Health Reform Off to Rocky Start

By Beacon Staff

Christine Neater arrived at the library in downtown Kalispell last Wednesday ready to help residents shop for insurance under the nation’s new health care law.

But the HealthCare.gov website was down.

Neater, a counselor with Flathead Community Health Center trained to help people navigate the intricacies of the Affordable Care Act, answered any questions she could about the sweeping changes in the health care system. But when it came to the fundamental part — using the online marketplace to actually enroll residents — Neater was rendered helpless like millions of other Americans.

“It is causing struggles,” she said of the persistent technical glitches that have blocked people from signing up for insurance and led the first four Kalispell residents at Neater’s information session to leave frustrated.

“It would be wonderful if we could just go into the website and answer the questions and get the results for what they’re eligible for and enroll. That’s how the website is designed to work, but we’re just patiently waiting for that.”

These are the troubled opening days in a new era for health care in the U.S.

Nothing has come easy for the historic overhaul, from its narrow passage into law three years ago to fiery opposition that remains entrenched to a close call with the U.S. Supreme Court.

The latest chapter is no less tumultuous.

A month after launching and two months before taking effect, the federal government’s online marketplace that 36 states including Montana rely on for enrollment is still consistently crippled by technical issues.

Concerns have also spiked over canceled health plans for existing individuals and small businesses that buy their own insurance.

GOP lawmakers are seizing on the moment to prolong their attack on the ACA, while President Obama is pointing out the emergent benefits that are beginning to materialize for millions of Americans.

Indeed, the biggest change to the U.S. health care system in nearly 50 years is playing out in dramatic fashion.

The most recent turmoil is centered on website malfunctions and canceled health plans for a segment of those with private insurance.

Beginning Jan. 1, all insurance plans must meet new standards under the ACA. Insurance companies are required to remodel private policies by covering a minimum share of health care expenses and 10 “essential health benefits.” Those benefits include emergency services, prescription drugs, maternity and newborn care, mental health and substance use disorder services, hospitalization such as surgery and pediatric services.

Insurance companies have begun sending notices to an estimated 10-15 million Americans informing them that their existing plans will be canceled. Customers will be offered new plans, often with better coverage, but in some cases, the president has acknowledged that “a fraction of Americans with higher incomes” will likely pay more.

In Montana, Blue Cross Blue Shield, the state’s largest health insurance provider and one of three companies offering plans on the state’s marketplace, mailed roughly 13,500 letters to customers affected by private policy changes.

“We are not dropping insurance for our members. We are merely altering our plans,” John Doran, a spokesperson with Blue Cross Blue Shield, told the Beacon.

“Some of our members are being notified that their current benefit plan will no longer be available after Dec. 31 of this year, but they will have other coverage options to choose from.”

There is, in fact, one change taking place specific to Montana. Nearly three decades ago, the state Legislature created the Montana Comprehensive Health Association to help residents who could not obtain insurance through traditional means. For example, people with cancer or other diseases deemed high risk could be denied insurance, but through the MCHA, Blue Cross Blue Shield offered coverage.

Now that no one in America can be denied insurance under the ACA, the MCHA is disbanding Dec. 31.

Doran said roughly 3,500 people are covered under the MCHA and will need to purchase new plans in the marketplace.

“They have a number of new safeguards that have historically only been provided by employer-based insurance,” Doran said. “And by purchasing a health insurance plan through the marketplace they will most likely have a better plan at a much more affordable cost.”

In light of the ongoing technical problems plaguing the online marketplace, Doran urged residents to remain patient and use other resources like Blue Cross Blue Shield’s online calculator that can prepare customers for deciding which insurance plan to choose. Enrollment remains open in the marketplace until March 31, 2014. After that, most Americans who do not sign up for coverage face tax penalties. Residents can also enroll over the phone or by mail, but the HealthCare.gov site is the go-to source for information about insurance plans.

“With any new system of this magnitude, it’s not uncommon for there to be some glitches,” Doran said. “We expected and are prepared for ebbs and flows throughout the entire open enrollment process.”

Meanwhile, the 17 states that opted to establish their own marketplaces have largely avoided the debacle playing out with the federally-run program.

“I think we will see better enrollment in the states that run their own exchanges, and that will play out for years to come,” Dan Mendelson, CEO of Avalera Health, which has been tracking the nation’s insurance marketplaces, told Fox Business last week.

Montana’s insurance commissioner, Monica Lindeen, has taken the opportunity to remind state legislators about her persistent campaign to create a Montana-run marketplace, which she unsuccessfully proposed in the 2011 legislative session; the Legislature opted to go with the federally built marketplace.

Lindeen is now echoing others’ frustration over the troubled website, calling for answers and a solution. She recently traveled to Washington, D.C., to meet with health department officials.

“I want to know what went wrong, what they’re doing to fix it – and when,” she said in a statement. “This website is integral to the smooth operation of Montana’s insurance markets. It’s a lifeline for working families looking for affordable, quality health insurance and it’s important it work correctly as soon as possible. I want answers.”

Appearing on Capitol Hill last week, the secretary of health and human services, Kathleen Sebelius, faced a wave of criticism and apologized profusely for the bungled rollout, taking full responsibility and ensuring that sign-up problems would end by Nov. 30.

President Obama joined in the damage-control effort, expressing regret for the administration’s blunder while reassuring Americans that the historic health care overhaul would succeed. He defended his signature legislation at the same site in Massachusetts — Faneuil Hall in Boston — where in 2006 then-Gov. Mitt Romney signed the state’s reformed health care system into law, creating an eventual model for the Affordable Care Act.

“All the parade of horribles, the worst predictions about health care reform in Massachusetts never came true,” Obama said. “They’re the same arguments that you’re hearing now.”

He added, “We are going to see it through.”

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