The Latest Mystery: What Is Happening to All Those Paper Applications?

Enrollments continue to trickle in. Health plans, with the kind of market share that would have to sign-up 100,000 to 200,000 people for the administration to hit its goal of 7 million people, are generally reporting they have enrolled only about 100 – 200 people over the first 35 days via Healthcare.gov.

Does this mean no one wants to sign-up? No. People can argue about whether we will see the administration hit their goal of seven million or we will end up getting two or three million relatively sicker people for all of the problems Obamacare has faced. But, undoubtedly millions of people, including all of those people who just got cancellation notices, do want to see what they can get for what cost and make a decision about signing up. But they can’t because they aren’t able get through the entire Healthcare.gov website.

As I have said before, Healthcare.gov, because of its many problems, is in de facto shutdown because virtually no one is able to really use it.

Why doesn’t the administration just tell people the site is still too frustrating for people to waste their time on until it is fixed? Instead, the administration says it is getting better and people should keep trying to make it through the gauntlet. More, they are telling them to call the 800 number to fill out a paper application.

If it is better, it is still not better enough for more than a very small trickle to make it through each day.

Many states have literally dozens of complex health plan choices on the federal exchange––each insurance company on the various exchanges is likely offering the four different plans. I find it hard to understand how a consumer can get any real sense of the options over the phone much more be able to understand which plans cover which doctors and hospitals. People really need to see the options on their computer or on the computer of a navigator or an insurance agent to understand what is available and how it fits their needs.

And, as ABC and NBC reported yesterday evening, the paper applications ultimately have to go through the Healthcare.gov system anyway. One thing is crystal clear from the health plans meager enrollment to date; the insurance companies are not getting these “thousands” of paper applications. Where are they sitting?

Health plans are separately enrolling more people on their own sites and through their call centers in great part because of all of the cancellation letters they have recently sent out. Existing customers worried about facing a lapse in coverage are calling in. Many health plans are offering the “early renewal option” to these cancelled customers, which lets people keep their plan but only until December of 2014. I continue to hear that an overwhelming number of existing customers are opting to keep their current plan versus taking an Obamacare compliant plan from the carrier––an interesting outcome given that so many of these plans are said to be “substandard.”

The most urgent need is for the government to fix the back-end enrollment transactions between the government and the health insurance plans (the 834 problem). It will be impossible to conduct any kind of high volume enrollment through the health portal’s front door so long as the data being transmitted to the insurance companies is unreliable.

Has the government made progress in fixing the large variety of detailed 834 transaction issues?

Yes. But the progress so far is incremental and nowhere near enough to be able to go to high volume processing.

The Obama administration finally seems to have a strong group of experienced managers in charge of fixing Healthcare.gov. I don’t mean to pile anymore bad news on them then they already have. But I also have to report that the confidence that this can all get fixed by December 1 is not high among the people on the other end of those 834 transactions.

Robert Laszewski has been a fixture in Washington health policy circles for the better part of three decades. He currently serves as the president of Health Policy and Strategy Associates of Alexandria, Virginia. You can read more of his thoughtful analysis of healthcare industry trends at The Health Policy and Marketplace Blog, where this post first appeared.

11 replies »

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  3. It’s a shame the enrollment process has turned into such a debacle. Even other avenues of enrollment tend to be problematic just as this post discusses.

    I work somewhere with a certified application counselor (CAC). In the first available paper application, there was a fake address listed. Our CAC received several applications back with “Address Not Found. Return to Sender.” After that, we found an updated copy of the paper application with a real address. After that, we were also notified to not push the paper applications because (1) You do need access to healthcare.gov to see your individual situation and pricing and (2) The process takes approximately 10 weeks.

    Telling people that they can find local help and enroll is also misleading. Yes, a navigator or CAC can guide you through the process, but they have no special powers in getting healthcare.gov to work. Our CAC has at least 20 people a day call her asking her if she can get the Web site to work, and she has to explain that she has no more resources than they do.

    What I have seen firsthand, though, is that people are interested in getting coverage. What also makes me hopeful is data from Massachusetts a few years back. On average, people interacted with the enrollment process and plans 18 times before actually selecting a plan.

    Even though enrollment is low now, I think we will see a surge in February and March. Hopefully, there will be a fully-functioning Web site to make things easier for people (Our CAC was finally able to enroll someone online the other day…yay). That’s why there has been so much complaining (and I am talking about from citizens and not from the media/ government) over this Web site, isn’t it? The process was supposed to be easy, and it hasn’t been. The healthy are in no hurry to enroll and are not going to put up with call the 800 number let alone calling different insurance companies to compare pricing. They are going to wait until a one-stop-shop site works properly.

  4. ShimCode, your claiming that “anyone with a life” isn’t willing to make a phone call to get insurance? I suppose that’s proof that the GOP is right about people in need aren’t even willing to lift a finger to help themselves.

    If you DO want to help yourself, the phone # to call healthcare.gov is 800-318-2596 (the call won’t cost you a thing). As HHS Sec. Sebelius told Congress yesterday, there are now 12,000 call center representatives who “can take a consumer through the entire process, from start to finish.”

    If you want to apply through the website, Marilyn Tavenner, the head of the U.S. Centers for Medicare and Medicaid Services said yesterday that healthcare.gov can now register 17,000 per hour or one every 5 seconds.

    If you just want to browse plans, simply go healthcare.gov and click on “SEE PLANS NOW” and it will take you to the specific plans and explain the general info you need.

    If you have too much of a life to do any of that, then tell me what city you’re in and your email, and I’ll have a navigator contact you in order to make things as easy as possible for you.

  5. Show me where I can see deductibles, co-pays and/or coinsurances by using the approach you describe. You can’t because it is simply not there at this time. So you really don’t understand what deductibles, co-pays and/or coinsurances are, do you Robert?

    What is a “deductible level?” “Oh, I’ll take one with the silver level-thingy?”

    Do you honestly think anyone with a life is going to be able to just call around and intelligently obtain ‘out-of-pocket” information to compare a bunch of health plans? And then there’s that little thing about APTC’s and CSR’s (aka. “subsidies” )

    Geesh…not wasting any more of my time trying to educate a Kool-Aid drinker.

  6. JM, if using a pencil and phone are too cumbersome for you, you can go to eHealthInsurance right now, TODAY, and look at the all the Obamacare plans, listing of copays, deductible and provider networks. You can also use their subsidy calculator. If you don’t qualify for a subsidy, sign up via eHealthinsurance right now, TODAY. If you do qualify for a subsidy just call the Healthcare.gov 800 # and sign up so you’ll get your subsidy.

    Comparing the platforms of eHealthinsurance and healthcare.gov are comparing apples and oranges. The first simply offers up choices like picking an item off the shelf. The latter has to interact with numerous legacy systems and databases with the IRS, Medicare, Medicaid, Immigration, etc., a much more difficult task.

    It’s a shame that healthcare.gov didn’t work well out of the gate, but that in no way hampers people from taking advantage of the the Obamacare plans if they want to. News programs should be focused on that rather than who yells the loudest.

  7. Actually asking the 800 operator or the individual insurance companies about copays, deductibles and provider networks is very cumbersome. To answer you question about how I’ve previously shopped, I used eHealthInsurance, which worked very well and had lots of the details of the individual plans. So I think we know what a good platform is supposed to look like.

  8. ShimCode, you can view all of the plans and their deductible levels (Bronze, Silver, Gold, Platinum) without creating an account, therefore the premium amounts are very meaningful. At healthcare.gov it also tells you, without creating an account, that maximum out of pocket expenses for any plan are $6,350 for an individual and $12,700 for a family. You can then ask whatever specifics you’d like to know via the 800# when you call. Or if you’re feeling extra energetic, you could actually call the insurance company offering the plan your interested in. Does any of that really seem so hard? After all, what would you have done when shopping for a plan just last year, or for the last 20 years? You’d have been extremely grateful for a comprehensive listing of plans comparing common essential benefits across standardized plans, just like on the website. That is, if you weren’t excluded from buying all plans due to a pre-existing condition. Is it too much to ask for you to do a tiny bit of work yourself instead of waiting for a magic button to push? Geeez.

  9. If Robert the Commenter had a clue, he’d realize that the “insurance plan options and details” that can be viewed on healthcare.gov without creating an account do not include information on “deductibles, copayments, and other out-of-pocket costs.”

    Therefore the premium amounts are meaningless.

    People: Be very suspect of low-information commenters like Robert.

  10. If the author had visited the healthcare.gov website, he’d know that he can easily browse insurance plan options and details without even creating an account. He can then simply call the 800 # and sign up for the plan he wants.

  11. Unfortunately I think fixing the website is only going to rectify one of numerous problems that we are likely to see arise as this law takes effect.
    Not to be flippant but those paper applications are likely in some limbo somewhere.