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Obama's Second Term

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Obamacare Health Insurance Marketplace is Two Years Old and Counting

November 15th 2014

ObamaCare's health insurance marketplaces opened for general enrollment Saturday, a pivotal moment for the administration as it seeks to extend coverage to more uninsured Americans and avoid another disaster at HealthCare.gov.

The online portal to 37 states exchanges will be under close scrutiny for any signs of the problems that appeared last fall, when HealthCare.gov crashed and was almost unusable for weeks.

Federal health officials say the site is significantly stronger than it was on Oct. 1, 2013, and have promised that the process for signing up will be more consumer-friendly. Still, they acknowledge that some technical problems might arise as users log on to the system.

"Consumers who are renewing their coverage or signing up for the first time will have an opportunity to obtain quality health coverage at a price they can afford," said Health and Human Services Secretary Sylvia Burwell. "Whether consumers visit the simpler, faster and more intuitive HealthCare.gov or contact the call center, they’re going to find more choices and competitive prices."

The White House is hoping for a smooth reboot that will allow them to focus on boosting enrollments and protecting President Obama’s signature program.

But if HealthCare.gov starts to crash, slow down or misdirect users, it will raise questions about repairs to the site that have been heavily touted by federal health officials.

The stakes are high for Burwell, who came to the department from the private sector less than six months ago with a mandate to clean up the problems that were seen in ObamaCare’s first year.

One of her first moves was appointing new leadership to run the system at HHS. HealthCare.gov now has a CEO, former Connecticut exchange chief Kevin Counihan, who oversees the site full-time and will take serious heat if it flounders.

Burwell also brought in Andy Slavitt to be principal deputy administrator at the Centers for Medicare and Medicaid Services, the agency tasked with running the exchanges. Slavitt is a former Optum executive who helped repair HealthCare.gov during the chaotic rollout last fall.

Both Counihan and Slavitt have described the site as markedly improved, with a shorter, cleaner application form, mobile capabilities and a long history of multi-layered security tests.

Most web users will take the repairs for granted. The new version of the insurance application will let users hit their "back" button, for example, something that was impossible before.

But the changes will not eliminate every problem for federal health officials.

While last year's sign-ups — together with the Medicaid expansion — helped the administration reduce the number of uninsured Americans by about 10 million, the people most likely to sign up are likely already enrolled.

Experts believe that the more progress the exchanges make, the harder it will be to convince the remaining uninsured to enter the system.

Anne Filipic, president of Enroll America, acknowledged the challenge this week but pushed back at the idea that the group's target population will be wary of the exchanges.

"There is no doubt we will have to work harder and smarter," Filipic said on a call with reporters. "[But] while the uninsured might be harder to reach, they aren't harder to convince."

The administration also faces logistical challenges.

The enrollment period will last only three months, while last year's was six. In addition to the compressed timeframe, enrollment groups are working with fewer resources for marketing and outreach.

Saturday also marks the first time that current enrollees can switch ObamaCare plans. Those who do not will be automatically re-enrolled in their coverage, resulting in confusion if consumers see their premiums rise.

Enrollment activists are encouraging people to shop around to avoid that outcome. But it's possible that HealthCare.gov will encounter other problems with re-enrollment, such as automatically renewing coverage for people who sought to drop their plans.

Avalere Health CEO Dan Mendelson predicted a smoother experience for consumers, but said health insurance companies might still see problems with the back-end of the federal exchange.

"My expectation is that plans are going to have to eat significant costs related to making the back-end operations work, and that's an issue," Mendelson said.

"There are data integrity issues that [HHS] needs to worry about," he continued. "There isn't a lot of control for fraud, and there isn't a lot of control for data inaccuracy. That's the part I worry about."

The administration is crossing its fingers for the best outcome, knowing that any difficulties will become political fodder for Republicans on Capitol Hill.

The GOP, now preparing to take control of the Senate in January, is already outlining the attacks it will make on the healthcare law once both chambers are under Republican leadership.

They renewed their assault on the law this week after videos surfaced of ObamaCare consultant Jonathan Gruber repeatedly insulting voters while discussing the law's passage. Republicans are weighing hearings on the matter, which would cause headaches for the White House and HHS. 

In the meantime, leaders such as Burwell are taking pains to lower expectations for this year's enrollment totals.

Rather than the 13 million enrollees projected by the Congressional Budget Office, HHS says its estimating that between 9.1 and 9.9 million people will be signed up for coverage in 2015.

Burwell has also stressed that HealthCare.gov is likely to have glitches despite the overhaul.

“We will have things that won't go right,” she said.

Elise Vliebeck writes for The Hill, from where this article is adapted.


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