The ACA’s Missing Pieces

Andrew Sullivan —  Dec 6 2013 @ 1:03pm

The part of Healthcare.gov that pays insurers won’t be built by January:

The administration is planning a “workaround” for payments, said Daniel Durham, vice president for policy and regulatory affairs at America’s Health Insurance Plans. Health plans will estimate how much they are owed, and submit that estimate to the government. Once the system is built, the government and insurers can reconcile the payments made with the plan data to “true up” payments, he said “The intent is to make sure plans get paid on time, which is a good thing,” Durham told Reuters.

The fix puts an additional “burden” on insurance companies, already taxed by having to double-check faulty enrollment data from the HealthCare.gov system. Now, companies need to quickly put together financial management systems to make the payment estimates, so they can be paid beginning in January, he said. “They have to recognize that plans are already quite stressed and introducing this at the last minute just adds substantial burden for plans to deal with,” Durham said.

Suderman takes the administration to task:

The core service that health insurers provide is paying for eligible claims by beneficiaries. But if insurers don’t get paid themselves, they can’t cut checks for those claims.

Some of the larger insurers could finance delays, at least for a little while, but as former Medicare official Kevin Lucia tells Reuters, smaller insurance plans, which are heavily represented in the health law’s exchanges, aren’t well equipped to do so. Plan providers need that money, and they need it soon if they’re going to be able to actually provide insurance to their plan members.

The fact that these critical systems haven’t been built—months after the launch of the exchanges and with just weeks to go until insurers need to start being paid—makes it clear that the implementation effort still lags far behind. And if the rollout of portions that remain incomplete resembles the rollout so far, that means there are lots of new problems still to come. But it’s not just that there’s a lot of work still to do. The insurer payment workaround also highlights how much of Obamacare’s buggy implementation is still being managed on a temporary, ad hoc basis. The administration is flying a broken vessel without a flight plan.

Meanwhile, Beutler parses recent enrollment numbers:

[T]he latest numbers — which administration officials are all of a sudden so eager to leak for some reason — really demonstrate three things. One is that it’s easy to torture scarce and selectively leaked data to fit just about any preconceived narrative. Another is that Healthcare.gov’s terrible rollout didn’t completely discourage people from giving the site a second look, let alone destroy the demand for health insurance across the country. Third is that, simply by leaking, administration officials demonstrated some degree of confidence that the worst of their implementation woes are behind them.

That’s all basically good news. But it’s really all we can say for now. And it doesn’t prove that the Affordable Care Act is completely out of the woods yet.