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U.S. says HealthCare.gov enrollment appeal hearings to begin soon

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

WASHINGTON (Reuters) - The Obama administration on Monday said it will soon begin hearings to resolve problems for people who enrolled in health insurance through the Obamacare website HealthCare.gov, only to encounter errors including unnecessarily high costs.

The U.S. Centers for Medicare and Medicaid Services (CMS), the lead agency responsible for implementing the healthcare reform law, issued a statement saying it was reaching out to consumers with error-ridden enrollments to help them complete applications for coverage without a formal appeal.

The statement came in response to a Washington Post report that said about 22,000 Americans have appealed to CMS for help fixing enrollment mistakes that have led to excessive charges, enrolled them in the wrong health plan, or denied them coverage altogether.

The appeals have hit a technological dead end, the newspaper reported, because the administration has yet to complete the technology infrastructure necessary to manage the appeals process.

Obamacare's rocky implementation has already weathered paralyzing glitches and a public outcry over insurance policy cancellations for millions of people in the health plan market for individuals.

"CMS is working to fully implement an automated appeals system. Until we have that functionality, we are putting in place a manual review process wherever possible and expect hearings to begin soon," said the agency.

"In the meantime, CMS is reaching out to these consumers to provide assistance so they can successfully complete their application without the need to complete the appeals process."

CMS did not confirm the number of appeals reported by the Post but said those filed are "largely related to earlier technology problems that have since been fixed."

A CMS spokesman declined to say how soon hearings might start. But analysts said a system would have to be in place before March 31, the end of the Obamacare open enrollment period for obtaining health coverage this year.

The Patient Protection and Affordable Care Act, President Barack Obama's signature domestic policy achievement, is intended to extend private health coverage to the uninsured by selling private plans at subsidized rates through new marketplaces. The law also calls on states to expand Medicaid coverage for the poor.

HealthCare.gov, the Web portal for a federal marketplace that spans 36 states, crashed soon after its October launch, blocking access to some while saddling others with inaccurate enrollment files. Four months later, CMS is still scrambling to complete back-end systems that would allow the federal marketplace to pay government subsidies to insurers on behalf of low-income beneficiaries.

Republicans in Congress pounced on news of the appeals problem as fresh evidence that the healthcare law's individual mandate should be delayed. The mandate requires most Americans to be enrolled in health coverage by March 31 or pay a penalty.

"Over four months after launch, the administration still does not have its act together. They appear to be incapable of addressing Obamacare's failures, unfairly leaving Americans on the hook," said Joe Pitts, chairman of the House Energy and Commerce health subcommittee.

(Reporting by David Morgan and Susan Cornwell; Editing by Karey Van Hall and David Gregorio)

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