Democratic lawmakers question move to shut down HealthCare.gov during open enrollment

Rep. Elijah E. Cummings (D-Md), the Ranking Member of the House Committee on Oversight and Government Reform, and Rep. Raja Krishnamoorthi (D-Ill), the Ranking Member of the Subcommittee on Health Care, Benefits, and Administrative Rules, are pressing the Trump Administration on its apparent decision to shut down HealthCare.gov during the upcoming open enrollment season.

Earlier, the Trump Administration announced that it would conduct maintenance outages from midnight to noon Eastern Standard Time on all but one Sunday during the upcoming open enrollment period and that it would shut down HealthCare.gov on Wednesday, November 1, 2017, the first day of open enrollment.

Why wasn’t the work done earlier? On September 29, the Congressmen sent a letter requesting documents and information relating to the decision by the Department of Health and Human Services (HHS) to schedule outages of the website at that particular time. Cummings and Krishnamoorthi pointed out that HHS has had the entire year to conduct routine maintenance without any disruption purchasers of healthcare plans through HealthCare.gov during the open enrollment period. Moreover, this year’s open enrollment period was reduced from 90 days to 45 days. And prior enrollment periods that lasted twice as long reportedly required fewer maintenance outages, according to the lawmakers.

Cumming and Krishnmoorthi also noted that there were earlier reports that the Trump Administration has withdrawn funding for open enrollment advertising and outreach as well as for the ACA’s Navigator program.

After the House of Representatives failed to repeal the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) in March, President Donald Trump argued that “the best thing we can do politically speaking is let Obamacare explode.”

Questions. Cummings and Krishnamoorthi requested documents and communications to address several questions, including:

  • What technical issues warrant shutting down HealthCare.gov during this year’s open enrollment period, and when were they identified?
  • What steps is the HHS taking to ensure that people are fully informed of when these outages will occur?
  • When were you made aware of the days and times for the scheduled website downtime during this year’s open enrollment period?
  • How was the decision made to shut down the website on Sundays from midnight to noon?
  • What alternatives to scheduled outages were considered? What, if any, consideration was given to the website traffic during that period in other time zones?

“Unfortunately,” the lawmakers wrote, “in addition to undermining the ACA, the Trump Administration’s recent actions may harm many Americans who are seeking to obtain health insurance to protect themselves and their families.”

Kusserow on Compliance: GAO reported continued fraud vulnerability under the Affordable Care Act

The Government Accountability Office (GAO) issued a report that the Affordable Care Act (ACA) marketplaces remain “vulnerable to fraud,” after the agency successfully applied for coverage for multiple fake people, who hadn’t filed tax returns for 2014 but were still able to get tax credits to help pay their monthly premiums for 2016 coverage. The GAO engaged in testing by using undercover attempts to obtain health-plan coverage from the federal marketplace and selected state marketplaces for 2015. The tests found the federal marketplace and selected state marketplaces approved each of 10 fictitious application for subsidized health plans. All 10 were approved, even though eight of these 10 fictitious applications failed the initial online identity-checking process.

Four applications used Social Security numbers that were never been issued. Other applicants obtained duplicate enrollment or obtained coverage by claiming that their employer did not provide insurance that met minimum essential coverage. Three of GAO’s applications were approved for Medicaid, although GAO provided identity information that would not have matched Social Security. For two applications, the marketplace or state Medicaid agency directed the fictitious applicants to submit supporting documents, and GAO provided fake information that resulted in the applications were approved. A third marketplace did not seek supporting documentation, and the application was approved by phone. CMS, California, Kentucky, and North Dakota, advised the GAO that they are only inspecting for supporting documentation that has obviously been altered; otherwise documentation submitted would not be questioned for authenticity.

Richard P. Kusserow served as DHHS Inspector General for 11 years. He currently is CEO of Strategic Management Services, LLC (SM), a firm that has assisted more than 3,000 organizations and entities with compliance related matters. The SM sister company, CRC, provides a wide range of compliance tools including sanction-screening.

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Copyright © 2016 Strategic Management Services, LLC. Published with permission.

Marketplace deductibles down, cost-sharing for common services low

Health coverage from the marketplace covers, on average, seven common health care services other than preventive services with no or low cost sharing before policyholders meet their deductibles. Additionally, the median individual deductible for HealthCare.gov policies went down $50 from 2015 to 2016, according to a CMS Data Brief. The brief looked through data on marketplace plans and discussed the numbers showing that health insurance is more affordable for consumers than it was before passage of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148).

The Data Brief noted that 60 percent of marketplace consumers qualified for financial assistance to reduce deductibles, out-of-pocket maximums, and other cost-sharing obligations in 2016. It also found that consumers are overwhelmingly choosing silver plans, with higher premiums and lower cost sharing, over bronze plans. Over all, approximately one-third of marketplace enrollees have deductibles less than or equal to $250.

All marketplace plans cover preventive care like cancer screenings and immunizations without cost sharing; however, the Data Brief shows that most HealthCare.gov policies also cover common health care services either without cost sharing or with low copayments, even if the yearly deductible has not been met. The main services accounting for this finding are primary care visits and prescription drugs.