Critics point to drawbacks in changing health law deadline, ‘individual mandate’

10/28/2013 6:11 PM

11/07/2013 8:24 PM

Extending the Affordable Care Act’s March 31 open enrollment deadline has become a familiar plea for congressional Democrats frustrated with the poor performance of the federal insurance marketplace.

Republicans on Capitol Hill want to go even farther and waive the health law’s “individual mandate,” which requires most Americans to have coverage in 2014 or face a fine.

While both consumer-friendly fixes make for good politics, neither proposal is as simple or as smart as it sounds, according to experts.

The health law’s open enrollment deadline and individual mandate are both designed to help entice young, healthy people and those who are older and sicker into purchasing newly mandated coverage. The Obama administration and insurers are counting on that diversity of enrollees to help keep monthly premiums in check for individual plans sold on the state and federal marketplaces.

But waiving the mandate likely would cause premiums to rise because healthy people would avoid coverage, while sicker people would be more likely to take advantage of the new consumer protections that guarantee access to coverage, regardless of current or past health problems. The law also bans premium variations based on gender, occupation or medical claims history and outlaws annual and lifetime benefit spending limits.

Delaying the mandate would also hurt the health law’s goal of reducing the number of people without health coverage. In fact, the number of uninsured Americans would increase by 11 million in 2014 without the mandate, according to the Congressional Budget Office and Congress’ Joint Committee on Taxation.

The 11 million uninsured would include 5 million fewer people who would otherwise receive coverage through Medicaid or the federal Children’s Health Insurance Program, 4 million who would otherwise have job-based coverage and about 2 million who would otherwise have individual coverage, according to the CBO.

Waiving the mandate would also undermine the work of 16 states that have expanded Medicaid coverage and set up their own marketplaces, said Joel Ario, managing director at Manatt Health Solutions in New York. Those states did so with the understanding that the mandate would be enforced.

“You could imagine what those 16 states would say,” said Ario, who once coordinated development of health insurance exchanges at the U.S. Department of Health and Human Services. “‘We’ve done everything we’re supposed to do. We have the right to move forward. The mandate should function like it’s supposed to. The federal government is obligated to back it up.’”

Ario said that “either you’re going to undercut states that have done everything they should have under this law, or you put yourself in a position where you pretty much have to stay the course.”

Some feel insurers would be in a similar position as the 16 states if the enrollment deadline is altered.

“The defined open enrollment period is critical to prevent people from simply being able to buy coverage on the way to the hospital,” said Robert Zirkelbach, a spokesman for America’s Health Insurance Plans, a health insurance industry trade association.

Health insurers set their 2014 rates and based their plan offerings, in part, on the idea that they could expect a certain number of new enrollees by March 31. Expanding the time limit to purchase coverage could scuttle those estimates.

In addition, Zirkelbach said insurers are already studying rates for 2015 coverage, which will be based in large part on the mix of people who get insurance in 2014. That analysis can’t be done until after the 2014 open enrollment period concludes.

On Monday, Obama administration officials resolved the latest problem to beset the insurance marketplace portal, the Healthcare.gov website. An external network failure at a Verizon affiliate shuttered the website in several states on Sunday. The problem was resolved Monday morning, but users continued to report problems completing the online enrollment process.

Julie Bataille, a spokesperson for HHS Centers for Medicare and Medicaid Services, said the administration’s team of website specialists, dubbed the “tech surge,” continues to work around the clock to resolve a “punch list” of technical problems that have frustrated users in 36 states that use the federal marketplace.

Consumers can still enroll by phone or by mail. Bataille said she expects the website’s Spanish-language site to be up and running by the end of November, the same time that the Obama administration has said the entire site will be functioning properly for most users.

People hoping to enroll in coverage on the federal marketplace by Jan. 1 have until Dec. 15, 2013, to purchase coverage. Under rules finalized Monday by the Obama administration, people have until March 31, 2014, to purchase coverage without being penalized under the individual mandate.

On Tuesday, Marilyn Tavenner, administrator for the Centers for Medicare and Medicaid Services, will testify before the House Ways and Means Committee about continued problems on the website. HHS Secretary Kathleen Sebelius will testify on Wednesday before the House Energy and Commerce Committee.

Also on Wednesday, President Barack Obama will appear at Faneuil Hall in Boston – the site where former Massachusetts Gov. Mitt Romney, the Republicans’ 2012 presidential challenger – signed the state’s universal health care legislation into law in 2006. The White House said Obama will “deliver remarks on the importance of providing all Americans with quality, affordable health insurance and the experience in Massachusetts.”

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