22,000 Americans have filed formal complaints with the federal health-care exchange, HealthCare.gov, because they say there’s something wrong with the plans they’ve bought: They’re being overcharged, they got the wrong insurance, or they couldn’t enroll at all. According to the report in the Washington Post, thousands more have called the federal exchange about problems, too, so the 22,000 electronic error reports is low-ball number. Unfortunately, for now, there is literally nothing that the online exchange can do about this problem:
The roughly 22,000 people who have appealed to date have filled out a seven-page form and mailed it to a federal contractor’s office in Kentucky, where the forms are scanned and then transferred to a computer system at CMS. For now, that is where the process stops. The part of the computer system that would allow agency workers to read and handle appeals has not been built, according to individuals familiar with the situation.
The story describes one enrollee whose insurance was ending at the end of December 2013. She was repeatedly quoted the full price of exchange insurance, when she knew she was supposed to be eligible for subsidies. She was told by customer-service representatives to go ahead and buy the full-priced insurance, and take up the issue later — now there’s no way for the problem to be addressed. Whether the people telling her just to sign up anyway might have known she wouldn’t have a mechanism for redress right away is unclear.
But it is clear that some of the bureaucracy running the exchanges, the Centers for Medicare and Medicaid Services, did know. Attorneys with a health-care-reform nonprofit wrote to CMS in late December, the Post reports, saying the following: ”There is no indication that infrastructure . . . necessary for conducting informal reviews and fair hearings has even been created, let alone become operational.”
Serious glitches and huge gaps in the federal exchange’s infrastructure have affected people trying to use it because the Obama administration was unwilling to delay the implementation of the law, for practical and political reasons, when they discovered the exchange was far from being ready (why the project wasn’t close to being done on time is another, more complicated question). But stories like the ones in the WaPo piece also point to another reason why the launch just had to go ahead: Unless the entire law could have been delayed, with the universal cooperation of insurance companies and state insurance commissioners, a lot of people’s plans were going to end on December 31 who needed or wanted to get onto the exchanges. That reveals two things about the law: One, it was basically too disruptive to existing systems to trust federal contractors to fill in the gaps, and two, the exchanges are as much about receiving people from the existing individual market as they are about covering the uninsured. For the uninsured, there was no particular need for the exchange to open October 1, and for the plans, which have had their own implementation problems, to begin January 1. But because the law was kicking people off their plans and raising premiums substantially, CMS told the currently insured on the individual market whatever they had to in order to get them to sign up for the exchanges. This creates horror stories like the one above, where they led a woman to pay a much more expensive premium than she’s supposed to under the law, in order to avoid an even worse story (that is, the law leaving entirely uninsured someone who had insurance before it was implemented).