Millions to see policies kick in

Sign-ups soar in December; nuns win stay on mandate

A motorcade carrying President Barack Obama and his family Tuesday heads along the southeast coast of Oahu toward the Hanauma Bay Nature Preserve Park, a popular snorkeling destination. As the president vacationed in Hawaii, his health-care law saw a late surge in enrollment, helping offset early technical foul-ups.

A motorcade carrying President Barack Obama and his family Tuesday heads along the southeast coast of Oahu toward the Hanauma Bay Nature Preserve Park, a popular snorkeling destination. As the president vacationed in Hawaii, his health-care law saw a late surge in enrollment, helping offset early technical foul-ups.

Wednesday, January 1, 2014

WASHINGTON - About 2.1 million people will have medical coverage today through President Barack Obama’s health-care law after a late surge in enrollment helped regain ground lost to the botched debut of the insurance exchanges created by the overhaul.

More than 1.6 million Americans signed up through state and federal exchanges in December alone, according to calculations from data released Tuesday by the U.S. Department of Health and Human Services. The December tally is more than quadruple the first two months of the government’s sign-up period.

The December surge provides a boost to Obama after the fumbled October rollout of the exchanges initially thwarted the high participation needed to spread the costs of his health-care expansion. The Patient Protection and Affordable Care Act is supposed to offer private coverage to as many as 7 million people by the end of March.

“The new law is transformational for our entire health-care system and for millions of Americans who finally have health security,” Kathleen Sebelius, the U.S. health secretary, said on a conference call Tuesday.

In addition to those gaining private insurance, about 3.9 million others have been newly determined eligible for Medicaid plans or for state children’s health-insurance programs. It’s not yet known how many of those people actually enrolled, since that process must be completed with state governments in most cases.

The government is preparing for newly insured people to begin seeking care at doctors’ offices, emergency rooms and pharmacies today and is coordinating with hospitals and insurers to smooth the process, Sebelius said.

The government considers people enrolled after they select a health plan. The final step to sign up is to pay the first month’s premium directly to insurers. Those payments aren’t due until Jan. 10 for most of the country, and officials said they don’t know how many of the 2.1 million have already paid.

By 2016, about 34 million people are expected to gain coverage from private health plans sold through the law’s government-run marketplaces or by expanded Medicaid programs, according to the Congressional Budget Office.

But for all its promise, the law’s future remains uncertain. While it survived a constitutional challenge before the Supreme Court in 2012, the law faces further court battles as well as a Republican-controlled House of Representatives that has voted more than 40 times to repeal or limit the statute.

Polls also have shown public support dwindling after the Oct. 1 debut of the insurance marketplaces greeted consumers with website breakdowns, higher prices than some expected and potentially broken promises.

Although the stated goal of the law was to cover the uninsured, at least 4.7 million insured people had individual policies canceled that didn’t measure up to new requirements. That forced an apology from the president, who had famously promised that if people liked their health plans, they could keep them. The administration said it believes most of those people have secured new coverage.

ORPHANS AND GHOSTS

And while the number of new enrollments show progress in fixing the consumer-access part of the federal healthcare.gov website, on the back end, insurers said they are still receiving thousands of erroneous sign-ups from the government.

One of the main worries is over certain error-tainted enrollment records that insurers call “orphans” and “ghosts.”

“Orphans” are sign-ups that the government has a record of, but they do not appear in insurer systems. “Ghosts” are new customers that the insurer does have a record of, but mysteriously the information does not appear in the government’s computers.

The Obama administration said the rate of such errors has been dramatically reduced, and insurers agree. But the surging volume of sign-ups means that even with a lower error rate the number of problem cases keeps growing. There is no automated way to clear up the mistakes quickly.

“Some people are actually going to start using their coverage Jan. 1, and that is a good thing for them,” said Mark McClellan, who oversaw the rollout of Medicare’s prescription drug benefit - a program that also had its share of problems in the early going. “But there are going to be problems for any number of people who thought they had signed up, and it won’t work right off the bat. It would be particularly disruptive for people in the midst of treatment.”

Anticipating disruptions, CVS Caremark Inc. and Walgreen Co., the largest pharmacy chains in the nation, said they would provide up to a month of prescription medications without any upfront cost to customers who can show they enrolled in an exchange plan, even if they don’t yet have an identification card or plan number. Many smaller independent pharmacies also have said they are ready to help.

Sebelius said people who experience trouble using their insurance at doctors’ offices, hospitals or other healthcare settings should first call their insurers. If that doesn’t resolve the problem, the government is putting 10,000 call-center agents on duty to handle questions about coverage from a toll-free number, (800) 318-2596, said Julie Bataille, a spokesman for the U.S. Centers for Medicare and Medicaid Services.

CATHOLICS APPEAL

Meanwhile, only hours before the health-care law was to take effect, a Supreme Court justice on Tuesday night blocked implementation of part of the law that would have forced some religion-affiliated organizations to provide health insurance that includes contraceptives for their employees.

Justice Sonia Sotomayor acted on a request from an organization of Catholic nuns in Denver, the Little Sisters of the Poor Home for the Aged. Its request for an emergency stay had been denied earlier in the day by a federal appeals court.

The government is “temporarily enjoined from enforcing against applicants the contraceptive coverage requirements imposed by the Patient Protection and Affordable Care Act,” Sotomayor said in the order. She gave government officials until 9a.m. CST Friday to respond to her order.

The law requires employers to provide insurance that covers a range of preventive care, free of charge, including contraception. The Catholic Church prohibits the use of contraceptives.

That was not acceptable, said their lawyer, Mark Rienzi.

“The Little Sisters are an order of Catholic nuns whose religious faith leads them to devote their lives to caring for the elderly poor. Not surprisingly, they have sincere and undisputed religious objections to complying with this mandate,” Rienzi said.

The Obama administration crafted a compromise, or accommodation, that attempted to create a buffer for religiously affiliated hospitals, universities and social-service groups that oppose the use of contraceptives. The law requires insurers or the health plan’s outside administrator to pay for the coverage and creates a way to reimburse them.

But for that to work, the nuns would have to sign a form authorizing their insurance company to provide contraceptive coverage, which would still violate their beliefs, Rienzi said.

Sotomayor’s decision to delay the contraceptive part of the law was joined by the U.S. Court of Appeals for the District of Columbia Circuit, which also issued an emergency stay for Catholic-affiliated groups challenging the contraceptive provision.

One judge on the three judge panel that made the decision, Judge David Tatel, said he would have denied their motion.

“Because I believe that appellants are unlikely to prevail on their claim that the challenged provision imposes a ‘substantial burden’ under the Religious Freedom Restoration Act, I would deny their application for an injunction pending appeal,” Tatel said.

Earlier Tuesday, several other parties, including the Roman Catholic archbishop of Washington, the Catholic Diocese of Nashville, Tenn., Catholic University and the Michigan Catholic Conference, asked Chief Justice John Roberts and Justice Elena Kagan to block the law until their arguments are heard.

Roberts and Kagan handle emergency requests for the U.S. Court of Appeals for the District of Columbia Circuit, and the 6th Circuit, which is based in Cincinnati.

The Supreme Court already had agreed to rule on whether businesses may use religious objections to escape a requirement to cover birth control for employees. The court will consider two cases involving Hobby Lobby Inc., an Oklahoma City-based arts and-crafts chain with 13,000 full-time employees, and Conestoga Wood Specialties Corp., a Pennsylvania company that employs 950 people in making wood cabinets.

Hobby Lobby won in the lower courts while Conestoga Wood Specialties lost. The combined cases probably will be argued in late March with a decision coming by summer.

Information for this article was contributed by Alex Wayne of Bloomberg News and by Ricardo Alonso Zaldivar and Jesse J. Holland of The Associated Press.

Front Section, Pages 1 on 01/01/2014