Tuesday, December 12, 2017
Health

PolitiFact: Is healthcare.gov working 'great' now

With a March 31 deadline fast approaching to purchase health insurance or risk a penalty, the White House is engaged in a media blitz encouraging people to check out healthcare.gov.

" Healthcare.gov works great now," President Barack Obama said this week during a video appearance on comedian Zach Galifianakis' faux talk show Between Two Ferns.

"Great" is a subjective term, but PolitiFact decided to investigate how the site is doing for consumers, health insurance companies and state Medicaid programs. What we found is an improved site that still has persistent technical issues.

• • •

In October, when healthcare.gov was unveiled for the 36 states that chose not to run their own exchanges, site response time initially was around 8 seconds, a glacial pace, and it couldn't handle a high volume of traffic.

A fix-it team got to work, and by mid January response time was "consistently less than half a second," according to the Center for Medicare and Medicaid Services. The site was able to handle 1.8 million visits a day, including 83,000 at once. The most recent numbers show 2.6 million have selected a plan on healthcare.gov through February.

Navigators who work with consumers say most people are having a dramatically better experience on the site.

"Some of the things that were being reported early on, a lot of folks experienced them, whether it was flow (from page to page on the site) or they got kicked out of it. We don't see any of those things anymore," said Jodi Ray, who teaches navigators for Florida Covering Kids & Families at University of South Florida.

Not everything is perfect, though.

Until recently, consumers who purchased coverage through healthcare.gov could not update their accounts for life changes, like having a baby or getting married. According to the CMS, that has been fixed.

About 22,000 Americans have filed appeals after discovering mistakes in the policies they purchased on healthcare.gov, according to the Washington Post.

CMS is personally contacting those individuals, a spokesman told PolitiFact, to remedy the situation without the need to formally complete the appeals process. Many of the issues were fixed in previous technical upgrades, the spokesman said.

• • •

Insurance companies are facing a handful of back-end issues with healthcare.gov that may not get fixed until after the open enrollment period ends on March 31, and perhaps longer.

For starters, a system has yet to be built for the government to pay them.

Here's how it's supposed to work: Uninsured Americans who are eligible for subsidies to buy coverage pay a discounted amount to the insurance companies. The federal government then pays the insurance company the difference.

But that system has yet to be built. In the interim, the federal government is funneling money through existing payment channels with providers, like the Medicare system.

For a while, the online portal was also sending a garbled mess to insurance companies when trying to transmit information on new enrollees. People who thought they bought a policy suddenly discovered that their provider didn't have the proper records for them.

This problem is more isolated now, America's Health Insurance Plans said. But because many errors were fixed manually, a lot must still be done in the back end. This is especially important for next year, when people will be able to shop again and change plans if they wish.

Some systems must still be built and tested, particularly for more complex consumer transactions. That could take months.

"At the end of the day it causes disruption for consumers," said Robert Zirkelbach, spokesman for America's Health Insurance Plans.

• • •

Not everyone accessing healthcare.gov is purchasing private insurance. Some low-income individuals are told they are eligible for Medicaid, and are then instructed to complete an application to apply for the federal-state health program.

But states that deferred control of their online marketplaces to the federal government are having a hard time getting information for new Medicaid enrollees. It's especially a problem for states that accepted the Medicaid expansion and are experiencing a large volume of new accounts.

Arizona, for example, estimates about 60,000 accounts created on healthcare.gov remain in limbo. By using a hard file sent by federal health officials, they have deleted duplicative accounts and prepared their system for when all the account information can be sent automatically.

"We have high confidence that we will accomplish our goal but want to be clear that progress is slow going," said Monica Higuera Coury with the Arizona Health Care Cost Containment System. "There simply isn't any way to make it go any faster."

States, and even the federal government, are telling people who need Medicaid to avoid healthcare.gov and apply through their state health departments.

CMS said some states have been able to automate Medicaid enrollment systems. New Jersey officials told PolitiFact that after early challenges, they have now processed 60,000 applications and receive a new batch of accounts weekly.

A Florida spokeswoman said they are "receiving accounts from the federal marketplace."

Our conclusion

Obama said healthcare.gov is "working great now." Compared to the site's functionality in October, that may be a fair assessment.

But for a website four years in the making, there are still a lot of issues that are making it difficult for states and providers, and that has indirect consequences for consumers. It's a fraction of the individuals who faced issues last year, but many complicated and critical functions must be built and tested before the site is operating "great" for everyone.

Edited for print. Read the full version at PolitiFact.com.

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