New challenges for O-Care’s second year

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The Obama administration is facing new challenges in ObamaCare's second year. 

The health insurance exchanges are set to re-open for enrollment in just two months. This countdown has the White House and federal health officials bracing to see if the system encounters any fresh technical problems. 

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The whole team is focused on avoiding the chaos of last year, when HealthCare.gov, unable to handle even a small number of users, floundered for months. 

Now, after a full recovery for the site, the administration has much to boast about the healthcare law. The exchanges surpassed 8 million enrollments, bringing down the rate of uninsured Americans. 

In their second year, the marketplaces are attracting more insurance companies. There is even evidence that key plans — like the benchmark second-lowest-cost silver plans — are decreasing in price around the country. 

But that doesn't mean all is well. Federal health officials acknowledged on Sept. 4 that HealthCare.gov was hacked this summer. Parts of the online system have still not been tested by the public. And many consumers are likely to see their premium costs rise this year. 

Here are five key questions for the administration as it plans its healthcare strategy for the fall: 

 

1) Is HealthCare.gov ready? 

The federal government's online exchange underwent significant repairs after stumbling out of the gate. 

It took new contractors, round-the-clock work and even a "tech surge" from Silicon Valley, but HealthCare.gov ultimately exceeded its enrollment goal this spring. 

Still, news that the site was hacked in July points to at least some vulnerability in the site's security. 

Top Department of Health and Human Services (HHS) officials have also said that the back end of the site remains unfinished. And the online marketplace for small business coverage ("SHOP") is debuting for the first time in November.

HHS says it is taking extra steps to ensure a smooth performance, like beta-testing the SHOP exchange in five states starting next month. 

The federal exchange will also renew people's coverage automatically unless they choose to shop again. But there is still the risk of political fallout if the system encounters problems. 

"It would create enormous perception problems if there are technical glitches during open enrollment," Kaiser Family Foundation Senior Vice President Larry Levitt wrote on Sept. 3. "The top priority should be making sure that the HealthCare.gov website functions … there's little margin for error." 

 

2) Are three months enough? 

Consumers have much less time to buy health plans on the exchanges this year. Instead of roughly six months like the first time, 2015 open enrollment is only three months long. 

This raises pressure on the Obama administration and its partners in the healthcare industry.

The government is already coping with less money to market the exchanges, and insurers are not expected to blitz the airwaves this year with quite as much vigor. 

"In some respects, it's going to be more complicated,” newly appointed HealthCare.gov CEO Kevin Counihan recently told the New York Times

"Part of me thinks that this year is going to make last year look like the good old days," he said, citing concerns about the shorter timetable. 

 

3) What are consumers hearing? 

Debate about ObamaCare has quieted significantly in the media since the exchanges came back from the brink of disaster. 

The administration has also benefited from a wave of good headlines about new insurers joining the exchanges and mostly modest premium hikes. 

But the Affordable Care Act remains unpopular with most of the public, and political ads that criticize the law far outnumber those than support it this election cycle. 

Consumer advocates have urged the administration to tout the law more aggressively and to encourage policyholders to comparison shop to avoid paying higher prices. 

"Effective communication to enrollees and consumer assistance will be key to helping people understand their options," the Kaiser Family Foundation said in a study released Sept. 5. “Many enrollees may be able to lower their premiums substantially by switching plans." 

Groups have also called for more campaigns targeting low-income people who typically have lower rates of health insurance.

 

4) What about cancelled plans? 

The administration has long dealt with controversy over health plans canceled because of ObamaCare. 

But the challenge is taking a different turn as hundreds of thousands of new enrollees struggle to verify their eligibility for the exchanges. 

HHS warned those consumers that unless they sent adequate citizenship and immigration documents by Sept. 5, their coverage would be canceled at the end of the month. 

This sparked a backlash from immigration advocates and some political leaders concerned that eligible policyholders are being kicked off the system because of poor federal record-keeping. 

"The president should suspend this requirement so that no American citizen loses their health insurance due to a bureaucratic requirement," Florida Democratic gubernatorial candidate Charlie Crist said in August. 

 

5) Who will take the fall for problems? 
 
Many people expected heads to roll at the Obama administration after last fall's botched rollout of HealthCare.gov. 

But it took until the spring of this year, once the healthcare law's rollout had improved, for then-HHS Secretary Kathleen SebeliusKathleen SebeliusRomney: Trump victory 'very possible' Fighting for assisted living facilities The chaotic fight for ObamaCare MORE to resign. 

Her successor, Sylvia BurwellSylvia Mathews BurwellOvernight Healthcare: McConnell unveils new Zika package | Manchin defends daughter on EpiPens | Bill includes M for opioid crisis Insurance executives ask for changes to ObamaCare Obama meets with insurance CEOs on health law MORE, is known for hands-on management and has already shaken up the leadership team at HHS to prepare for round two of open enrollment. 

Burwell also centralized control of HealthCare.gov by creating a new CEO position and naming Counihan to fill it. 

Management experts have praised this as a smart move, noting that any problems with the site will lie squarely on his shoulders. 

Having someone to fire, even if the possibility is slim, is not a bad thing, they said.