? No. People can argue about whether we will see the administration hit their goal of seven million or we will end up getting two or three million relatively sicker people for all of the problems Obamacare has faced. But, undoubtedly millions of people, including all of those people who just got cancellation notices, do want to see what they can get for what cost and make a decision about signing up. But they can't because they aren't able get through the entire Healthcare.gov website.

As I have said before, Healthcare.gov, because of its many problems, is in de facto shutdown because virtually no one is able to really use it.

Why doesn't the administration just tell people the site is still too frustrating for people to waste their time on until it is fixed? Instead, the administration says it is getting better and people should keep trying to make it through the gauntlet. More, they are telling them to call the 800 number to fill out a paper application.

If it is better, it is still not better enough for more than a very small trickle to make it through each day.

Many states have literally dozens of complex health plan choices on the federal exchange––each insurance company on the various exchanges is likely offering the four different plans. I find it hard to understand how a consumer can get any real sense of the options over the phone much more be able to understand which plans cover which doctors and hospitals. People really need to see the options on their computer or on the computer of a navigator or an insurance agent to understand what is available and how it fits their needs.

And, as ABC and NBC reported yesterday evening, the paper applications ultimately have to go through the Healthcare.gov system anyway. One thing is crystal clear from the health plans meager enrollment to date; the insurance companies are not getting these "thousands" of paper applications. Where are they sitting?

Health plans are separately enrolling more people on their own sites and through their call centers in great part because of all of the cancellation letters they have recently sent out. Existing customers worried about facing a lapse in coverage are calling in. Many health plans are offering the "early renewal option" to these cancelled customers, which lets people keep their plan but only until December of 2014. I continue to hear that an overwhelming number of existing customers are opting to keep their current plan versus taking an Obamacare compliant plan from the carrier––an interesting outcome given that so many of these plans are said to be "substandard."  

The most urgent need is for the government to fix the back-end enrollment transactions between the government and the health insurance plans (the 834 problem). It will be impossible to conduct any kind of high volume enrollment through the health portal's front door so long as the data being transmitted to the insurance companies is unreliable.

Has the government made progress in fixing the large variety of detailed 834 transaction issues?

Yes. But the progress so far is incremental and nowhere near enough to be able to go to high volume processing.

The Obama administration finally seems to have a strong group of experienced managers in charge of fixing Healthcare.gov. I don't mean to pile anymore bad news on them then they already have. But I also have to report that the confidence that this can all get fixed by December 1 is not high among the people on the other end of those 834 transactions.
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