|
 For the nation's healthcare system as well as its politics, the
stakes are huge in Wednesday's launch of the program known as
Obamacare.
For anxious Democrats with an eye on the 2014 congressional
elections, it is a chance for the Obama administration to rebound
from the disastrous rollout of the website that enrolls people in
private coverage through the program — and show that the White
House's effort to help millions of uninsured and underinsured
Americans is finally gaining its footing.
Or, as Republican congressman Fred Upton and other critics of
Obamacare warned in recent days, Wednesday could represent the
beginning of another debacle that fuels Republicans' push to make
dissatisfaction with Obamacare the chief issue in the November
elections.
More immediately, the question is whether the program will work as
advertised on January 1, after a chaotic enrollment period in which
problems with the HealthCare.gov website led to a series of deadline
extensions and undermined public support for Obamacare and the
president.
The White House said early Sunday that about 1.1 million people have
enrolled in coverage plans through the federally run HealthCare.gov,
which covers 36 states. That figure does not include the latest
enrollment data from 14 states that run their own healthcare
enrollment sites — including California, Connecticut, Kentucky, New
York and Connecticut — and where response to Obamacare has been
enthusiastic, so the total enrollment nationally is likely more than
1.5 million.
That is well short of the 3.3 million enrollees administration
officials were hoping for by now, but it represents a dramatic
improvement from a month ago, when barely 150,000 had signed up
because of a series of technical problems with the HealthCare.gov
site.
Many of the newly insured under the Patient Protection and
Affordable Care Act — about 975,000 on the federally run exchange — signed up just ahead of a deadline on December 24 to receive
benefits on January 1, giving health insurers a tight framework to
create accounts that can be accessed by doctors.
One fear, as expressed by administration officials and insurance
industry executives, is that some people who need medical care
during the first days of 2014 will head to the doctor, only to find
there is no record of their new insurance.
That could mean patients would have to pay upfront and submit a bill
to their insurance carriers later.
And even though the Obamacare program is not directly responsible
for the private insurance purchased through its online exchanges,
White House officials have acknowledged that any early problems with
the coverage are likely to reflect on the administration.
Some insurance executives say that even a few stories of coverage
problems during the next few weeks — which seems inevitable when
dealing with such a massive program — could damage the reputations
of the White House and the healthcare overhaul.
"The big moment of trust is 12:01 a.m. on January 1st, when a mother
is standing in a pharmacy with a baby in her arms trying to get a
script filled," Aetna Inc Chief Executive Mark Bertolini said this
month. "Getting that information right so that we don't have these
events which ultimately end up in our lap if we don't do them well,
it's very important for us all to get it right."
A senior administration official acknowledged that "there will be
bumps in the road."
"We need to plan for them, we need to anticipate and we need to make
sure that we are ready to respond," the official said.
Physicians say they are used to dealing with changes to patients'
insurance coverage and it is not unusual for there to be lag times
between enrolling in a new insurance policy and the time it becomes
official.
Some doctors will be willing to delay billing. Others may not be.
"Come the start of the year there will be dueling narratives: the
people who have never had insurance before who are actually getting
decent care for the first time in their lives, and people who are
having issues with the administration's new policies," said Dan
Mendelson, chief executive of Avalere Health, which has been
tracking the healthcare overhaul.
"They are going to kind of cancel each other out," he predicted.
"Three months from now when we are in the electoral cycle, the
policies will be judged on the basis of enrollment (numbers), rather
than any technical problems."
Mendelson expects the early 2014 problems to be limited given the
light pace of enrollment spread out across the nation, and the fact
that hospitals and other providers are experienced in
troubleshooting coverage questions for patients.
[to top of second column] |
"WE CONTINUE TO HOLD OUR BREATH"
Stories of patients with Obamacare plans who were turned away or
asked to pay higher-than-expected medical fees upfront because of
technical or administrative delays within the program would help the
case of Republicans and other foes of the law.
During the past week, Republicans signaled that they will be closely
watching what happens with Obamacare enrollees who seek medical care
during the first several days of the new year.
"We continue to hold our breath with the next shoe to drop," said
Upton, a Michigan Republican who is leading a charge in the House of
Representatives against Obamacare.
"When folks visit their doctor or take a child to get necessary
treatment (this) week, will the services actually be available? The
consequences of the administration's incompetence could not be
greater," Upton said.
Some Democrats, including House Minority Leader Nancy Pelosi of
California, see the start of Obamacare coverage on January 1 as a
turning point for the program that will work in Democrats' favor and
reverse polling trends against Obama and his party.
"By the time we get into the spring, I think the Affordable Care Act
will either be a (political) wash or a plus for Democrats," Pelosi
told reporters last week.
As many as 7 million people had been expected to sign up for
Obamacare coverage when the 2014 enrollment period ends on March 31,
but that estimate has been thrown into doubt because of the
program's error-plagued rollout.
GETTING IT RIGHT
The Obama administration and several of the state-run exchanges have
urged consumers to call up their new insurance plans to make sure
they are covered.
The administration and several states have offered their call-center
personnel to assist in cases in which there are problems with
enrollments.
Late last week, the U.S. government indicated that it was ready to
respond to any stories of distressed patients who emerge beginning
this week.
The administration said it has set up contacts at all of the health
plans working in the federal marketplace to "have a mechanism to
address the issue (and) ... make sure that it can be resolved as
quickly as possible."
Doctor groups said they were confident their current systems for
handling patients who need help clarifying insurance coverage would
make sure people receive needed care.
"Whenever a patient changes an insurance company or plan there is a
period of adjustment," said Dr Richard Schilsky, chief medical
officer with the American Society of Clinical Oncology.
While there may be a period of limbo for some people between signing
up and the insurance taking effect, unless there is a medical
emergency, patients probably will be able to wait a week or so to
see a doctor, Schilsky said.
"If someone needs care, they will get it," he said.
Dr Charles Cutler, chair of the Board of Regents of the American
College of Physicians, said many fellow experts in internal medicine
who treat people for chronic disease would not be concerned if it
took several weeks to get insurance information for a patient.
"In my practice we assume people are honest," said Cutler, whose
practice is in suburban Philadelphia. "If they say they have signed
up but are not in the system, we will get it straightened out."
(Reporting by Toni Clarke in Boston and Michele Gershberg in New
York; additional reporting by Roberta Rampton in Washington; editing
by David Lindsey, Vicki Allen and Eric Beech)
[© 2013 Thomson Reuters. All rights
reserved.] Copyright 2013 Reuters. All rights reserved. This material may not be published,
broadcast, rewritten or redistributed.
 |
