Paid Obamacare Enrollment Data Likely Not Released Until February

    The Obama administration has come under fire for weeks now for selectively releasing "enrollment" data for Healthcare.gov and the state exchanges.  The latest figure of 2.1 million was met with skepticism by many observers, even some who are sympathetic to the administration.  Based on previously published guidance for insurers by the Centers for Medicare and Medicaid Services (CMS), however, it is likely any data the administration has on paid enrollments is substantially incomplete.
    On October 3, two days after the launch of Healthcare.gov, CMS published a document called "Federally Facilitated Marketplace Enrollment Operational Policy & Guidance."  The manual begins with a preamble that reads in part:

This draft manual will go into effect with minimal changes as of October 1, 2013. All enrollments made on or after October 1, 2013, must be processed in accordance with these requirements. It is CMS’ intention that this will be a living document, updated regularly, and supported by clarifying bulletins in the interim between updates.

    Although CMS says the manual will be "updated regularly", it appears from the Regulations and Guidance page of CMS's website that the October 3 draft of the manual is the most recent version.  That same page does, however, include various updates relating to the Affordable Care Act, including one just issued on December 31.
    The pertinent guidance relating to the reporting of enrollment data is found in the October 3 draft manual in Section 2.4 Relationship between Premium Payments and the Confirmation/Effectuation 834 Transaction. Some of this guidance is already outdated, such as these statements: "Issuers do not have the ability to grant grace periods for payment of the initial month’s premium" and "...issuers may receive payments the day prior to the enrollee’s coverage effective date."  Once it became clear that January 1 coverage would be jeopardized for many due to problems with the website, CMS worked with insurers to extend payment due dates to January 10 in some cases.  California, which operates its own exchange, extended the payment deadline to January 15.  Several Blue Cross Blue Shield plans, including Illinois and Texas, have extended their deadlines all the way to January 31 according to a Wednesday report from Reuters.
    The portion of the guidance from the October 3 manual that directly impacts the timing of reporting, which technically only applies to the Federally Facilitated Exchanges (FFEs) but practically speaking would affect the state exchanges also, reads as follows [emphasis added]:

For purposes of generating the confirmation transaction, full payment occurs when the issuer receives full payment... of the portion of the premium for which the enrollee is responsible. We realize that some enrollees will wait until just prior to their coverage effective date to make payment, and therefore issuers may receive payments the day prior to the enrollee’s coverage effective date. In such circumstances issuers may not be able to transmit all confirmation transactions prior to the coverage effective date. However, the FFM expects QHP and QDP issuers to send all confirmation transactions by the fifth calendar day of the effective month of coverage. 

    Under the original guidance, this would have meant all insurers would have been required to send confirmations to CMS by January 5.  However, with the payment deadlines extended to as late as January 31, those insurers presumably have until as late as February 5 to transmit the confirmation of paid enrollments for coverage effective January 1 to CMS.  Again, although this guidance applies specifically to FFEs, state exchanges will need to transmit confirmations to CMS as well in order to have tax credit subsidies processed and paid to insurers.  As noted in the guidance, insurers must send confirmations after receiving payment from consumers and not wait for the balance of the payment from ant government subsidy.  It is unclear when and how those subsidies will be remitted to insurers since the "back end" of the system is apparently still under construction.

    February 5 may actually be an optimistic estimate of when complete paid enrollment data will be available.  The following diagram is from a March 2013 version of a CMS document regarding transaction information in the FFEs:

    Although revisions of this process will have changed the information flows illustrated by this diagram, the inclusion of information from state exchanges will certainly not make the accumulation of aggregate enrollment data any simpler.  The public may have to wait until mid-February or later to find out the true Obamacare enrollment as of its January 1, 2014 debut.


Note: A version of this article first appeared at The Weekly Standard.

Healthcare.gov Still Promoting Coverage Effective January 1 [Updated]

    Six days into the new year and fourteen days after the extended December 23 deadline, the federal Obamacare website Healthcare.gov is still holding out hope of coverage beginning January 1 to some consumers.  The notice, which first appeared on December 24 (the unofficial extra-extended deadline), advises consumers who had "problems" with the website to call the Marketplace Call Center which may offer the option of "starting a new application over the phone to get coverage effective on January 1."

    No additional details are given about what type of "problems" might qualify one for the special treatment or what kind of proof might be required from consumers that they experienced a qualifying problem.  Also unclear is how the government could require an insurer to offer coverage retroactive to January 1 to a consumer who began a "new application" almost a week past the effective coverage date.

    A Healthcare.gov chat agent contacted late Sunday night said that the option is no longer available, and that the "earliest your coverage could start now is February," yet the notice has not been removed.  An email to the Health and Human Services press office about the website page offering coverage effective January 1 was not immediately returned.

UPDATE: Some time on Tuesday, the website was updated to remove the above message.  It was replaced with this:

    The change was not notated.

Note: A version of this article (before the update) first appeared at The Weekly Standard.

Once Again, HHS Extends Obamacare Signup Deadline For January Coverage

    Even now that the December 23 deadline has passed, and even the informal one-day extension through Christmas Eve has also passed, the Healthcare.gov website is holding out hope that some may still sign up for coverage effective January 1, 2014.  A page entitled "Tips to help you enroll in Marketplace coverage" asks, "Couldn’t enroll by December 23?"  The answer reveals that calling the Marketplace Call Center and speaking to a representative could yield options that "include starting a new application over the phone to get coverage effective on January 1."

    Although the site indicates that enrollment by January 1 may still be possible "because of problems you had using HealthCare.gov," no further details are provided online about the specific qualifications for the exception.  Problems with Healthcare.gov have ranged from simply logging on to problems with subsidy calculations to enrollments not reaching insurance companies, but it unclear which problems merit special treatment and how consumers must prove they have experienced problems with the site.
    The Department of Health and Human Services (HHS) has not issued any additional guidance, so it is not apparent how Marketplace Call Center representatives determine if someone is eligible for an exception, or how insurance companies will be compelled to grant the January 1 effective coverage date.  An email to HHS requesting clarification has not been returned.

Part of Obamacare's Health Insurance Marketplace Taken Offline

    With the launch of the Obamacare Health Insurance Marketplace less than three weeks ago, one of the only functions consumers were already able to access, creating an account, has been taken "offline" for "upgrading."
    In 2010, after Obamacare was signed into law, the Department of Health and Human Services (HHS) created Healthcare.gov, a website designated to answer questions about the new law and eventually serve as the portal for the new health insurance "marketplace" or "exchange" that are a fundamental part of Obamacare.  This summer, the website was relaunched in anticipation of the October 1 opening of the marketplace.  One of the feature added was the ability to create an account to prepare for the open enrollment period that begins at that date:

    However, the link provided now merely takes users back to the main page for individuals.  The reason for this is that on Wednesday, September 11, HHS took the "create an account" feature offline, as the website explains:

Creating an account and logging in: Temporarily off-line 

To get everything ready for Open Enrollment, we’re upgrading the Marketplace account service. You won’t be able to create an account or log in to one you’ve created until Tuesday, October 1.
If you’ve already created a Marketplace account, great! You’ll be able to log in again starting October 1 and start your application for coverage.
If you haven’t created a Marketplace account yet, that’s okay. You’ll be able to do that starting October 1 and get going on your application too.

     There have been reports of technical glitches, delays, and security concerns with the new Marketplaces.  It is unclear of this latest move by HHS is a reflection of those issues.


Note: A version of this article first appeared at The Weekly Standard.