Analysis: Optimism And Doubt Surround Health Care Law

The Record ( — Thursday, December 5, 2013

The Record

The White House went on a public relations offensive this week after two months of damaging news about the disastrous rollout of President Obama's signature health care plan.

Declaring success in fixing the website used by people in 36 states who are uninsured or whose coverage has been canceled, administration officials on Wednesday touted health services they say have already benefited 71 million Americans under the law.

About 29,000 people enrolled in insurance plans in the first two days of this week, exceeding the number of enrollments on the site for all October, according to a source familiar with the data. That is the clearest sign yet that the federal health insurance website is vastly improved and an encouraging sign for the administration.

And at a news conference earlier in the week, the president was introduced by a young woman who benefited from a popular feature of the Affordable Care Act — the ability for people up to age 26 to stay on their parents' plans.

"We will make this work for all Americans," Obama declared.

When problems crop up — "as they always do when you're launching something new," Obama said — "we'll fix those, too."

Despite the positive messages, however, it's far from certain whether the president can restore his badly damaged credibility and redeem the promise of the Affordable Care Act.

It's still unclear whether everyone who wants to sign up for coverage that begins on Jan. 1 will be able to do so by the Dec. 23 deadline. For people whose current coverage has been canceled because of the Affordable Care Act — a number that includes at least 110,000 New Jersey policyholders — going without insurance for some period in January could do more than damage Obama's popularity.

There are other issues as well, including errors and omissions in the enrollment data the website transmits to the insurance companies.

"It's very troubling, very troubling," said Linda Schwimmer, vice president of the New Jersey Health Care Quality Institute and a former executive at Horizon Blue Cross Blue Shield of New Jersey. "I have a lot of optimism that over time this will all be worked out, but a great deal of concern today."

The Obama administration has a tough sell ahead of it. Opposition to the law has swelled since the website's Oct. 1 rollout. Fifty-seven percent of Americans said they opposed the law in a Washington Post/ABC News poll taken Nov. 14-17, and the country was evenly split on whether the program could even be salvaged because of its flawed start.

A survey by Harvard's Institute of Politics revealed more bad news on Wednesday: More than half of those 18 to 29 years old say they disapprove of Obamacare and half expect it will increase their health care costs. Four in 10 say they anticipate the quality of their coverage will get worse.

"The word 'Obamacare' is dragging down all those things that people love, and what the president is trying to do is flip that, so that all the things people love will actually lift up the support" for the law, said Steve McMahon, a Democratic political strategist and co-founder of Purple Strategies, a Washington public affairs and communications firm.

To promote the law, the administration on Wednesday brought to the White House about 160 people described as young leaders. The president asked them to talk to their peers about health care options.

"This law is already making a difference for millions of young people," Obama said. "I'm going to need your help to spread the word."

More than 2.3 million consumers nationwide visited the federal health care website from Monday through noon on Wednesday, after the administration's relaunch of the troubled site on Sunday, said Julie Bataille, a spokeswoman for the Centers for Medicare & Medicaid Services.

But it was impossible to look beyond the administration's limited data and determine if enrollment from New Jersey and the other states relying on the federal marketplace is on pace to meet the Affordable Care Act's goals.

The law is supposed to help bring health coverage to most of the 41 million Americans who are uninsured. In New Jersey, an estimated 900,000 uninsured residents are eligible for coverage through the federal marketplace or the state's expanded Medicaid program. Another 110,000 people whose "basic and essential" plans cannot be renewed will need to choose coverage by their renewal dates next year. And a special plan for 1,000 residents with serious preexisting conditions will sunset on Dec. 31, so they, too, will need to use the federal website to choose new policies.

On Wednesday, the administration called attention to other parts of the law, already implemented, that have provided free checkups and cancer screening to millions of Americans, including 2.2 million in New Jersey.

Even as Obama professed confidence, however, serious questions about remain.

Insurers this week drew attention to their concerns about the website's back end — the accuracy of the information it transmits, once customers have selected a plan, to the insurance companies. Mix-ups in that data, including listing a spouse as a child, or omitting key information, plagued applications for coverage in October and November. Customers who think they have enrolled in a plan were urged to confirm with insurers that they have coverage and make sure they send in the first month's premium and receive enrollment materials.

The problems may be deeper than that, however.

Parts of the system that calculates the federal payments to insurance companies have not been built out yet, according to Congressional testimony. Without detailed information on subsidies, the insurance companies don't know how much to bill customers coming through the federal marketplace.

Imagine, Schwimmer said, that received all its holiday orders, but didn't have connections worked out with suppliers or those who ship the goods.

Another problem: Tens of thousands of New Jersey residents with coverage they bought on their own or received as part of a small-employer group don't know yet whether their insurers will allow them to renew their policies next year.

Trying to make good on his promise that "if you like the plan, you can keep it," President Obama last month said he'd leave it to states to decide whether insurers can renew health plans that don't include the 10 essential benefits required by the Affordable Care Act. But he didn't lift the law's ban on annual or lifetime caps for insurance benefits.

That spelled doom for New Jersey's popular, low-cost basic-and-essential plans, which this year cover 110,000 people. Those customers — many of whom appear not to be aware that their plans have these limits — need to choose a more comprehensive plan when their renewal date comes up in 2014.

Even though Governor Christie decided last week to leave it to "the free market — not the government — to decide the fate of health insurance plans impacted by new Obamacare regulations," companies like Horizon Blue Cross Blue Shield of New Jersey, UnitedHealthcare and Ameri\0xADHealth have yet to say what they'll do. The longer they wait, the less likely it is the plans will be continued, experts said.

These issues worry lawmakers in New Jersey. The state Senate Commerce Committee, headed by Nia Gill, D-Essex, has asked Insurance Commissioner Kenneth Kobylowski and representatives of the insurance industry to testify at a hearing today.

"This is an important decision that could affect 800,000 New Jerseyans," as well as "the overall insurance market in our state," said Gill, whose district includes Clifton. "This is certainly a matter that cannot be taken lightly or without public discussion by the decision makers."

Consumers in New Jersey desperately need information about what their options are, said Maura Collinsgru, a health advocate for New Jersey Citizen Action. For example, those who want to continue their old plans can do so for most of 2014, if they renew them by the end of this year. "The governor and the administration and insurers should inform consumers that they have choices," she said.

At a news conference on Tuesday by New Jersey Policy Perspective, a progressive research center, Collinsgru and others pointed to federal funds the state received to develop an insurance marketplace, but has not yet used.

Christie's "passivity," she said, "really is a problem for consumers. They are not hearing what they need to hear, they are not being informed of their choices. Consumers in New Jersey ... deserve better."

She added, "The governor is still sitting on $7.6 million. This is a perfect example of what we could do to further consumer knowledge."

The group called on the Christie administration to use some of the "windfall" it will receive — $222 million in the first six months of 2014 — from the federal government to pay for Medicaid next year to bolster subsidies for those who are buying plans on the site.

"Most people don't want to keep plans that are inadequate," said Raymond Castro, a senior analyst with the policy group. "What most people are concerned about is their cost — are they going to have to pay more?"

The one bright spot for New Jersey has been a surge in applications for Medicaid coverage, which Christie agreed to expand to cover childless adults too poor to qualify for subsidies on the federal marketplace. Nearly 22,000 people submitted applications for Medicaid coverage in October, according to a new federal report — a jump of 59 percent over previous monthly averages.

While many individuals may find they qualify for tax subsidies or Medicaid's zero premiums when they go to the federal marketplace, they've been frustrated by its technical problems. Only 741 New Jersey residents signed up for a health plan on the website in October.

"I think people will come back to it," said Schwimmer. "But the administration has a lot of work to do to convince people that it's a trustworthy, consumer friendly place to shop for something that they want."

This article contains material from Bloomberg News and McClatchy News Service.

Web alternatives

If you are uninsured or need to purchase a new health policy because your current individual plan has been canceled, you may not need to use the federal marketplace for New Jersey at Here's what to do:

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