Insured's data, U.S.' don't jibe

2 million facing snags in coverage

Thursday, June 5, 2014

WASHINGTON -- A government document indicates that at least 2 million people enrolled for taxpayer-subsidized private health insurance under President Barack Obama's health-care law have data discrepancies in their applications that have the potential to affect what they pay for coverage, or even their legal right to benefits.

According to the Obama administration, the 2 million figure reflects only consumers who signed up through the federally administered healthcare.gov website and call centers.

The government signed up about 5.4 million people, while state-run websites signed up another 2.6 million.

For consumers, a discrepancy means that the information they supplied, subject to perjury laws, does not match what the government has on record.

For example, someone who underestimated his income, and got too generous a subsidy as a result, could owe the Internal Revenue Service money next year.

The seven-page slide presentation from the Health and Human Services Department was provided to The Associated Press as several congressional committees investigate the discrepancies. Most of the data conflicts involve important details on income, citizenship and immigration status -- which affect eligibility and subsidies.

Ensuring that health-care benefits are delivered accurately is a priority for Health and Human Services nominee Sylvia Mathews Burwell, who goes before the Senate this week for a confirmation hearing for department secretary.

Responding to the document, administration officials expressed confidence that most of the discrepancies can be resolved over the summer. Nonetheless, the department has set up a system to "turn off" benefits for anyone found to be ineligible.

Julie Bataille, communications coordinator for the health-care rollout, said many of the discrepancies appear to be due to outdated information in government files -- and the "vast majority" of cases are being resolved in favor of consumers. The government is making an all-out effort to reach those with various discrepancies.

"The fact that a consumer has an inconsistency on their application does not mean there is a problem on their enrollment," Bataille said. "Most of the time what that means is that there is more up-to-date information that they need to provide to us."

For example, for people applying for coverage this year, the latest income information on record with the IRS dates to 2012, in most cases.

The May 8 document provided to the AP said 2.1 million people enrolled through the new health-insurance exchanges were "affected by one or more inconsistency" as of the end of April.

The exchanges offer subsidized private coverage to lower-income and to middle-class people who have no health care on the job. The sliding-scale subsidies are based on income and family size, and are affected by where a person lives. Under the law, only citizens and legal immigrants are entitled to subsidized coverage.

Because the subsidies are tax credits, the IRS can deduct any overpayments to a consumer from that taxpayer's refund the next year. Conversely, if the consumer got too small a credit, that person would be due a bigger refund.

Updated numbers provided by Bataille indicate the total number of people affected remains about the same as reflected in the document. About 1.2 million have discrepancies related to income; 505,000 have issues with immigration data and 461,000 have conflicts related to citizenship information.

An individual can have more than one data problem.

Republicans leading the House Energy and Commerce Committee said Wednesday that their investigation shows at least 4 million inconsistencies, mostly unresolved. That number was quickly challenged by Rep. Henry Waxman, the Californian who serves as the panel's senior Democrat, who said it includes applications never completed.

The law provided for a 90-day window to clear up any discrepancies. During this time, a consumer's coverage is not affected. The administration has the option to extend the 90-day period for this year.

About 60 percent of all the people with discrepancies are still within the initial 90-day period, Bataille said.

In Arkansas, more than 180,000 Arkansans were covered by plans offered on the federal exchange as of April 30, including more than 140,000 whose premiums were being paid by the state Medicaid program under the so-called private option.

The Arkansas Department of Human Services last month notified about 4,800 private-option enrollees and others covered under the state's expanded Medicaid program that their coverage was set to end this month because their eligibility had not yet been verified.

The affected Arkansans had applied through the federal enrollment portal, healthcare.gov. The federal government sent the data to Arkansas with code indicating that the applicants' eligibility had not been verified, but state officials didn't know about the code and thought the applications had already been approved.

Human Services Department Amy Webb said applicants' eligibility for Medicaid is normally verified by checking the information submitted against other records, such as tax-return information. The applicants will not be approved for coverage until any discrepancies are resolved, she said.

Bataille said that nationally, consumers who get a request for additional information can upload documents electronically or mail them in. The Health and Human Services request is supposed to specifically describe any information that the government needs to verify.

It may not be that easy.

The document provided to the AP describes a laborious effort to try to resolve the problems, largely requiring hands-on attention from a legion of workers employed by government contractor Serco Inc.

"Current system access and functionality ... limits the ability to resolve outstanding inconsistencies," the document says. "A phased approach is proposed, initially leveraging manual processes."

At the top of the priority list are citizenship and immigration issues, then annual income.

Information for this article was contributed by Ricardo Alonso-Zaldivar of The Associated Press and by Andy Davis of the Arkansas Democrat-Gazette.

A Section on 06/05/2014