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 More than 2 million people enrolled in private plans offered under
the Affordable Care Act, popularly known as Obamacare, during the
initial sign-up period for health benefits. Enrollment began in
October and lasts through March, but Americans in most states had to
enroll by last week to get coverage that takes effect with the start
of the new year.
A spokeswoman for the Centers for Medicare and Medicaid Services, or
CMS, part of the U.S. Department of Health and Human Services, said
there were no hiccups to report in the first day the plans were in
effect.
The expansion of coverage through the new plans is one of the main
parts of the 2010 law, the most sweeping U.S. social legislation in
50 years. Over time, the law — which requires most Americans to buy
insurance, offers subsidies to help low-income people get covered
and sets minimum standards for coverage — aims to dramatically
reduce the number of Americans who lack health insurance, which the
U.S. government has estimated at more than 45 million.
After a difficult October launch plagued by problems with the
website used to enroll people in coverage, the focus for the
government and healthcare providers has turned to what will happen
beginning on Wednesday when patients with the new coverage start to
seek care.
The law still faces political and legal hurdles. Roman Catholic
Church-affiliated organizations obtained last-minute court
injunctions on Tuesday that gave them temporary exemptions from a
part of the healthcare law that requires employers to provide
insurance policies covering contraception.
U.S. Supreme Court Justice Sonia Sotomayor granted one temporary
injunction to Baltimore-based Little Sisters of the Poor and
Illinois-based Christian Brothers Services, plus related entities.
The Centers for Medicare and Medicaid Services had 10,000 agents on
call for New Year's Eve and New Year's Day to field questions from
people dealing with enrollment problems.
"We are ready ourselves to assist consumers as well with our full
complement of call center representatives available," said Julie
Bataille, spokeswoman for the CMS.
At the start, confirming a patient's plan may present headaches for
care providers. The Obama administration has acknowledged that
errors occurred in transmitting enrollment data to insurers,
especially early in the enrollment period. An official said it was
"reaching out" to providers who have expressed concerns about
implementation, and was also trying to help anticipate problems.
"It will be difficult for us to actually verify coverage — that's my
concern," said Dr. William Wulf, chief executive of Central Ohio
Primary Care, which has 250 primary-care physicians.
The task could be made more difficult by decisions by the U.S.
government and many states to push back enrollment deadlines toward
the end of the year. The late deadlines mean that many enrollees who
seek care initially may lack insurance cards or other proof of
coverage.
Wulf said his physician offices will assume existing patients are
covered if they say they are when they come in for appointments and
their coverage cannot be verified immediately. But if they require
expensive tests, such as MRIs or heart-stress tests that can cost up
to $700, the practice will check with insurers first to make sure
the patient has coverage.
Dr. Andy Chiou, chief executive of Peoria Surgical Group Ltd in
Illinois, said that if the practice finds a "significant minority"
of its patients do not have coverage when they believe they do, it
might delay elective surgeries for patients until their insurance is
confirmed.
"For the protection of patients and us, we'll have to say, 'Sorry,
you don't have insurance,'" Chiou said.
POLITICAL STAKES HIGH
For the Obama administration, the political stakes are high in
ensuring a smooth transition period for coverage, particularly after
the website's problems damaged the popularity of the Democratic
president and the healthcare overhaul, his signature domestic
achievement.
The White House trumpeted New Year's Day as the start of healthcare
coverage for millions of Americans.
"The challenges in our healthcare system were decades in the making
and won't be solved overnight, but now more than 6 million Americans
have been enrolled in marketplace or Medicaid coverage and are
getting peace of mind," wrote White House health policy adviser Phil
Schiliro in a blog post.
Republicans, who control the House of Representatives, have called
Obamacare a costly program that will rob many Americans of insurance
choices and have said they will make Obamacare's problems their top
issue in the November 2014 elections, when control of Congress will
be at stake.
Late Wednesday, though, Democrats in the House seized on the first
day of the expansion as a political victory and pushed Republicans
to give up on defanging the law.
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"When Congress reconvenes next week, it is my hope that Republicans
will work with Democrats to implement this law rather than
continuing their focus on repealing its important patient
protections and cost-saving reforms," said Steny Hoyer, who is the
second most powerful Democrat in the House as Minority Whip, in a
statement.
Still, Republicans were bolstered by Sotomayor's injunction, with
Senator Roy Blunt, vice chairman of the Senate Republican
Conference, saying the insurance mandate is "an egregious and
blatant violation" of religious freedom.
The U.S. government has tried to anticipate the coverage problems
new enrollees might encounter. The federally run Healthcare.Gov
website posted advice last week on what enrollees should do if they
have not received an insurance card, encounter problems getting
coverage for a drug prescription, or need to appeal a decision by an
insurer.
"For consumers whose marketplace coverage begins on January 1, we're
doing everything we can to help ensure a smooth transition period,"
Kathleen Sebelius, the U.S. secretary of health and human services,
said in blog posting on Tuesday.
"What we are stressing to folks is that if they get to a provider
(and) there is some confusion (about coverage), call their insurer,"
Schiliro said. "If the insurer is not able to resolve it, they
should call our toll-free number (800-318-2596) ... and operators
will be there 24/7."
Some healthcare companies are trying to get ahead of potential
problems as well.
The pharmacy chain Walgreen Co said on Monday it would allow
consumers who had not yet received plan identification numbers from
their insurers to get prescriptions at no upfront cost in January,
if they could provide evidence of their coverage or pharmacy staff
could otherwise confirm it.
Wal-Mart said on Tuesday it would institute a similar practice.
HOSPITALS READY FOR CHANGE
Hospital executives said they were ready for potential hiccups with
the newly insured.
The vast majority of Americans have employer-based coverage and
Medicare plans and can choose new plans every January, so executives
said the beginning of the Obamacare plans represented a more intense
version of an insurance transition period they were already familiar
with.
"Hospitals feel like they're pretty well prepared because they've
had systems in place and tools in place to work through these sorts
of issues," said Jeff Goldman, vice president of coverage policy for
the American Hospital Association. "We expect an uptick in volume,
but we don't think it's anything beyond what most hospitals are
prepared to handle."
As many as 7 million people were expected to sign up for coverage in
the Obamacare plans for 2014, but enrollment is so far well short of
that figure, largely because of the problems with the HealthCare.gov
website. Residents of 36 states use the site to enroll. Those in the
other 14 states use state-run websites. Hospitals, therefore, may
have been preparing for more new enrollees than they are likely to
see at this point.
At New York's Montefiore Medical Center, staffers were trained on
how the new healthcare plans work, partly so they could help
patients resolve any coverage issues, said Lynn Richmond, the
medical center's chief of staff.
"There's not a lot of active worry on our part," Richmond said. "We
feel ready to manage the hiccups."
Indeed, many have eagerly anticipated the law's broadening of
coverage. Across the country, hospital operators' finances have been
weighed down by patients who have been unable to pay their bills
because they lacked sufficient insurance.
"We're looking forward to the first quarter and beyond because we
feel we're in a very good position to benefit from the ACA," said
Steven Campanini, a spokesman for Tenet Healthcare Corp, one of the
largest publicly traded hospital chains.
(Reporting by Lewis Krauskopf in New York and Julie Steenhuysen in
Chicago; additional reporting by Susan Cornwell, Valerie Volcovici,
Lisa Lambert and Lawrence Hurley in Washington; editing by David
Lindsey, Jonathan Oatis, Peter Cooney and Chris Reese)
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