WASHINGTON - More than 250,000 Americans selected private health-insurance plans last month through the federal and state enrollment systems created by the Patient Protection and Affordable Care Act, twice as many as in October when the exchanges opened amid technology errors and service failures.
Health and Human Services Secretary Kathleen Sebelius called for an investigation of what went wrong with the Oct. 1 debut and said she’s taking steps to prevent future failures. While the Obama administration said it’s optimistic about the improved performance of the online exchange, it’s behind in the effort to meet a goal of 7 million people enrolled by March 31.
All told, 364,682 people in two months selected insurers using the federal and state exchanges created by the federal Affordable Care Act, according to a government report released Wednesday. An additional 803,077 were found eligible for state children’s health plans or Medicaid, the program for the poor being expanded next year in at least 26 states, including Arkansas.
Enrollment in private plans on Arkansas’ exchange reached 1,404, up from 250 who enrolled from Oct. 1-Nov. 2.
In addition, the Arkansas Department of Human Services reported last week that at least 64,635 newly eligible adults had enrolled through the department for Medicaid coverage as of Dec. 2.
That included 59,203 who will receive coverage through plans on Arkansas’ exchange whose premiums will be paid by Medicaid under the so-called private option approved by the state Legislature this year.
Also, 5,432 applicants were assigned to the traditional Medicaid program be-cause they were determined to have exceptional healthcare needs.
Those who have enrolled in the expanded Medicaid program include food-stamp recipients who responded to letters sent out by the Human Services Department in September, as well as people who applied by phone, submitted paper applications to the state or applied through a state website, access.arkansas.gov.
The numbers released by the federal Health and Human Services Department on Wednesday showed that 11,827 adults and children in Arkansas who applied through healthcare.gov were found to be eligible for Medicaid.
The state Human Services Department has not received information from the federal government on those applications, spokesman Amy Webb said.
A federal Health and Human Services Department memorandum dated Sept. 5, obtained by the House Ways and Means Committee, projected that 1.2 million people would be enrolled in private insurance coverage by the end of November - more than three times the actual number.
“We’re not exclusively focused on reaching a particular number,” Mike Hash, the director of the office of health reform at the Health and Human Services Department, said on a conference call with reporters. “What we’re focused on is reaching the millions of people who are looking for affordable health-care coverage.”
The botched debut of the exchanges prompted President Barack Obama to recruit Jeffrey Zients, scheduled to become his top economic adviser after Jan. 1, to oversee a “tech surge” to fix the flaws. Error messages, service failures and other shortcomings regarding the website contributed to about 1 million people abandoning the application process in October before choosing plans.
“I don’t think there’s any question that the flawed launch of the website put a damper on people’s enthusiasm about early sign-up,” Sebelius said Wednesday at a House Energy and Commerce subcommittee hearing in Washington. “We had a lot of visitors early on who got very frustrated and have not re-engaged.”
Republican members on the committee said they felt lied to about the promises and progress of the health law.
“Words start to lose their meaning when they’re delivered by individuals who have either misled this committee or were woefully ignorant of the disastrous consequences that have unfolded since enactment” of the Affordable Care Act, said Rep. Joseph Pitts, a Pennsylvania Republican who led the hearing.
Democratic lawmakers said they are relieved the website is finally working, but some are not convinced the turnaround is complete.
“How confident I am? I’m hoping that we’re moving in the right direction,” said Rep. Eliot Engel, D-N.Y., after the committee hearing. “And if we find the day has come and we find that it’s not what we had hoped, then I think there should be changes.” The law should be fixed, not repealed, he said.
Sebelius said that in hindsight she might have done things differently.
“I would have probably done a slower launch, maybe with fewer people, and done some additional beta testing, which is part of what has happened, frankly, in the early months of the launch, to identify what problems we had,” she said.
The administration announced Dec. 1 that it had met its goals for repairs and that most customers would find the federal website working well. About 110,000 people signed up in November from 36 states that rely on the federal enrollment system. That’s about four times the number who selected plans on the federal exchange in October. Data for December will be released next month.
The improved performance has both major political parties shifting strategies, with Obama preparing a January advertising blitz and wave of celebrity promotions, and with Republican opponents in Congress highlighting examples of people who are paying more for insurance or losing access to their doctors.
The hearing Wednesday touched on the costs of the website, which has been difficult to track through public records. Sebelius said a subset of her agency spent $319 million building the federally run marketplace through October, out of $677 million that has been obligated to contractors.
There is still no conclusive way to track that spending, including what contractors CGI Group Inc., Verizon Communications Inc., Hewlett-Packard Co. and United Health Group Inc. have received, Bloomberg News found.
The Centers for Medicare and Medicaid Services, which is part of Sebelius’ agency, had obligated $630 million for the work through September, spokesman Julie Bataille has said. On the basis of Sebelius’ testimony Wednesday, repairs to the website cost at least $47 million in October alone.
Sebelius said she’s asked for a formal investigation of what went wrong with the exchange’s debut, and has taken steps to avoid future debacles, including the creation of the position of a chief risk officer within the Centers for Medicare and Medicaid Services who will review purchases and contracts related to information technology.
“We need a thorough review of the contractor performance and program management structure,” Sebelius said in a blog post Wednesday. “I am asking the Inspector General to review the acquisition process, overall program management, and contractor performance and payment issues related to the development and management of the healthcare.gov website.”
In the meantime, more than 1 million visitors were willing to give the federal website another chance on Dec. 2, a day after the government said it had made software repairs that ensure the site is functional for most users.
Yet the revamped site continues to have problems, and some states running their own sites also face problems. Oregon had signed up only 44 people as of Nov. 30.
Other states were faring better. About 17,900 Floridians signed up through the end of November, the most of any state using the federal exchange, and 14,038 Texans enrolled, according to Wednesday’s Health and Human Services Department report.
California, one of the 14 states to create its own health marketplace, led all states in enrollment, with about 107,000 signed up through Nov. 30. About 45,500 New Yorkers selected plans through their state’s program, according to the report.
“Evidence of the technical improvements to healthcare.gov can be seen in the enrollment numbers,” Sebelius said in a statement.
The next challenge is resolving the back-end problems involving data transfers to health insurers. In what are known as “834 transactions,” the companies have said information from the federal system has been incomplete or garbled, raising the prospect that thousands of people who thought they had signed up won’t have coverage if the errors aren’t corrected.
About a quarter of 834 forms transmitted in October and November probably contained errors, Bataille said. That error rate has been cut to about 10 percent now, she said.
A “reconciliation process” is underway with insurers to match the government’s enrollment records with those of the companies, she said, to make sure people who think they have bought coverage are indeed signed up.
The problems with the health exchanges have created stress and uncertainty not only for the uninsured but also for people who have insurance but are seeking to avoid an interruption in coverage in January.
Those who are trying to preserve their coverage include some of the more than 4 million people who received notice that their individual plans were canceled because they didn’t measure up under the law - as well as hundreds of thousands who are in federal and state programs for people with serious health problems, from cancer to heart disease to AIDS.
Americans have until Dec. 23 to sign up for coverage that begins Jan. 1. In its report, the government counts people who have selected a plan as enrolled, though they won’t have coverage until they make their first premium payment. Similarly, people who are designated eligible for Medicaid must complete enrollment with their state government.
Sebelius said at least 1.9 million people have been found eligible to enroll but haven’t yet picked plans. If they’re all procrastinators who rush forward on Dec. 23, the website would be overwhelmed. It can only handle 50,000 people at a time.
Those who don’t find health insurance by March 31 may have to pay a fine of as much as 1 percent of their income.
Information for this article was contributed by Alex Wayne, Derek Wallbank, Mike Dorning, Kathleen Miller, Meg Tirrell and Alex Nussbaum of Bloomberg News; by Laurie Kellman and Ricardo Alonso-Zaldivar of The Associated Press; and by Andy Davis of the Arkansas Democrat-Gazette.
Front Section, Pages 1 on 12/12/2013