As a benefits consultant and former manager of benefits for a multi-state corporation, let me state the obvious, the rollout of the www.healthcare.gov website could definitely have been handled better and needs to further improve. On Friday, I browsed the website which is handling enrollment for 36 states and found it to be very informative and helpful. Yet, I did not attempt to set up an account, which is where the rubber needs to hit the road. My ability to browse on Friday was not permitted when it launched on October 1, as a late decision was made to require the set up of an account first to activate the subsidies engine when looking at premium rate information. The administrators have since changed that decision which will allow people like me to look around before we set up an account to purchase coverage.
Let me make three major points as we look forward and backwards. First, the enrollment process is only one of five key pressure points in the execution of coverage. Once you have enrolled, the next pressure point is for the system to pass your information to the insurance carrier you have selected for coverage. That will likely occur in multiple feeds, so it is incumbent on the carrier not to process duplicate records. Plus, for late enrollees who want coverage January 1, there is only fifteen days for a final true up file between the system and carriers.
This enrollment file is vital to making sure coverage begins. So, the third key pressure point is getting enrollment ID cards to verify coverage. When I think of this process, I recall the time one healthcare vendor for my company sent some enrollees six ID cards, some three and some zero. Apparently, the ID printer kept stalling and the system started printing from the start.
The fourth pressure point is when the billing process starts, which actually will occur after the effective date of coverage for many. Will the subsidies be properly applied and will the premiums be properly invoiced each month? In the corporate world, the first pay period when premium deductions are made in January is when people realize they may have signed up for the wrong plan.
The fifth and major pressure point is when a person goes to the doctor in early January. Do they have coverage? This is what is known as the point of reckoning. In my job as manager of benefits, you did not want to get a call from an employee or spouse of an employee whose doctor is seeing coverage denied on the system. So, fixing the website is important, but the administrators and insurance carriers need to make sure they get these other parts right as well.
Second, I want to state the obvious that Obamacare is designed to get insurance coverage to people who did not have access. In the finger-pointing and misinformation campaign, we lose sight of the fact that almost fifty million people do not have access to health coverage. Those with coverage pay for these uninsured now through pass through costs and taxes to support county and federal subsidies. Yet, those without insurance are using the system at the worst time and place – when a medical issue is critical and at the emergency room which is a very expensive place. Getting people access to coverage beforehand will permit a better cost and utilization model for all concerned. And, preventive care will be introduced to help avoid medical issues to worsen.
Already through the earlier implemented items under Obamacare, adult children under 26 not in college can stay on a parent’s plan (this has added over 3 million enrollees), pre-existing condition restrictions are waived for children (and will be waived for all January 1), lifetime limits on medical costs have been lifted, the Medicare prescription drug benefits have been improved and insurance company profits are limited on premiums (which has caused refunds to some premium payers the last two summers). These features are well received and the further elimination of the pre-existing condition restrictions and better mental health benefits are significant changes coming January 1.
Third and final, looking backwards two major stakeholders could have done better. The President’s team should have started earlier and involved more quarterbacking of various efforts. Plus, decisions on the design of the website and supporting call center should have been put to bed months before to permit detailed User Acceptance Testing. If you ask AonHewitt, Mercer, TowersWatson, etc., they each want their clients to put to bed plan design changes and premium rates by early August when they go into the October enrollment cycle for their clients – and this is with a fully designed system. So, the fact someone made decisions late to the design of a very complicated system was a poor move and should have been disallowed.
The other group which should not be overlooked is the role Republicans played in this whole process to make a hard thing harder. They should not be too smug, as when you do the following:
– fight the constitutionality of a law designed to help people (using a structure that is largely a GOP idea no less) through the spring, 2012;
– this fight delayed efforts by many states to set up their own exchanges, which would have made the process less complicated as exhibited by some states having few glitches thus far;
– the Republican led states who decided not to expand Medicaid to defeat Obamacare, which is and was a win-win decision for the people in need, hospitals and the state economies, made it a mixed bag of offerings to administer and communicate; and
– the constant fight to defund, disinform, and dissuade people from using and understanding the new law has done a law designed to help people a huge disservice;
the implementation is made harder. So, to sit back and point fingers as to why did you allow this to happen and see I told you so, does not sit very well with this Independent voter. To me constructive questions on how to make it better and get people enrolled are fair game. I go back to a comment I made in an earlier post – in his twenty-one hours of filibustering, Senator Ted Cruz failed to mention that his state of Texas was dead last out of fifty states and Puerto Rico, by having the most uninsured people in the US. So, my question to him and others is why don’t you support Obamacare and why doesn’t your state expand Medicaid to help those in need? Those uninsureds are citizens of Texas, too.
So, I hope this can get fixed. I think it will get fixed, but the question is when. If it does not or if it takes too long, then it is truly unfortunate as people will get hurt. The political chess game may turn against the new law and the real losers will be those pawns I keep fighting for who need healthcare coverage. They cannot get coverage because of access, cost and pre-existing conditions. There are almost 50 million of these pawns and include Republicans, Libertarians, Democrats and Independents. They will be helped by the Affordable Care Act. Let’s see it through.