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Washington’s health insurance exchange will open on time next Tuesday, but it won’t be able to tell people right away if they are eligible to join Medicaid instead of buying insurance.
Small businesses will be able to window shop on the new health insurance marketplaces, but they won’t be able to enroll until November, and the Spanish-language version of the healthcare.gov website will not be ready to handle enrollments for a few weeks. An estimated 10 million Latinos are eligible for coverage.
Opponents of the administration are crowing about these and other glitches in the rollout of one of the main phases of health reform, but many experts say such problems are only to be expected when introducing a complex system that requires secure, instant communication among the Health and Human Services Department, the IRS, immigration officials and the Labor Department.
“Another day, another delay. But that does not deter President Obama and administration officials from insisting that implementation of the health care law is on track,” Republicans on the House Energy and Commerce Committee wrote in a blog post.
“Add these delays to the administration’s July 4th holiday delay of the employer mandate and income verification system, and it is painfully clear that this law is not ready for prime time.”
Jay Angoff, a health insurance expert who helped set up the exchanges at HHS who is now at private law firm Mehri and Skalet, describes the problems as minor. “I wouldn't even characterize the one-month delay in the shop exchange as a glitch, since coverage can't begin anyway until January 1. There may well be real glitches--we'll know on October 1--but this isn't one,” Angoff said.
Obama administration officials say there is plenty of time for everything to work for people who want to buy health insurance.
"What is happening with the SHOP exchange -- the small business exchange where for first time a lot of small business owners will be able to compare plans side by side -- that will be available on October 1 as promised,” Health and Human Services Secretary Kathleen Sebelius told MSNBC’s Alex Wagner.
“People will be able to see what is in their marketplace, how to look at coverage, ask questions about whether or not this is a good deal for their employees, find out about the tax credit, and then beginning November 1, do the online enrollment.”
Sebelius noted that the plans don’t go into effect until Jan. 1, 2014. The Oct. 1 date was set to give at least three months lead time for enrollment.
Washington, D.C, health officials denied the problem was serious. "DC residents seeking Medicaid coverage can still receive medical assistance and apply for Medicaid on October 1. Despite recent media coverage about software issues that that are being resolved, the process for receiving and reviewing Medicaid applications, as well as determining Medicaid eligibility, will continue without delay," they said in a statement.
The system for calculating tax credits will be ready by November, they said.
The health insurance exchanges are one of the main components of the 2010 Affordable Care Act, known as Obamacare. They’re designed to be an online marketplace where people and small businesses can compare different insurance plans available in their states, choose a level of coverage, and find out if they are eligible for federal government subsidies to pay the premiums.
The technology behind them is complex and represents an unprecedented effort to take people from shopping for insurance, to being signed up and getting any government subsidy they have coming in one online session.
The Federal Data Services Hub that underlies the whole system has to connect several federal agencies, state databases and the private health insurance companies providing plans. It’ll search IRS records, Social Security databases, data on immigration and citizenship from the Homeland Security Department, state records for verification of residency, criminal history from the Justice Department and check to make sure the applicant doesn’t qualify for veteran’s benefits through the VA.
It will also check income and entitlement information to make sure applicants are not eligible for Medicare, Medicaid or some other government program instead of having to buy insurance. Then it will calculate how much of a subsidy the applicant gets. The federal government will help pay the premiums for anyone making up to about $46,000 for an individual and as much as $94,000 for a family of four.
It will be a confusing and potentially overwhelming process, experts say.
But senior administration officials have said the program will run smoothly enough and that surveys have indicated people will find the wait time acceptable once they are seated at the computer and being enrolled.
Most Americans -- about 55 percent, or 157 million people -- get health insurance through an employer, and 30 percent more get Medicare, Medicaid or some other government insurance, with just a few buying their own insurance privately. The U.S. Census Bureau says 15 percent of Americans don’t have insurance at all.
Experts expect about 7 million people will sign up for insurance on the new exchanges.