Shots - Health News
3:05 pm
Wed October 23, 2013

Why Postponing Insurance Mandate Is No Easy Fix For Obamacare

Originally published on Wed October 23, 2013 6:57 pm

The Obama administration has entered full damage-control mode over the balky website intended to enroll people in new health plans under the Affordable Care Act.

Senior officials met Wednesday morning with Democrats on Capitol Hill, and in the afternoon insurance CEOs got an audience at the White House. Tomorrow some of the private contractors responsible for building the website, HealthCare.gov, will testify at a House committee hearing.

One of the big questions now circulating concerns what will happen if the website can't be fixed soon. Will the government really penalize people for not having insurance if they can't realistically buy it?

Technically, people are supposed to have coverage starting Jan. 1, 2014. But there's a 90-day grace period, meaning you actually have until the end of March, which is also when the current open enrollment period ends.

Still, the way the sign-up works, you have to enroll by the middle of the month before you want coverage for the insurance to take effect in time. So right now, to be covered by the end of March and avoid being penalized, you have to enroll by Feb. 15.

Even the administration says it wants to fix this. At a briefing Monday, White House spokesman Jay Carney said, "In terms of the Feb. 15 date that you just mentioned, there's no question that there's a disconnect between open enrollment and the individual responsibility time frames in the first year only. And those are going to be addressed."

And if that mismatch does get changed, it would give people an additional month and a half to sign up without risking a penalty — and without extending the existing open enrollment date.

But what about the possibility of extending the enrollment period, which even some Democrats are now calling for if the website isn't fixed soon? Or of waiving the penalty for the first year?

That's where you start to run into big issues with the insurance companies that are offering these products in the exchanges. They set their premiums based on the rules as they're written — that healthy young people would be strongly encouraged to sign up by the prospect of a penalty, and that they would be encouraged to sign up within this six-month window.

As one insurance industry representative said today, "If you change the rules, insurers are going to want to change their premiums" to reflect the possibility that fewer healthier people may sign up.

The other big problem is timing. Stretching out open enrollment past that March 31 deadline starts to bump up against planning for 2015. Insurance companies have to start submitting premiums for that next year starting in April, insurance officials say, so they really need to know who's signed up for the current year by the end of March.

Copyright 2013 NPR. To see more, visit http://www.npr.org/.

Transcript

MELISSA BLOCK, HOST:

From NPR News, this is ALL THINGS CONSIDERED. I'm Melissa Block.

AUDIE CORNISH, HOST:

And I'm Audie Cornish. The Obama administration today is in full damage control mode over the troubled website that's supposed to help people sign up for health insurance. Senior officials this morning met with Democrats on Capitol Hill and this afternoon with insurance CEOs at the White House.

Tomorrow, some of the private contractors responsible for building the website, healthcare.gov, will testify at a House committee hearing. But one of the big questions now is what happens if the site can't be fixed soon. Will the government really penalize people for not having insurance if they can't easily buy it? With us to discuss that is NPR's Julie Rovner. Hey there, Julie.

JULIE ROVNER, BYLINE: Hey, Audie.

CORNISH: So remind us again, how long do people have to sign up in order to avoid paying that penalty for not having coverage?

ROVNER: Well, technically you're supposed to have coverage starting on January 1, but there's a 90-day grace period, meaning you actually have until the end of March, which is also when the current open enrollment period ends. But, and this is a little bit confusing, the way the signup works, you have to enroll by the middle of the month before in order to be covered, so right now, in order to be covered by the end of March and avoid being penalized, you actually have to enroll by February 15.

CORNISH: Okay. So even if you figured out the blizzard of dates, it doesn't seem to make a whole lot of sense.

ROVNER: No, it really doesn't it and it's something even the administration says it wants to address. When White House spokesman Jay Carney was asked about the February 15 date at his briefing earlier this week, here's what he said.

JAY CARNEY: And there's no question that there's a disconnect between open enrollment and the individual responsibility time frames in the first year only. And those are going to be addressed.

ROVNER: So if that does get addressed, it would really give people an additional month and a half to sign up without the possibility of having to pay a penalty and without extending the existing open enrollment date.

CORNISH: But what about the possibility of just extending open enrollment? I mean, even now some Democrats are calling for that if the website isn't fixed soon. Or what about waiving the penalty for the first year?

ROVNER: Well, that's where you start to run into some really big issues with the insurance companies that are offering these products in the exchange. They set their premiums based on the rules they way they're written now, that healthy young people would be strongly encouraged to sign up by the prospect of there being a penalty, and that they would be encouraged to sign up within this six-month window.

As one insurance industry representative said to me today, if you change the rules, insurers are going to want to change their premiums to reflect the possibility that fewer healthier people may sign up. The other big problem you can run into here is timing. If you stretch out that open enrollment past that March 31 deadline, you start to run into planning for 2015.

Insurance plans have to start submitting their premiums for that next year starting in April, so they really need to know who's signed up for the current year by the end of March. That's one reason why the administration has been very, very reluctant to talk about the possibility of extending that open enrollment deadline past March.

CORNISH: Meanwhile, what have learned about - any more about what's wrong with the website or how soon it might be fixed?

ROVNER: Well, not that much today, but tomorrow, as you mentioned, some of the key private contractors who worked on the site, including that league contractor, CGI Federal, will testify before the House Energy and Commerce Committee. I imagine they'll have a lot to answer to, not just from Republicans, but some frustrated Democrats as well.

CORNISH: So was this the hearing where Health and Human Services Secretary Kathleen Sebelius was supposed to appear?

ROVNER: That's right. It was. And she said she had a scheduling conflict. Obviously, that was not an answer that Republicans or, frankly, Democrats wanted to hear. Now it's been worked out that she's going to appear next week and I imagine both sides are going to have a lot of questions, not just about how things got to this point, but more importantly when things might start to get straightened out.

CORNISH: That's NPR's Julie Rovner. Julie, thank you.

ROVNER: Thank you. Transcript provided by NPR, Copyright NPR.