Federal Gov’t Working To Address HealthCare.gov Appeals Issues
The Obama administration on Monday said it will convene hearings to address problems U.S. residents are facing while enrolling in health insurance through HealthCare.gov, Reuters reports (Morgan/Cornwell, Reuters, 2/3).
Background on Appeals Issues
According to the Post, internal government data show about 22,000 U.S. residents have mailed appeals forms contending that they were overcharged for premiums, enrolled in the wrong coverage or denied coverage.
Legal experts note that under the Affordable Care Act, U.S. residents are guaranteed due process rights to timely hearings if they believe they have been wrongly denied coverage or subsidies. Consumers are supposed to be able to file an appeal via computer, phone or mail. However, filling out and mailing a seven-page document is currently the only available option.
The appeal forms are mailed to a federal contractor in Kentucky, where they are scanned and transferred to a CMS computer system. The parts of the federal computer system that would allow agency workers to read and handle the appeals have not yet been built, according to sources familiar with the situation. Three individuals, who spoke on the condition of anonymity, told the Post that it is unclear when the appeals process will be fixed because it is not among the Obama administration's top priorities.
Instead, the administration has focused on fixing an electronic payment system for insurers, setting up a system to send enrollment information to state Medicaid programs and establishing a method for individuals to adjust individuals' coverage to accommodate major life changes, such as the birth of a child (Goldstein, Washington Post, 2/2).
CMS, White House Respond
CMS, which declined to confirm the number of pending appeals, said in a statement that a manual appeals process will be created while the automated system is being built. The agency added, "In the meantime, CMS is reaching out to these consumers to provide assistance so they can successfully complete their application without the need to complete the appeals process."
A CMS spokesperson also declined to specify when the hearings could start. However, analysts said the process would have to begin before the health insurance exchanges' open enrollment period ends on March 31 (Reuters, 2/3).
Meanwhile, White House press secretary Jay Carney offered similar assurances, touting CMS' efforts to contact those who have filed an appeal and fixing problems that caused the errors.
Carney noted that only "a very small percentage" of the more than three million people who have already applied for coverage have been affected by the issue. He added that the federal exchange website is now working for "the vast majority of people who use it" and that the administration would "keep at it" ("Healthwatch," The Hill, 2/3).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.