The numbers are in: only 3,571 people have successfully enrolled in a private insurance plan in Florida in the first month of the Affordable Care Act’s federal marketplace, according to the Department of Health and Human Services. The target was 33,400, resulting in a success rate of just 11 percent. Nationally, a dismal 27,000 people have enrolled through the federally run marketplace.
State-run websites have enrolled 79,000 people, but Florida refused to run its own website.
Some 67,366 additional Floridians have completed applications but have not yet been enrolled. Among those, 12,887 Floridians were deemed eligible for Medicaid or CHIP, the children’s portion of Medicaid. Almost 124,000 Floridians applied, though one in five Floridians–or 3.8 million people–are without insurance. The latter figure does not reflect the number of people who have received notices that they will no longer be insured due to requirements of the new health law that they buy more extensive coverage.
Hundreds of thousands of Floridians have received cancellation notices, feeding into something of a revolt across the country by formerly insured individuals who had heard President Obama pledge previously that if they wanted to keep their insurance, they could. The plans were cancelled because they don’t meet the minimum requirements of the new health law, which calls for better coverage, including broader coverage for prescription pills, while eliminating bare-bones plans and capping deductibles.
Those cancellations will stop.
Repeatedly saying that the largely failed roll-out of the Affordable Care Act’s website was his responsibility, President Obama this afternoon conceded that some changes to the law will be necessary to stop people from losing insurance plans they would rather keep, at least for an additional year. It’s not yet clear if the fix will be done as a rule change, which could be put in effect swiftly, or as a change in the law, which would be more laborious.
“Insurers can extend current plans that would otherwise be canceled into 2014,” Obama said, giving in to pressure from his own party. But people enrolling freshly in the marketplace will not be eligible for those bare-bones plans. A Republican proposal is being floated in the House of Representatives to give people the option of enrolling in such plans regardless.
“I think it’s fair to say the rollout has been rough so far,” Obama said. “This fix won’t solve every problem, but it will help a lot of people.”
Meanwhile, the Affordable Care Act is under intense questions as Republicans continue their efforts to scrap it while Democrats hope it will survive the bad rollout, beyond which it may be impossible to reverse course. The Q&A below clarifies some issues.
Q: Can the federal portal be fixed in time?
A: Many don’t think so, and some worry about the consequences.
“Given where they are right now, it would be an unbelievable feat if they were to be ready” even by Jan. 1, said Bill Copeland, a top health care consultant at Deloitte.
The administration faces a credibility problem if it fails to meet the Nov. 30 deadline, said Dr. Ezekiel Emanuel, a former White House health care adviser. Signup delays could distract consumers from the benefits of coverage and cause many to tune out, he said.
Q: Why not wait until the websites are fixed and then have people line up? Or extend the enrollment period for individuals to gain coverage into the middle of next year?
A: Many can’t wait. Their policies expire Dec. 31, and they fear a gap in coverage. Others are uninsured and had expected ACA benefits starting in 2014.
Waiting worries insurers, too. They designed and priced marketplace policies based on the idea that consumers would enroll between Oct. 1 and March 31 for coverage starting as early as Jan. 1. Delaying signup could leave carriers with disproportionately sicker and more expensive customers, they say.
Q: What about a bigger fix? Let people keep the policies they have for another year. Or create a bailout pool for those who need emergency coverage until the websites presumably work in 2015.
It’s getting late even for extending this year’s policies. In many cases neither insurers nor state regulators are prepared.
“If we had known this was going to happen in September, early renewing (of existing plans) probably was going to be the answer,” said Joseph Antos, a health economist at the American Enterprise Institute. “Now that we know in November it’s not looking too great.”
Anything more ambitious, such as a new, national “risk pool” similar to the temporary coverage given those with existing illness starting in 2010, would probably require Congress to pass a new legislation.
“Since Congress can’t agree on big things like debt ceilings and a budget,” said Copeland, “I don’t know how this is going to get solved.”
Q: What’s the worst-case scenario for those unable to sign up?
A: Millions, including those with existing illness, could have trouble getting coverage. The administration may be working on a plan to have consumers contact insurers directly, but some worry they could end up buying the wrong policies if they don’t see the full online menu.
“We have had concerns about direct enrollment,” said Judith Solomon, vice president for health policy at the Center on Budget and Policy Priorities, which supports the law. “Consumers won’t have the full ability to shop in the short term.”
Those who do obtain insurance could have trouble gaining online premium subsidies, which so far are available through the government portals.
If computer breakdowns disproportionately deter the young and healthy from joining the ranks of the covered, insurers could lose money. That could set the stage for premium spikes and the kind of instability in the individual insurance market that the health law was supposed to solve.
Q: What about the law’s safety valves for unexpectedly large claims in the early years?Measures to compensate insurers with high initial expenses are supposed to keep them from making it up with higher prices for the first three years.
A: Because a quick solution for signup bottlenecks seems increasingly unlikely, those buffers could become more important. Even with extremely low first-year enrollments, some experts argue they could keep prices stable until portals are fixed for a smooth launch in 2015.
“In the long run, our view is that the exchanges and the entire ecosystem are going to be fine,” said Bryce Williams, a health benefits and technology consultant at Towers Watson. “But you’d have to talk about a two- to three-year horizon.”
Successful websites and signup efforts in big states such as California and New York will show that the online marketplace can work and should lead to acceptance elsewhere despite short-term problems, said James Morone, a political science professor at Brown University who specializes in health policy.
“Bottom line: No, they won’t be working” soon, Morone said of many marketplace portals. “And double no, they are not going away.”
Q: How badly do Web failures threaten other aspects of the Affordable Care Act?
A: The health law didn’t just offer commercial insurance on the Web. It expanded Medicaid for low-income consumers in states that chose to accept it. Because the programs have years of enrollment experience, Medicaid expansion is progressing better in many states than efforts to expand access to private insurance.
While the federal site “has been nowhere near as easy to use and efficient as anybody would have dreamed, we’re hopefully in the early innings” of the larger goal of expanding coverage, said Bob Kocher, a partner at venture capital firm Venrock and a former Obama health adviser.
Nor may Web problems have much effect on the health law’s other grand goal of containing costs and making care safer and more efficient.
Online government insurance portals have inspired similar, private sites that are transforming employer-sponsored coverage.
“The notion that one website associated with one part of the law is up late — that the whole law should be thrown out — is an extreme reaction,” said Alan Weil, executive director of the National Academy for State Health Policy.
— Jay Hancock and Phil Galewitz, Kaiser Health News