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Health care site improving, but still much to be done

Nov. 29, 2013 - 06:00AM   |  
By KELLY KENNEDY   |   Comments
US President Barack Obama speaks on immigration reform at Betty Ann Ong Chinese Recreation Center in San Francisco, California, on November 25, 2013. AFP PHOTO/Jewel Samad (JEWEL SAMAD / AFP)


WASHINGTON — The White House is expected to announce this weekend that is now operating smoothly, meeting its Saturday deadline by adding enough capacity for 50,000 people at a time and 800,000 people a day.

But that does not mean the work is done, or that the site is fully functional.

"The site is better today than it was on October 1," said Julie Bataille, during a briefing for reporters Wednesday.

She said Dec. 1 is not a relaunch and "does not represent a magical date," but the site is expected to work smoothly for "the majority of users."

But after such a rocky launch of the federal health insurance exchange site, what will it take for the White House to declare success?

On Wednesday, the administration announced a one-year delay in online enrollment in plans for small business owners. Republican leaders, including House Majority Leader Eric Cantor, R-Va., and Speaker John Boehner, R-Ohio, promptly issued statements saying the delay showed the whole Affordable Care Act should be scrapped.

But Stan Dorn, a senior fellow at the Urban Institute, said much of the political pressure is unfair. It's a joint federal-state cooperative, and it takes a lot of work, he said.

"You don't just snap your fingers and make it happen," he said. He cited the Children's Health Insurance Program, saying it took six years to ramp up, but 90% of those eligible for coverage are now enrolled.

"It would be great if the political decision-makers could take a deep breath and say, 'We need to be patient,' " he said. "That doesn't mean there's something wrong with the policy; we're just living in the real world."

To be a success, consumers need to feel like they had a good experience enrolling, he said. And for the enrollment process to be a success politically, everyone needs to know that people are no longer encountering major problems at the website.

“Marketing is going to be important,” Dorn said. “But on the other hand, negative publicity is publicity.” Recent polls have found that more people are familiar with the health exchanges because of the problems the website has had.

Even with the front-end, consumer element of the website working smoothly, Dorn said, there are concerns about the back-end code. During testimony to the House last week, Henry Chao, chief information officer for CMS, said 30% to 40% of the “back-office systems” — accounting and payment functions — still needed to be completed.

Bataille said that portion of the site should be complete by mid-January. Dorn said delaying the back-end development of insurer-related code was a decision the administration made so it could focus on consumers.

“If the insurers get their paperwork a little bit later than planned, that’s not the end of the world,” he said.

David Howard, associate professor at Emory’s School of Public Health, said he’s concerned people will find they haven’t actually been enrolled, even though the consumer portion seems to be working well. “If it were all a matter of the consumer website working, the Obama administration would already be proclaiming victory,” he said.

Instead, he said insurers are getting bad data and much of the paperwork is being done by hand at the back end — or where the government makes sure the insurer gets paid.

“If enrollment picks up, that will be impossible,” he said. “We’ll know if it’s actually working when people show up at their doctor’s office in January and find out they’re actually insured.”

Assuming all goes well, Dorn said, as few as 2 million enrollees — rather than the Congressional Budget Office projection of 7 million — could be enough to make the federal exchange work. Hundreds of thousands have enrolled because of Medicaid expansion in the states that chose to do so.

“Everyone’s been trumpeting this 7million target,” he said. “I think they can fall well short of it and still be on their way to a very successful program.”

Dan Mendelson, CEO of Avalere Health, agreed that a couple of million people enrolled, rather than 7 million, would be enough to claim “minimum success.”

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