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| Marilyn Tavenner, the administrator of the Centers for Medicare and Medicaid Services, pauses while testifying on Capitol Hill in Washington, Tuesday, Oct. 29, 2013, before the House Ways and Means Committee hearing on the implementation of the Affordable Care Act. Stressing that improvements are happening daily, the senior Obama official closest to the administration's malfunctioning health care website apologized Tuesday for problems that have kept Americans from successfully signing up for coverage. |
WASHINGTON
(AP) -- Move over, website woes. Lawmakers confronted the Obama
administration Tuesday with a difficult new health care problem - a wave
of cancellation notices hitting small businesses and individuals who
buy their own insurance.
At the same time, the
federal official closest to the website apologized for its dysfunction
in new sign-ups and asserted things are getting better by the day.
Medicare
chief Marilyn Tavenner said it's not the administration but insurers
who are responsible for cancellation letters now reaching many of the
estimated 14 million people who buy individual policies. And, officials
said, people who get cancellation notices will be able to find better
replacement plans, in some cases for less.
The
Associated Press, citing the National Association of Insurance
Commissioners, reported in May that many carriers would opt to cancel
policies this fall and issue new ones. Administratively that was seen as
easier than changing existing plans to comply with the new law, which
mandates coverage of more services and provides better financial
protection against catastrophic illnesses.
While
the administration had ample warning of the cancellations, they could
become another public relations debacle for President Barack Obama's
signature legislation. This problem goes to the credibility of one of
the president's earliest promises about the health care overhaul: You
can keep your plan if you like it.
In the
spring, state insurance commissioners started giving insurers the option
of canceling existing individual plans for 2014, since the coverage
required under Obama's law is more robust. Some states directed insurers
to issue cancellations. Large employer plans that cover most workers
and their families are unlikely to be affected.
The
cancellation notices are now reaching policyholders, and they've been
complaining to their lawmakers - who were grilling Tavenner on Tuesday.
"Based
on what little information the administration has disclosed, it turns
out that more people have received cancellation notices for their health
care plans this month than have enrolled in the (health care website),"
said Ways and Means Chairman Dave Camp, R-Mich. He cited a news report
of 146,000 cancellations in his state alone.
Up
and down the dais, lawmakers chimed in with stories of constituents who
had received similar notices.
Republicans offered examples of people
being asked to pay more.
Democrats countered
by citing constituents who had been able to find lower-cost coverage
than they have now. Ranking Democrat Sander Levin of Michigan said one
of his constituents has been paying $800 a month for a
BlueCrossBlueShield plan and managed to find comparable coverage for
$77, after tax credits that lower the premiums.
Still, Levin added, "this has become a matter of legitimate discussion."
It
could take months to sort out the balance of individual winners and
losers. There's not a central source of statistics on how many people
have gotten cancellations. Even the number of people who buy insurance
individually is disputed.
It isn't the administration's fault, said Tavenner. "In fact the issuer has decided to change the plan; (they) didn't have to."
Obama's
promise dates back to June 2009, when Congress was starting to grapple
with overhauling the health care system to cover uninsured Americans.
"If
you like your health care plan, you'll be able to keep your health care
plan, period," the president said in remarks to the American Medical
Association. "No one will take it away, no matter what."
Some
immediately saw the promise as too broad to deliver on, given that
health plans are constantly being changed by the employers that sponsor
them or by insurers directly.
Nonetheless,
Democrats in Congress devised a complicated scheme called
"grandfathering" to try to make good on Obama's pledge. It shields plans
from the law's requirements, provided the plans themselves change very
little. Insurers say it has proven impractical.
The
White House weighed in Tuesday, with spokesman Jay Carney saying the
changes are part of a transition to better coverage. "The good news," he
said, "is that for every one of these individuals who might have a plan
that is almost by definition providing less than minimal benefits ...
you are now being offered a variety of options, including options by the
very insurer that covers you already, for new coverage."
Critics
say that's like an airline forcibly upgrading you from economy to
business class, and exposing you to a higher ticket price.
Proponents
of the health care law offered evidence to support the administration's
position that losing coverage could be advantageous. In California,
Anne Gonzalez, a spokeswoman for the state's health care exchange,
Covered California, said that about 900,000 people are expected to lose
existing plans that do not provide the minimum level of coverage
required under the health care law.
"They
basically had plans that had gaping holes in the coverage. They would be
surprised when they get to the emergency room or the doctor's office,
some of them didn't have drug coverage or preventive care," Gonzalez
said. About a third of those people will be eligible for subsidies, she
said, if they come to the health exchange.
During
the House hearing, Tavenner delivered the most direct mea culpa yet
from the administration for the technical problems that have kept many
Americans from signing up through HealthCare.gov.
"I want to apologize to you that the website has not worked as well as it should," she told the committee.
The
first senior official to publicly answer questions from lawmakers,
Tavenner was pressed not only on what went wrong with the website, but
also whether lawmakers can trust recent promises that things will be
running efficiently by the end of November.
She
declined to provide enrollment numbers, repeating nearly 20 times they
will not be available until mid-November. But she did try to lower
expectations of a strong initial sign-up. "We expect the initial number
to be small," Tavenner said.
An internal memo
obtained by the AP showed that the administration expected nearly
500,000 uninsured people to sign up for coverage in October, the
program's first month. Committee chairman Camp told Tavenner that by his
math, the administration appears headed for less than a fourth of that.
Outside
contractors testified last week that there wasn't sufficient time to
test the complex online enrollment system, which froze the day it was
launched, Oct. 1.
The website is supposed to
be the online portal to coverage for people who don't have health plans
on the job. Its audience is not only uninsured Americans but those who
already purchase coverage individually.
Under
the law, middle-class people can qualify for tax credits to make private
health insurance more affordable, while low-income people will be
steered to Medicaid in states agreeing to expand that safety net
program.
