After years of anticipation, coverage on the new Obamacare marketplaces -- the centerpiece of the sweeping health care law that was passed in 2010 -- finally begins on Wednesday. The new, expanded version of Medicaid also goes into effect in some states, and new consumer protections kick in.
Wednesday is not only a milestone for Obamacare but also a day of reckoning: The start of coverage on the state-based marketplaces should shed light on whether the administration truly resolved one of the major technical problems that initially plagued HealthCare.gov, the federal site that serves as an Obamacare portal for 36 states. The opening of the marketplaces will also test some steps the administration is taking, with the help of the private sector, to make sure those who have signed up for insurance receive the coverage they’re expecting.
As of Dec. 28, more than 2.1 million Americans had signed up for private insurance through Obamacare, the administration said Tuesday. Approximately half of the enrollees signed up on state-run Obamacare sites, while the rest signed up on Healthcare.gov. Anyone who signed up for insurance on Healthcare.gov by Dec. 24 should have coverage when the marketplaces open Wednesday. On a conference call with reporters, Health and Human Services Secretary Kathleen Sebelius said Wednesday will be “a new day in health care for millions of Americans.”
Along with coverage on the new marketplaces, Sebelius noted that new consumer protections also kick in. “Starting tomorrow being a woman will no longer be a pre-existing condition,” she said. The new rules also bar insurers from denying coverage to anyone with actual pre-existing conditions, and they limit the variation of rates offered to consumers. Also in 2014, insurers will be barred from imposing annual limits on coverage.
This year also marks the expansion of Medicaid, a joint federal-state program that previously only provided health care to certain poor Americans, such as children and the elderly. Under Obamacare, states have the choice to expand Medicaid so that it's available to anyone with an income under 138 percent of the federal poverty line. States can decide to expand the program at any time, but only half are expanding it in 2014.
In October and November, administration officials confirmed Tuesday, 3.9 million people were found eligible for Medicaid or the Children's Health Insurance Program (CHIP) under Obamacare. The administration has yet to collect the data for December.
The “individual mandate,” the requirement for most Americans to obtain insurance or pay a fine, also technically kicks in on Wednesday, though people have until March 31 to enroll in a plan before getting hit with the fine.
While 2.1 million Americans have signed up for insurance plans via Obamacare, it’s unclear exactly how many will be able to access their new coverage starting Wednesday.
In some cases, a technical glitch may have disrupted some consumers’ attempts to enroll online, though administration officials insisted Tuesday that this problem has been resolved.
When open enrollment began in October, a number of technical problems plagued HealthCare.gov, along with some of the state-run Obamacare sites. Insurers initially said they were at times receiving incorrect information -- or no information at all - from HealthCare.gov users who thought they had successfully enrolled in private plans.
The administration said in December that it fixed the glitch and has been working with insurers to confirm that they have the correct information for all enrollees. On Tuesday, Julie Bataille, a spokeswoman for the Centers for Medicare & Medicaid Services (CMS), said that this “meticulous process” is ongoing.
She added, “What’s most important is to know that all of the issuers have all of the data for consumers who have selected a health plan on Healthcare.gov.”
Even if insurers have all the correct information for enrollees, they may not in some cases be finished processing payments or issuing membership cards. Insurers typically don’t begin coverage until they’ve received a customer’s first payment. Administration officials on Tuesday said they don’t have data for the number of enrollees who have paid their first bill, but the Wall Street Journal reports that a significant portion of new enrollees have yet to do so.
The administration is taking various steps to mitigate any problems that may arise for consumers on Jan. 1. Sebelius on Tuesday published a blog post with tips for Obamacare enrollees. “Consumers who think they’ve signed up for Marketplace health insurance, but haven't heard from their insurance company can get help finding out if they're covered,” Sebelius wrote, adding a link to information on how to get assistance.
The blog post also reminds enrollees to “Get your insurance card or a temporary card with your new plan’s information,” and “Make sure you know when your first premium payment is due and pay it by the due date.”
While the Obamacare marketplace has its own hotline for consumers looking for help, the administration is also working with companies in the health sector to get in front of possible problems. Sebelius reached out to the chief executive officers of major pharmaceutical companies, and two have responded with contingency plans. The CVS pharmacy chain announced it may provide "a transitional supply of a prescription to a patient experiencing a temporary disruption in coverage." Walgreens pharmacy announced it would provide a similar service.
The administration on Tuesday could not say how many of the 2.1 million enrollees were previously uninsured and how many were signing up for a plan to replace their expiring coverage. Millions of Americans have been dropped from insurance plans that no longer meet Obamacare coverage standards, but President Obama earlier this year offered insurers the chance to re-enroll those consumers in their plans for another year. The federal government in mid-December set up a hotline for people who lost their coverage, but the hotline has received only about 2,400 calls to date, Bataille said Tuesday.
While Obamacare coverage begins on Wednesday, Sebelius on Tuesday stressed that “we’re just halfway through a six-month open enrollment period.” The administration initially expected to have around 7 million Obamacare enrollees when the open enrollment period ends in March; that goal seems more elusive now, but the administration is still aiming for it.