In some ways, the Affordable Care Act seemed to catch a break last week. Republicans in Congress failed in their attempts to repeal the law or delay its implementation.
At the same time, consumers and journalists began reporting success — after many failed attempts — at creating accounts on healthcare.gov, the online home for the federal insurance marketplaces. They include Sarah Kliff of the Washington Post, Phil Galewitz of Kaiser Health News (after 63 tries) and, yes, me. Heck, the state of Delaware even got its first enrollee, albeit 11 days after healthcare.gov launched.
But just as the front-end problems seemed to be getting worked out, even larger problems started popping up: namely, the back-end enrollment system that passes information between the government and insurance companies.
Consider this from Bob Laszewski, a plain-spoken consultant, in an interview with Wonkblog's Ezra Klein:
The insurance industry is literally receiving a handful of new enrollments from the 36 Obama administration-run exchanges. It's really 20 or 30 or 40 each day through last week. And a good share of those enrollments are problematic. One insurance company told me, "we got an enrollment from John Doe. Then five minutes later we got a message from CMS disenrolling him. Then we got another message re-enrolling him." On and on, up to 10 times. So insurers aren't really sure if the enrollments they've got are enrollments they should have.
On Friday, the Wall Street Journal published a comprehensive and damning story about what appears to be happening:
Emerging errors include duplicate enrollments, spouses reported as children, missing data fields and suspect eligibility determinations, say executives at more than a dozen health plans. Blue Cross & Blue Shield of Nebraska said it had to hire temporary workers to contact new customers directly to resolve inaccuracies in submissions. Medical Mutual of Ohio said one customer had successfully signed up for three of its plans.
The flaws could do lasting damage to the law if customers are deterred from signing up or mistakenly believe they have obtained coverage.
Health-department officials have pressured insurers to refrain from commenting publicly about the problems, according to executives at four health plans, who asked not to be named. The HHS declined to comment.
Politico had a smart take on it too:
People who can't or don't want to sign up for Obamacare through the troubled federal website have the option of enrolling directly with an insurance company — but there's a glitch. The insurers haven't yet been able to make a key connection with the IT infrastructure for federal exchanges.
And without that connection, they can't help millions of people who may be eligible for federal subsidies to purchase insurance.
It's the flip side of the problems consumers are facing as they try to get in the front door of Healthcare.gov. The health plans can't get in the back door.
Things don't appear to be getting better. I've seen many Obamacare supporters turn to Twitter to call on the government to be more open about what is actually going on. And late Friday, Laszewski sent out a mass email noting that the problem was not improving:
A senior exec from a large plan just emailed me saying enrollments sent to them yesterday were the lowest number since day one.
I report this because a number of reporters have been calling saying enrollments are supposed to be improving.
His longer blog post is worth reading, too.
So, where does that leave us?
As he notes, there's always paper and the telephone.