Pricing Glitches Affect ACA Exchanges Two Weeks Before Launch

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The Obama administration is "scrambling" to quickly address a series of "pricing quirks" in the software that will be used for the roughly three dozen federal health insurance exchanges under the Affordable Care Act, according to several insurance executives and sources familiar with the issue, the Wall Street Journal reports.

The online marketplaces are scheduled to open for enrollment in less than two weeks.

According to the unidentified executives and sources, the software -- which still is in the testing phase -- cannot reliably determine the costs that consumers would have to pay for coverage, the Journal reports. They also noted that testing of the software began behind schedule.

One senior health insurance executive said, "There's a blanket acknowledgement that rates are being calculated incorrectly," adding that some "tech and operations people are very concerned about the problems they're seeing and the potential of them to stick around" (Weaver et al, Wall Street Journal, 9/19).

The news about the software pricing glitches comes a little more than a week after representatives of four CMS contractors involved in developing and implementing the exchanges expressed confidence -- in testimonies before the House Energy and Commerce Health Subcommittee -- that the marketplaces will be ready by Oct. 1 (California Healthline, 9/11).

An estimated 32 million uninsured people who are being targeted as beneficiaries of the exchanges live in the 36 states where the federal government is operating an exchange.

However, according to the Journal, the long-term consequences of any software glitches in registration or pricing might be limited, because consumers would still be able to sign up offline, even if the online exchanges are not fully functional.

Consumers have until mid-December to enroll in the marketplaces for policies that take effect on Jan. 1, 2014. The open enrollment period is scheduled to end in March 2014, when the glitches likely should be resolved and analysts expect the majority of eligible consumers to sign up for coverage (Wall Street Journal, 9/19).

House Committee Blasts CMS Official

Meanwhile, several House Republicans on Thursday -- during a hearing of the House Energy and Commerce Oversight and Investigations Subcommittee -- "lit into" a top CMS official, accusing him of mismanaging the federal exchanges' "navigator" program and lying about the readiness of the marketplaces, CQ HealthBeat reports.

The lawmakers also accused Gary Cohen -- director of the Center for Consumer Information and Insurance Oversight -- of being evasive and less than knowledgeable about the safety of a key ACA program that he has been charged with implementing (Reichard, CQ HealthBeat, 9/19).

Late last month, the panel's Republicans sent a letter to dozens of recipients of the navigator funds, seeking a variety of information relating to how they intend to use the funds, as well as all communications between them, the White House and insurers. On Aug. 15, HHS Secretary Kathleen Sebelius announced that 105 groups nationwide will receive federal grants totaling $67 million under the ACA to serve as navigators.

GOP lawmakers in recent months have raised concerns about navigator workers' level of training and access to consumers' personal and potentially sensitive data. In particular, some GOP leaders have stepped up their scrutiny of the navigator program and a separate "in-person assisters" program in the states that will operate their own exchanges (California Healthline, 9/3).

During Thursday's hearing, Subcommittee Chair Tim Murphy (R-Penn.) said that consumer privacy in the exchanges continues to be a concern. He noted that a plan for a door-to-door outreach initiative under the navigator program could allow potential scammers to gain access to consumers' personal information.

Cohen told Murphy that CMS has revised the outreach initiative and requires recipients of the navigator grants to hire personnel from long-standing and trusted organizations. He also defended CMS' decision to forgo background checks for navigator personnel, noting that counselors in the State Health Insurance Assistance Program do not undergo such checks. He added that he was unable to provide specifics about the criteria for awarding the navigator grants, even though he acknowledged that he was involved with establishing the criteria.

In response, Rep. Bill Johnson (R-Ohio) said, "I think it's reprehensible that you can come before the American people as the director of the department and you don't know" such information, calling Cohen's lack of clarity on the subject "appalling."

Democrats during the hearing accused their Republican counterparts of trying to intimidate recipients of the navigator grants and discourage consumers from enrolling in the exchanges.

Rep. Harry Waxman (D-Calif.) said, "I don’t know what this hearing is all about except to intimidate people." He added, "I resent the kinds of questions that our witnesses have been subjected to" (CQ HealthBeat, 9/19).

House, Senate Introduce Data Privacy Bills

In related news, Republicans in the House and Senate have introduced legislation that would delay consumer enrollment in the online marketplaces until the Government Accountability Office verifies that strong data privacy provisions are in place, The Hill's "Floor Action Blog" reports.

Sen. Orin Hatch (Utah) is sponsoring the bill (S 1525) -- called the Trust But Verify Act -- in the Senate, which has the support of Senate Minority Leader Mitch McConnell (Ky.) and 27 other Republicans. The House bill (HR 3119) -- by Rep. Erik Paulsen (R-Minn.) -- has three Republican co-sponsors (Kasperowicz, "Floor Action Blog," The Hill, 9/19).


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