The marketplaces open amid some technical snafus and fierce political clashes
TUESDAY, Oct. 1, 2013 (HealthDay News) -- The Affordable Care Act's new health insurance exchanges opened for business Tuesday amid the first federal government shutdown in 17 years and a push by Republicans in the House of Representatives to delay further implementation of "Obamacare."
The rollout of the exchanges, or marketplaces, marks a crucial step in the expansion of health insurance access to millions of uninsured Americans beginning in 2014. Under the law, most people without insurance face the prospect of a fine.
Despite the Capitol Hill clash between Republicans and Democrats, the exchanges were up and running -- with varying degrees of success -- on Tuesday because the Affordable Care Act doesn't rely exclusively on annual appropriations from Congress.
Speaking to reporters late Tuesday afternoon, Marilyn Tavenner, administrator of the Centers for Medicare and Medicaid Services (CMS), said the federal website serving as the enrollment hub in 34 states experienced system glitches during the day. Those problems have been corrected, she added.
But Tavenner and other CMS officials participating in the briefing declined to say how many people had successfully signed up for coverage on Day One. "We're not releasing that information yet," she said.
CMS officials said it takes time to gather that data and that it would be released periodically -- but not Tuesday. Heavy traffic accounted for some of the difficulties consumers may have experienced trying to access the enrollment site, the toll-free hotline and the online chat function.
"We have received more than 81,000 calls thus far," Tavenner said, while another 60,000 people requested a web chat.
Tavenner noted that, since midnight, more than 2.8 million people visited HealthCare.gov. She said the federal marketplace website had more than seven times the users than had ever logged onto the Medicare.gov at any one time.
The rollout of the new programs wasn't entirely smooth. Some health insurance exchanges were open but not fully functional.
Officials in Colorado, Oregon and the District of Columbia had previously announced that there would be computer system problems when the enrollment process opened.
People in Oregon, for example, can't apply for coverage online for several weeks. Those who want to apply immediately must connect with one of the exchange's licensed agents or community partners.
Jesse Ellis O'Brien, a health-care advocate with the Oregon State Public Interest Research Group Foundation, said Monday that he "wouldn't be surprised" if other states found their websites weren't quite ready to go live, either.
"I think the key thing is October 1st is a starting point -- it's not a finish line," he said.
The enrollment process will last through March 31, 2014.
Federal health officials also confirmed last week that small businesses won't be able to apply online for coverage in federally run small business insurance exchanges until November, and that the Spanish-language version of HealthCare.gov, the government's health reform website, won't be ready to enroll people for a few weeks.
Nicole Kaeding, state policy manager for Americans for Prosperity, a conservative advocacy group in Arlington, Va., said she expects these sorts of stories to persist. "Piling thousands of pages of regulation onto an insurance market is an unworkable solution. We're beginning to see just how unworkable it is," she said.
Not even proponents of the health reform law had expected such an immense undertaking to get off the ground without a hitch.
"You know, I think it would be foolish to say that everything is going to go perfectly," Gary Cohen, director of the Center for Consumer Information and Insurance Oversight at the U.S. Centers for Medicare and Medicaid Services, said during a news briefing last week. "On any big IT [information technology] project, there always are going to be things that you can improve on and make better," he said.
The new health exchanges offer one-stop shopping for health insurance coverage. Eligible Americans can compare health plans and prices and choose the coverage that suits them best.
The exchanges will also determine whether people are eligible for public health coverage under Medicaid or the Children's Health Insurance Program.
Some 7 million people are expected to enroll in private health coverage through the exchanges in 2014, according to estimates by the nonpartisan Congressional Budget Office. Another 9 million will enroll in Medicaid and the Children's Health Insurance Program, according to the research outfit's projections.
If you are uninsured, here's how the exchanges are designed to work:
- When you apply for coverage through the health exchanges, you'll find out if you are eligible for federal tax credits to lower your monthly health plan premiums. That help is available to people earning between 100 percent and 400 percent of the federal poverty level, or $11,490 to $45,960 for a single person and $23,550 to $94,200 for a family of four. And depending on your income, you may qualify for cost-sharing subsidies to reduce your out-of-pocket expenses.
- The exchanges also serve as a gateway for people with very modest incomes to enroll in Medicaid. If you live in one of 24 states or the District of Columbia where Medicaid eligibility is expanding in 2014, you can earn up to 138 percent of the federal poverty level -- $15,856 for a single person or $37,384 for a family of four -- and qualify for coverage in the public health program.
How smoothly enrollment goes is likely to vary somewhat by state.
Pennsylvania, for example, is one of 27 states where the federal government is running the state's health insurance exchange.
The U.S. Department of Health and Human Services awarded a little more than $2.5 million in grants -- a third of what some states received -- to train so-called "navigators" to provide in-person assistance to people who need enrollment help, according to Antoinette Kraus, director of the Pennsylvania Health Access Network.
"Our concern is that there will not be nearly enough (navigators) to keep up with the demand," she said. Her organization is encouraging community organizations to get certified to help educate consumers and assist them in applying for coverage.
"We will need an all-hands-on-deck approach to getting the word out," Kraus said.
Visit the official federal government website for details on coverage under the Affordable Care Act (https://www.healthcare.gov/ ).
SOURCES: Centers for Medicare and Medicaid Services, news briefing, Oct. 1, 2013, with Marilyn Tavenner,agency administrator; Jesse Ellis O'Brien, health care advocate, Oregon State Public Interest Research Group Foundation, Portland, Ore.; Nicole Kaeding, state policy manager, Americans for Prosperity, Arlington, Va.; Sept. 26, 2013, news briefing with Gary Cohen, deputy administrator and director, Center for Consumer Information and Insurance Oversight, U.S. Centers for Medicare and Medicaid Services, Washington, D.C.; Antoinette Kraus, director, Pennsylvania Health Access Network, Harrisburg, Pa.; May 2013 report, Congressional Budget Office; HealthCare.gov