Even the biggest supporters of the Patient Protection and Affordable Care Act acknowledge the rollout is going to be turbulent. The sweeping new regulations involve enrolling millions of people on dozens of brand new untested exchanges.
The president himself has acknowledged that such an enormous undertaking will not go smoothly. Speaking at the Clinton Global Initiative yesterday, Obama urged Americans to tune out critics of the program and “just look for yourself.” He acknowledged the plan was not very popular but pointed to a reluctance to embrace change on the part of Americans.
While some unanticipated malfunctions and technical errors are par for the course when creating such a vast system, fault lines that health care advocates have been warning about for months or years still show no sign of being corrected before open enrollment launches next week, although federal and state employees are said to be troubleshooting.
Here are the top five Obamacare mistakes that should have been fixed by now:
1. The Exchanges Aren’t Ready. As recently as last week, sources told the Wall Street Journal that the software that will run the federal exchanges was unable to reliably establish how much consumers should pay for various insurance plans. Tests on the calculator used to determine prices were supposed to begin months ago – but began only last week, the Journal reported.
If unresolved before Oct. 1, the problems would hit consumers in the 36 states where the federal government is administering the exchanges. There are also issues in states running exchanges themselves. In Colorado, residents will have to buy their insurance offline in order to get a tax subsidy, because the online exchange is not yet reliable; users of the Nevada exchange will not immediately be able to filter by cost or provider; and Oregon residents won’t even have access to the online marketplace until at least mid-October.
2. There’s a ‘Family Glitch.’ Under the law as currently written, employees who have access to affordable care via their employer are ineligible for federal subsidies to purchase insurance on the public exchanges. Congress defined affordable as 9.5 percent or less of an employee’s household income, but that limit applies only to an employee – not to his or her family. The oversight could leave up to half a million children without access to affordable coverage, according to USA Today.
“The family glitch is definitely a drafting error that Congress made that needs to be fixed,” Joan Alker, executive director of the Georgetown University Center for Children and Families, told the paper. “But that seems unlikely.”
3. The Security Hasn’t Been Independently Tested. Cyber contractors claim that the data hub built for the federal exchange is completely secure. The hub will allow enrollees to enter personal information and will transfer that data to other federal organizations such as Social Security and the Internal Revenue Service. However, no independent agency has verified the security of that system, according to NextGov. “Whether the security of the data hub is as secure as the White House and the [Center for Medicare and Medicaid Services] have asserted will be proven after these exchanges go live,” Deven McGraw, Health Privacy Project director with the Center for Democracy and Technology, told NextGov.
The state exchanges are also facing questions about data security. Last week, Minnesota launched an internal security review after firing an employee who inadvertently emailed an insurance agent the Social Security and drivers’ license numbers of 1,600 other agents.
4. The ‘Navigators’ Are Inadequately Prepared. In August, the Obama administration handed out $67 million to 105 community organizations, including health clinics, hospitals, and health advocacy groups, to train ‘navigators’ who will help uninsured – often uneducated – consumers evaluate their insurance choices and select the plan that’s best for them, according to The New York Times. The ACA requires navigators to complete 20 to 30 hours of training, and some states have implemented additional certifications via their departments of insurance, a tall order given that many exchanges are not yet up and running and many of the organizations employing the navigators do not have insurance experience. Navigators face an especially difficult time in at least 17 Republican-controlled states that have taken steps to restrict them, according to Kaiser Health News.
An August letter to the department of Health and Human Services from 13 Republican attorneys general expressed concern about the navigators’ limited training and screening, claiming the navigators “will be more prone to misappropriate – accidentally or intentionally – the private data of consumers.”
Just how much are these navigators needed? A new Harris poll out Tuesday found that large majorities of Americans, including the uninsured, know little or nothing about the exchanges. Just 9 percent of those questioned said they’re extremely or very familiar with the term health insurance exchange. Fully 70 percent are not at all or not familiar with it.
5. The Medicaid Expansion Shortchanges Some. The Affordable Care Act originally required all states to expand Medicaid coverage to all residents earning less than 138 percent of the federal poverty line, or about $31,800, according to CNNMoney.com. However, the Supreme Court threw out that portion of the law in 2012, ruling that states could determine whether to expand their Medicaid programs. That decision, Bill Clinton recently stated, created a “whopper” of a problem. Twenty-two states have opted not to expand the program. In states that don’t expand Medicaid, residents with an income above their states’ Medicaid eligibility limit and below the federal poverty line would not receive subsidies for the exchanges or have Medicaid coverage.