Lupin 2023

Implementation of ACA proceeds by fits and starts

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WASHINGTON — Heavy website traffic late last month led the Obama administration to twice extend the enrollment deadline for health insurance under the Affordable Care Act.

The White House first pushed back the deadline by one day, to December 24. The administration then said people who had missed the due date because of problems with the website,, could have still more time for a “special enrollment period.” The website had more than 2 million visitors on December 23.

The deadline extensions notwithstanding, Kurt DelBene, the site’s new manager, said it was responding quickly and accurately to its highest volumes to date.

For its part the National Association of Chain Drug Stores backed a pharmacy-specific recommendation by the Centers for Medicare and Medicaid Services to improve the ACA rollout. NACDS also urged additional steps that it considers necessary to improve the experience of the newly insured and existing patients alike, especially in the early days of the launch of coverage.

“We welcome the additional millions of Americans who will have new insurance coverage,” NACDS wrote to CMS. “We are committed to working with all parties to address challenges and to maximize the experience of patients — similar to the efforts of community pharmacy that were noted as vital to smoothing the transition during the rollout of Medicare Part D.”

The comments responded to an interim final rule extending health insurance exchange and premium payment deadlines, and taking steps to ease transitions as exchange-based insurance coverage begins.

NACDS expressed support for CMS’ encouragement of plans to cover a patient’s existing nonformulary drugs as if they were formulary drugs for the first 30 days of coverage after January 1. The association also welcomed CMS’ urging that plans treat out-of-network providers as in-network providers during the initial months of enrollment, to address situations in which an out-of-network provider was listed as in-network at the time of enrollment or was providing treatment for an acute episode of care at the start of the year.

NACDS urged CMS to be clear that pharmacies are included in the recommendations.
The association also made other recommendations focusing on the patient experience. “It will be important to empower patients with information that will be necessary to maximize their experience and ultimately to foster utilization of the benefits that will improve their health,” NACDS wrote.

“We are concerned that the initial enrollment deadline extensions may result in some newly insured patients not having the information necessary to process pharmacy claims for them in January,” the comments said. “We are also concerned that some patients who enroll in a plan and take the opportunity to pay January premiums later in January may not be aware that they must pay for their health care and prescription drug services out-of-pocket pending payment of their insurance premium.”

In light of the concerns, NACDS urged CMS and insurers to engage in consumer education and outreach, offer ample support for pharmacies via call centers, and use techniques that helped to smooth the initial enrollment in Medicare Part D.

In addition to working with member companies to advocate for steps to optimize patients’ experiences during the launch of exchange-based insurance, NACDS will be gaining insights from members throughout the rollout and recommending any further actions that may be ­necessary.

Insurers said policies issued under the law would kick in even for customers who had yet to pay their initial ­premiums. They agreed in December to give consumers an extra 10 days to pay their first-month premiums. Almost all the major insurance companies said they would cover their customers retroactively if they had medical or pharmacy bills after January 1 but sent in their payment by January 10.

“Our community is taking an important step to give consumers greater peace of mind about their health care coverage,” said Karen Ignagni, president and chief executive officer of America’s Health Insurance Plans (AHIP).

Insurers made the onetime change to the payment deadline to help protect consumers from potential gaps in their coverage caused by the ongoing technical problems with, which sells insurance in 36 states. While significant progress had been made in improving the enrollment process, more work was needed to resolve back-end challenges ­— particularly those related to processing enrollment files — to ensure all consumers who selected a plan were enrolled, the insurance association said.

Companies offering the delayed payment deadline include WellPoint Inc., which operates 14 Blue Cross Blue Shield plans, Aetna Inc. and Molina Healthcare Inc., both of which had already announced extensions. WellPoint, one of the country’s biggest insurers, said it would also boost assistance to consumers trying to sign up for coverage, with call centers staffed throughout the holidays and teams of employees working to process applications quickly.

AHIP said the deadline extension would help to reduce potential consumer confusion in the marketplace, noting that states had the flexibility to impose different due dates.

Californians need to have paid by January 6, said Peter Lee, executive director of Covered California, the state’s health insurance exchange. “Health care is local,” he said. “The arrangements are local. The delivery is local. The payment is local.”

Connecticut, which extended its payment due date to January 7 for some shoppers, also said that it was sticking to its deadlines, saying that the changing information, rules and policies created confusion.

Also in the states, Minnesota’s exchange became the fourth to lose its chief. The resignation of MNsure director April Todd-Malmlov followed the departure of exchange leaders in Hawaii and Maryland, and a medical leave for the director in Oregon.

Scott Leitz, who was appointed interim chief executive of MNsure, said, “There is no doubt that this process will improve moving forward. It will be a much better process than it is now, and it will be much easier to enroll.”

At the federal level, a Health and Human Services (HHS) spokeswoman applauded insurers for the payment deadline extension. She said the government looked forward to continuing to work with insurers to find ways to allow as many Americans as possible to obtain coverage through exchanges.

HHS Secretary Kathleen Sebelius said Americans giving a second look were finding that “the consumer experience is night and day compared to what it was back in October.”

“While more work remains,” she blogged last month, “ is working smoothly for the vast majority of users. As a result of hundreds of software fixes and hardware upgrades — along with countless hours of hard work — the steps we’ve taken have put us on a path for millions of Americans to finally obtain affordable health coverage.”

To prevent problems with the website from recurring, Sebelius announced that HHS’ inspector general will thoroughly review the contractor performance and program management structure that resulted in the botched launch.

She also asked CMS administrator Marilyn Tavenner to appoint a chief risk officer who will focus on mitigating risk across CMS programs. The appointee’s first assignment will be to review risk management practices when it comes to IT acquisition and contracting, starting with identifying the risk factors that fouled up

Also, CMS employee training on best practices for contractor and procurement management, rules and procedures will be updated and expanded.

About 360,000 people had enrolled in private plans through exchanges through mid-December. The Obama administration has put the number of potential insurance recipients under the ACA at 7 million.

According to a Gallup poll, Americans last month were slightly less negative about the law. While 51% disapproved of the statute, more than two in five (41%) expressed approval.


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