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U.S. lays out steps to smooth Obamacare coverage for January

A man looks over the Affordable Care Act (commonly known as Obamacare) signup page on the HealthCare.gov website in New York in this October
A man looks over the Affordable Care Act (commonly known as Obamacare) signup page on the HealthCare.gov website in New York in this October

By David Morgan

WASHINGTON (Reuters) - The Obama administration asked insurers on Thursday to be flexible with Americans trying to buy new health policies through the federal website HealthCare.gov, as officials race to fix problems still plaguing the enrollment process.

U.S. officials laid out a series of steps to help prevent disruptions in coverage for health policies due to start January 1, including the possibility of retroactive coverage.

Widespread stories of coverage gaps could pose new political problems for President Barack Obama, whose signature domestic policy has already sparked a public uproar over the botched launch of the website and the millions of cancellation notices sent out for policies that do not comply with the law.

The administration said it would consider further extensions of the enrollment deadlines if required by "extraordinary circumstances," having extended its December 15 enrollment deadline for obtaining benefits on January 1 to midnight December 23 (0500 GMT December 24).

It also required insurers to enroll people who meet the deadline and provide an initial premium payment by December 31.

Officials led by U.S. Health and Human Services Secretary Kathleen Sebelius also urged insurers to be flexible by allowing new Obamacare customers to enroll for retroactive January 1 coverage, if they wait until after New Year's Day to sign up or make only a partial premium payment.

The list of what one official described as "mitigation strategies" also asked insurers to maintain care for enrollees by treating out-of-network physicians as in-network providers for acute episodes and honoring refill prescriptions covered under previous plans during January.

"The steps ... are important to help ensure that consumers seamlessly transition from their current health plans into marketplace coverage without experiencing any gaps," Mike Hash, director of the Department of Health and Human Services Office of Health Reform, told reporters on a conference call.

The Obama administration has acknowledged that 10 to 25 percent of enrollments since October 1 have been transmitted inaccurately to insurers or failed to show up at all.

Insurance industry officials have warned repeatedly that enrollment errors could leave some people uninsured even after they have signed up for coverage on HealthCare.gov, which serves consumers in 36 states.

"The big moment of trust is 12:01 am on January 1st, when a mother is standing in a pharmacy with a baby in her arms trying to get a script filled," Aetna Inc Chief Executive Mark Bertolini told an investors meeting on Thursday.

The main trade group representing health insurers said its members would continue to do everything to protect consumers from potential coverage disruptions cause by the problems with the government website.

"With only weeks to go before coverage begins, continued changes to the rules and guidance could exacerbate the challenges associated with helping consumers through the enrollment process," said Karen Ignagni, president of America's Health Insurance Plans.

LAST-MINUTE FIXES

The pace of enrollment has accelerated in the run-up to the December 23 deadline, though numbers remain well below projections that would enable the administration to reach a goal of signing up 7 million people in private insurance by the time enrollment ends on March 31.

But some welcome news arrived for Obama late on Thursday from California, where state officials announced that their own Obamacare marketplace saw an enrollment surge in the first week of December that put the state on track to meet its target.

Republicans, who want to repeal and replace the law, are already claiming it will create more uninsured people than it will enroll next year.

"It's clear the administration knows Obamacare's problems are only going to get worse, and patients will be the ones who suffer. What's not clear is whether they understand the confusion and chaos they continue to cause," said Rory Cooper, a spokesman for House or Representatives Republican leader Eric Cantor.

The government and insurers this week began searching for problem enrollment files in data on about 137,000 people who signed up for coverage through HealthCare.gov in October and November. But because the automated system intended for the job is not available yet, the data search is relying on slower and more cumbersome manual methods.

The government also announced on Thursday a one-month extension through January for a $5 billion federal insurance program that currently provides coverage for almost 86,000 people with serious health problems and said some states could follow suit on their own programs.

"We don't want these folks to experience a coverage gap," said Sebelius.

(Additional reporting by Caroline Humer and Sharon Begley in New York; Editing by Karey Van Hall and Tim Dobbyn)

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