Health care errors can't be fixed
WASHINGTON — Tens of thousands of people who discovered that Healthcare.gov made mistakes as they were signing up for a health plan are confronting a roadblock: The government cannot yet fix the errors.
About 22,000 Americans have filed appeals with the government to try to get mistakes corrected, according to internal government data obtained by The Washington Post. They contend that the computer system for the federal online marketplace charged them too much for health insurance, steered them into the wrong insurance program or denied them coverage entirely.
For now, the appeals are sitting, untouched, inside a government computer. And an unknown number of consumers who are trying to get help through less formal means — by calling the health care marketplace directly — are told that Healthcare.gov's computer system is not yet allowing federal workers to go into enrollment records and change them, according to individuals inside and outside the government who are familiar with the situation.
The Obama administration has not made public the fact that the appeals system for the online marketplace is not working. In recent weeks, legal advocates have been pressing administration officials, pointing out that rules for the online marketplace, established by the 2010 Affordable Care Act, guarantee due-process rights to timely hearings for Americans who think they have been improperly denied insurance or subsidies.
But at the moment, “there is no indication that infrastructure ... necessary for conducting informal reviews and fair hearings has even been created, let alone become operational,” attorneys at the National Health Law Program said in a late-December letter to leaders of the Centers for Medicare and Medicaid Services (CMS), the agency that oversees Healthcare.gov. The attorneys, who have been trying to exert leverage quietly behind the scenes, did not provide the letter to The Post but confirmed that they had sent it.
A CMS spokesman, Aaron Albright, said, “We are working to fully implement the appeals system.”
Three knowledgeable individuals, speaking on the condition of anonymity about internal discussions, said it is unclear when the appeals process will become available. So far, it is not among the top priorities for completing parts of the federal insurance exchange's computer system that still do not work. Those include an electronic payment system for insurers, the computerized exchange of enrollment information with state Medicaid programs, and the ability to adjust people's coverage to accommodate new babies and other major changes in life circumstance.
The exchange is supposed to allow consumers who want to file appeals to do so by computer, phone or mail. But only mail is available. The roughly 22,000 people who have appealed to date have filled out a seven-page form and mailed it to a federal contractor's office in Kentucky, where the forms are scanned and then transferred to a computer system at CMS. For now, that is where the process stops. The part of the computer system that would allow agency workers to read and handle appeals has not been built, according to individuals familiar with the situation.
In the meantime, CMS is telling consumers with complaints about mistakes to return to the website and start over. “We are inviting those consumers back to HealthCare.gov, where they can reset and successfully finish their applications without needing to complete the appeals process,” said Albright, the agency spokesman. The rationale is that, since the computer system is working better now, it's less likely to make mistakes.
Agency officials have no way of knowing how many people have taken that advice, according to two individuals familiar with the situation. The computer system containing the scanned appeals forms cannot yet communicate with HealthCare.gov's enrollment database, so it is impossible to cross-check the information.
Show commenting policy
TribLive commenting policy
You are solely responsible for your comments and by using TribLive.com you agree to our Terms of Service.
We moderate comments. Our goal is to provide substantive commentary for a general readership. By screening submissions, we provide a space where readers can share intelligent and informed commentary that enhances the quality of our news and information.
While most comments will be posted if they are on-topic and not abusive, moderating decisions are subjective. We will make them as carefully and consistently as we can. Because of the volume of reader comments, we cannot review individual moderation decisions with readers.
We value thoughtful comments representing a range of views that make their point quickly and politely. We make an effort to protect discussions from repeated comments either by the same reader or different readers.
We follow the same standards for taste as the daily newspaper. A few things we won't tolerate: personal attacks, obscenity, vulgarity, profanity (including expletives and letters followed by dashes), commercial promotion, impersonations, incoherence, proselytizing and SHOUTING. Don't include URLs to Web sites.
We do not edit comments. They are either approved or deleted. We reserve the right to edit a comment that is quoted or excerpted in an article. In this case, we may fix spelling and punctuation.
We welcome strong opinions and criticism of our work, but we don't want comments to become bogged down with discussions of our policies and we will moderate accordingly.
We appreciate it when readers and people quoted in articles or blog posts point out errors of fact or emphasis and will investigate all assertions. But these suggestions should be sent via e-mail. To avoid distracting other readers, we won't publish comments that suggest a correction. Instead, corrections will be made in a blog post or in an article.
- Schools grapple with immigration overload
- FAA reviews contingency plans, security policies after Chicago air traffic control center fire
- Cost of taking fight to ISIS pegged at $2.4B to $6.8B a year
- Intruder made it to East Room of White House, overpowered Secret Service officer
- NSA relies on 1981 executive order signed by Reagan
- Police link 2 more cases to University of Virginia suspect
- Some La. hospitals bill rape victims; legislators vow to end policy
- Arrest of British Islamic radicals might spur attacks against Western targets
- Widow’s case questions definition of ‘seaman’
- Security whips up service problems at CIA Starbucks
- Supreme Court blocks start of early Ohio voting