Clinton urges Obama to give on health law

Accept revisions to keep pledge on policies, he says

Former President Bill Clinton, shown speaking Oct. 30 in Charlottesville, Va., said in an interview Tuesday that while there were flaws in the new health-care law, “the big lesson is that we’re better off with this law than without it.”
Former President Bill Clinton, shown speaking Oct. 30 in Charlottesville, Va., said in an interview Tuesday that while there were flaws in the new health-care law, “the big lesson is that we’re better off with this law than without it.”

WASHINGTON - Former President Bill Clinton said President Barack Obama should accept changes to his health-care law if that’s what it takes to fulfill his promise that Americans who like their health insurance can keep it.


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Clinton stepped into the debate over how to fix the flawed roll out of a central element of the law days before a vote in the Republican-controlled House on a measure that would let individuals keep their health-care plans into next year without penalty.

“Even if it takes a change to the law, the president should honor the commitment the federal government made to those people and let them keep what they’ve got,” Clinton said in an interview posted Tuesday by Ozy.com,a media startup backed by Laurene Powell Jobs, the widow of Apple founder Steve Jobs.

Obama’s pledge was a central selling point of his health-care law, aimed at calming consumers concerned that they would be forced to give up their policies and doctors as the program expanded coverage to many of the nation’s 48 million uninsured. As the enrollment period opened, hundreds of thousands of Americans received notices from insurers that their policies were being canceled because they didn’t meet the standards set under the law.

Republicans seized on Clinton’s remarks. House Speaker John Boehner of Ohio said the comments “signify a growing recognition that Americans were misled when they were promised that they could keep their coverage under President Obama’s health-care law.”

While Clinton generally praised the health-care law, Boehner called it “a train wreck that needs to go.”

White House press secretary Jay Carney repeated that the administration was looking at options “that would address this problem” administratively. He declined to say whether Obama would be open to legislation that changed the law.

Even as Clinton - a Democrat, like Obama - highlighted a flaw in the health law, the former president said that “the big lesson is that we’re better off with this law than without it.”

Clinton said younger, healthy Americans who bought policies on the individual market and earn incomes above 400 percent of the poverty level are primarily affected by the insurance cancellations.

Obama said in a Thursday interview with NBC News that he’s “sorry” that some Americans are “finding themselves in this situation based on assurances they got from me.”

The insurance cancellations for some people who buy policies on the open market came on top of technical faults with the federal website that was intended to serve as the portal to insurance marketplaces for the 36 states that don’t have their own.

The website flaws have hobbled the start of the six month enrollment period that began Oct. 1, and the administration said it expects that the number of people who get policies through the exchanges will be lower than expected.The Wall Street Journal, citing two unidentified people familiar with the matter, reported that fewer than 50,000 people had successfully signed up for insurance plans.

Carney said he couldn’t confirm that number and said the administration plans to release enrollment data by the end of the week.

Meanwhile, an official with knowledge of the project said Tuesday that software problems with the federal exchange, especially in handling high volumes, are proving so stubborn that the system is unlikely to work fully by the end of the month as the White House has promised.

The exchange is balking when more than 20,000 to 30,000 people attempt to use it at the same time - about half its intended capacity, said the official, who spoke on condition of anonymity to disclose internal information. And the main contractor that built the site, CGI Federal, has been able to fix only about six of every 10 defects.

Government workers and technical contractors have concluded, the official said, that the only way for large numbers of Americans to enroll in the health-care plans soon is by using other means, such as call centers, so that the online system isn’t overburdened.

But call centers have had problems, too. Within the network of 17 federally sponsored call locations staffed by more than 10,000 people, consumers are discovering that telephone representatives lack the authority to correct errors in online applications. And sometimes, consumers with more than routine questions are promised that specialists will call them back, but the calls never come, the official said.

Federal and state officials said Tuesday that in addition to slowing the pace of insurance enrollments, the problems with the website also have prevented tens of thousands of low-income people from signing up for Medicaid even though they are eligible.

Though healthcare.gov is primarily seen as a place to buy private insurance with federal subsidies, it is also a gateway to Medicaid, which generally provides more benefits at less cost to consumers.

The Obama administration has adopted what it calls a “no wrong door” policy: If a person files an application with the exchange for private insurance but appears to be eligible for Medicaid, the exchange will automatically transfer the full application to the state Medicaid agency, and vice versa.

Under rules issued last year by Kathleen Sebelius, the secretary of health and human services, an exchange must transfer information to Medicaid “promptly and without undue delay,” using a “secure electronic interface.”

But Marilyn Tavenner, the administrator of the Centers for Medicare and Medicaid Services, who oversaw the creation of the troubled federal website, said she decided in September to delay the Medicaid transfers so technicians could “spend more time concentrating on the application process” and other priorities.

People going to an exchange do not necessarily know whether they are eligible for Medicaid or for tax credits to subsidize the purchase of private insurance on the exchange. Sebelius has said repeatedly that “the marketplace will provide consumers and small businesses one-stop shopping for health insurance.”

However, if the exchange finds people potentially eligible for Medicaid, it may be faster for them to file separate applications with a state Medicaid office than to wait for the federal government to transfer their files to the state, officials said.

Gov. Dave Heineman of Nebraska, a Republican, said the delay was “further evidence that Obamacare is not ready for implementation.”

Because of the website difficulties and policy cancellations, the administration is being pressured by some Democrats as well as Republicans to either extend the enrollment period or delay the imposition of penalties for people who don’t have insurance by the deadline.

White House staff members met last week with representatives of top House Democrats to discuss ideas for changes that wouldn’t require legislation. Republican attempts to strip funding for the law led to a budget standoff that caused a 16-day partial shutdown of the government last month.

The House is poised to vote Friday on a proposal to let individuals keep their health-care plans into next year without penalty. The bill would grandfather plans in effect as of Jan. 1, 2013, to satisfy the 2010 law’s requirements that insurance plans offer minimum essential coverage.

Carney said the House bill would undermine the Patient Protection and Affordable Care Act by letting some insurers continue selling plans that don’t meet the standards set under the law.

In Arkansas, the state Insurance Department gave companies the option to renew customers’ policies on Dec. 31, extending existing coverage until Dec. 30, 2014. After that, policies that were issued after March 23, 2010, when the president signed the federal health-care law, must be terminated or amended to comply with the law.

Arkansas Blue Cross and Blue Shield, United Healthcare and QualChoice Health Insurance have notified the Insurance Department that they will use the option the department outlined to extend customers’ policies through the end of 2014.

The three companies collectively insure more than 90 percent of the 100,000-plus people in the state who buy insurance on their own rather than through employers.

Meanwhile, some major health insurers are so worried about the Obama administration’s ability to fix the health-care website that they are pushing the government to create a shortcut that would allow them to enroll people entitled to subsidies directly rather than through the federal system.

In proposing the idea, the insurers said a bypass giving them direct access to the federal platform that determines a consumer’s eligibility for a subsidy would alleviate the traffic on healthcare.gov, and provide more breathing room to fix the complicated technical problems.

But even if such a shortcut could be designed, federal officials are concerned about protecting personal data, such as confidential financial and tax information and immigration status. The security and privacy concerns are likely to overshadow any possible compromise, according to people briefed on the discussions.

A more likely solution is for consumers to be able to work directly with an insurer to estimate their qualifications for a subsidy, leaving federal verification to a later date, some insurers said. Insurance executives declined to speak on the record because of company policies and concerns about alienating political officials.

Information for this article was contributed by Margaret Talev, Roxana Tiron, Julianna Goldman and Michael C. Bender of Bloomberg News; by Reed Abelson, Sharon LaFraniere, Susanne Craig, Robert Pear and Ian Austen of The New York Times; by Amy Goldstein, Juliet Eilperin and Lena H. Sun of The Washington Post; and by Andy Davis of the Arkansas Democrat-Gazette.

Front Section, Pages 1 on 11/13/2013

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