15,000 Obamacare Enrollments Disappeared; Payment Still an Issue


U.S. Government

Healthcare.gov may now working better-ish, in that users aren't regularly hitting a wall or pulling up code salad, but the Obama administration still seems to have a low threshold for invoking the word "fixed." According to the Department of Health and Human Services, information that went in the front end, from people applying for health coverage, didn't necessarily make it to the companies who are supposed to provide that coverage. Although that's getting better. Of course.

Says an HHS announcement conveniently released on Saturday:

As the technical improvements to HealthCare.gov continue making a difference to consumers using the website, our attention remains on addressing issues with the more "back end" parts of the system, including the creation and accuracy of 834 transaction forms.  These transaction forms are processed by health plans when consumers choose a product in the Marketplace, and our priority is working to make sure that every 834 form – past and present – is accurate, and that consumers are able to successfully enroll in the coverage of their choice. …

Our analysis indicates that between October 1st and December 5th, the number of consumers for whom 834s were not produced was fewer than 15,000.  But as the graph shows, since the beginning of December, missing 834s as a percentage of total enrollments has been close to zero.  These significant improvements are due to the technical fixes put in place by the end of November.

So, a fair number of people who diligently banged on the system to get their Obamacare plans were shouting into the void, never to be heard.

Glad to hear that their efforts in self-sacrifice won't be demanded on an ongoing basis.

Unfortunately, another thing that's not making it through the system is money. People may be "enrolling" in coverage, but that doesn't mean they've closed the deal by paying premiums for what they'll receive. Charles Ornstein of ProPublica quotes industry executives saying that only five to 15 percent of those who have made it through the sign-up process have actually paid a bill and truly enrolled.

[A]mid the rush to enroll as many people as possible by the Dec. 23 deadline, there's a huge caveat that isn't getting much public attention: In order for coverage to take effect on Jan. 1, enrollees must pay their first month's premium on time. (The deadline varies somewhat by state and by insurer.)

That's slow going, according to consultants and some insurers, raising the prospect that actual enrollment will be far lower than the figures HHS is releasing.

"There is also a lot of worrying going on over people making payments," industry consultant Robert Laszewski wrote in an email. "One client reports only 15% have paid so far. It is still too early to know for sure what this means but we should expect some enrollment slippage come the payment due date."

Another consultant Kip Piper, agreed. "So far I'm hearing from health plans that around 5% and 10% of consumers who have made it through the data transfer gauntlet have paid first month's premium and therefore truly enrolled," he wrote me.

Which may explain why the feds are leaning on insurers to provide coverage even to those who haven't cut a check. New rules to be published in the Federal Register (PDF) are very clear on when coverage must begin—and in asking for "flexibility" of insurers in terms of receiving payment.