As most people know, the Obamacare exchanges have experienced technical glitches that have made it difficult, and sometimes impossible, for people seeking to enroll in Obamacare to get enrolled. These glitches are slowly being fixed but no one knows if we are talking about 2 weeks or 2 months or more before everything is running smoothly. Two ideas have emerged that have the potential to speed up enrollment and could probably be implemented quickly. They are:
(1) Attestation—One of the biggest glitches slowing the exchanges has to do with checking an individual’s eligibility for obtaining insurance through the exchanges and for subsidies. The way the exchanges are designed now, eligibility is checked BEFORE a person can even see what insurance might be available and what it will cost after subsidies, if any. (See the chart below from the Washington Post) The exchange software has to check six different data bases to make this determination and bottlenecks can, an often do occur, at each of these six points thereby slowing down the whole system. Under Attestation, the eligibility check would be moved to later in the process, either between the Shop and Compare stage or even after Enrollment. In other words, individuals wanting to find out if purchasing insurance through the exchanges would work for them would provide (attest) to the information—age, income, citizenship, etc. The exchange software would accept that information as correct and use it to make an initial determination of eligibility and amount of subsidies, if any. The individual could make a choice about coverage and be enrolled provisionally until a formal check of eligibility and qualification for subsidies could be made at a later date, before the end of the initial enrollment period at the end of March. If the eligibility check was completed and eligibility verified before January 1, 2014, then coverage would begin. If the eligibility check was not completed in time and/or turned up information contrary to the attestation, then the person’s enrollment would be canceled and/or postponed until the discrepancy was resolved. This arrangement would fully meet the provisions of the original law and eligibility check requirement that the Republicans insisted on in order to open the government.
(2) Enroll people through Ehealth and GetInsured—Two online insurance brokers—eHealth and GetInsured have already negotiated deals with HHS to allow them to enroll individuals in plans on the exchanges and to connect to the “Health Exchange Data Hub” to verify eligibility. Even without connecting to the data hub, these private online insurances could use attestation (as in #1) to enroll individuals provisionally. Either way, traffic through the private online insurance brokers (who already handle such transactions in the non-ACA market) would take some of the demand off the public exchanges.
Of course, Republicans won’t like either of these two options. After all, they want the exchanges to fail. But, for the rest of us who support Obamacare, these are two options worth considering to give the designers of health insurance exchanges time to fix whatever is wrong.
Read more about these fixes and what is wrong with the Exchanges here: http://thehealthcareblog.com/blog/2013/10/18/a-pragmatic-fix-for-healthcare-gov-the-hixs/ andhttp://www.washingtonpost.com/blogs/ezra-klein/files/2012/11/anatomy.png
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