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Should healthcare law's individual mandate be de delayed as glitches persist?

SEBRING - Navigators at Central Florida Healthcare, a three-county healthcare nonprofit group, have helped about 350 Highlands County residents apply for healthcare coverage since the Affordable Care Act's open enrollment started Oct. 1. Most of the applications have been filled out on paper, said Central Florida's PCMH Navigator Supervisor Ermelinda Centeno, partly because some parts of the federal healthcare.gov web site are still facing glitches and also since most residents have expressed a preference for paper applications. "The web site is working slower than anticipated," she said. "But a lot more people want to do paper applications." Recently, the Obama administration extended the deadline for signing up for coverage without facing a penalty to March 31, 2014, the end of the open-enrollment period, in response to massive technical issues with the federal web site.
What also has been reportedly delayed to late November is the launch of the federal government's new health insurance marketplace for small-businesses, SHOP. Paper applications can, however, be mailed in. Centeno explained there are four parts to signing up online. Parts 1 and 2 allow people to enter their personal information and give them a rough idea of what subsidy they may receive -- based on their income and family size -- and what kind of premiums they may pay. The first two parts are available to subscribers on the federal web site, but the third and fourth parts -- where subscribers find out their payment amounts and options and choose a method to pay -- are down, Centeno said. So far, Centeno has not managed to help anyone complete the process and actually purchase coverage, but has set up appointments for people, who she is expecting will be receiving back enrollment information, so they can go ahead and sign up. It's expected to take four to six weeks for the exchanges to provide people with paper applications the plan choices and prices, she said. In Highlands County, Blue Cross Blue Shield is the only company offering insurance on the health exchange but subscribers can choose from multiple plans in four metal categories --platinum, gold, silver and bronze-- along with a high deductible, catastrophic health coverage plan for those 30 and under. To avail of a subsidy, either with the monthly premium amount or a cost sharing reduction with out-of-pocket expenses, subscribers have to choose at least a silver plan and have to obtain insurance through the health exchanges. There is some "gray area," however, in connection with subscribers who may have otherwise been eligible for expanded Medicaid but can't avail of it in states such as Florida, which chose not to expand its Medicaid, Central Florida's Clinical Operations Manager Gregory Okwengu said. These subscribers can buy insurance from the exchanges but have to pay full price. They won't have to pay a penalty, however. Meanwhile, new Medicaid enrollment "is far outpacing new insurance customers under Obamacare so far, a subtle sign that the program could play a greater role in the law's coverage expansion than first anticipated," politico.com states. Some people are signing up for the Medicaid expansion created by the president's health law. Others were already eligible for their state's current Medicaid program, but until this outreach campaign about health coverage, they had never signed up, the report adds. Highlands County Republican Party Chairwoman Kathy Rapp sees this as a troubling sign, saying it may mean that down the road those states that opted for Medicaid expansion may have to ultimately shoulder the cost of providing health care after federal assistance phases out. Eventually, how the numbers of new Medicaid recipients vs. new private policy holders play out remains to be seen. The government has promised to reveal enrollment figures sometime in November and more than four months remain before open enrollment ends. Even though the government has promised to get the federal web site full up and running by the end of November, people such as Rapp feel the individual mandate should be delayed for a year, especially since security issues raise major new concerns on top of the long list of technical problems. The Associated Press recently obtained a document that revealed that the troubled website was granted a temporary security certificate on Sept. 27, just four days before it went live on Oct. 1. The memo said incomplete testing created uncertainties that posed a potentially high security risk for the website. It called for a six-month "mitigation" program, including ongoing monitoring and testing. On Capitol Hill Wednesday, Health and Human Services Secretary Kathleen Sebelius countered that the system is secure, even though the site's certificate, known in government parlance as an "authority to operate," is of a temporary nature. A permanent certificate will be issued only when all security issues are addressed, she stressed. Spokeswoman Joanne Peters added separately: "When consumers fill out their online ... applications, they can trust that the information they're providing is protected by stringent security standards and that the technology underlying the application process has been tested and is secure. Security testing happens on an ongoing basis using industry best practices." Rapp said employers got a year's extension, and it is only fair that average Americans also get the break. "Both Democrats and Republicans should put politics aside," she said. "This (Obamacare) is the law. Let's get it right. It's going to fail or succeed on its own merit." Highlands County Democratic Party chairman Dave McCarthy said calls to delay the individual mandate are premature right now and people should be patient. The penalty provision may have to be delayed, he reasoned, but only if the fixes are not in place by a certain time. Dr. Bruce Borkosky, who is a certified applications counselor for the health exchanges, has not managed to help anyone because the federal web site is "up and down." He said while the subsidies and the changes to requirements for insurance plans should remain intact, he is not opposed to extending the individual mandate. The Affordable Care Act requires plans to cover certain benefits, such as maternity care, hospital visits and mental illness. The law also caps annual out-of-pocket costs consumers will pay each year. "I think those are good things, such as women's health care, no pre-existing conditions, and screening tests paid at 100 percent. Overall, those changes will improve the health of Americans," he said. Borkosky did manage to file his own application for health insurance, after several frustrating attempts. His experience with the online chats and phone help have been "most unsatisfying." "The 'helpers' merely select from a list of pre-written paragraphs, and then they read that paragraph to you, like they were in third-grade," he wrote in an email. "It seems to matter little whether the selected paragraph solves or even addresses your problem. Although I've asked them to stop 'reading at me', and talk to me like another human being, they seem to be required to read to callers." The website had no information about enrolling into a plan, he said, but he eventually figured it out after many attempts. "The 'letter' they sent to me said 'next step: enroll in a plan.' For weeks, the phone assisters read the 'glitches' paragraph to me. Come to find out, after about a dozen calls, they were waiting on verification of income," he wrote in an email. "Although I was told I could upload it, and the instructions said to upload a document to the website, it appears that this part of the website has never been programmed, because it doesn't exist! After a few more calls, I found out I have to mail it in...." Central Florida Healthcare navigators are helping both walk-ins and those who have set up appointments and are even taking questions over the phone, Centeno said. By the end of March, the group hopes to have counseled at least 5,000 people in Highlands, Hardee and Polk counties and will continue to assist residents with other things, such as how to pay light bills and rent, after enrollment ends, Okwengu said. "Our navigators have to do something," after open enrollment ends, he said. Despite the glitches, Okwengu said people they have helped have appeared interested in obtaining health insurance. "We've had a positive response," he added. The Associated Press contributed to this report.