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 The Centers for Medicare and Medicaid Services (CMS) has not yet
finished building the part of the website that would transfer
billions of dollars in subsidies for plan premiums and cost-sharing
payments to insurance companies.
It is part of a long technical to-do list that has so far focused on
fixing the errors and lag times in the part of the website used by
consumers.
The administration recently overhauled HealthCare.gov after its
botched launch two months ago. The fixes are now expected to allow
millions of Americans to shop for insurance.
The health care program faces a critical test to enroll hundreds of
thousands of people by December 23, the deadline for people who need
insurance coverage starting on January 1, 2014.
Julie Bataille, a spokeswoman for CMS, said the government will make
the payments to insurers for premium tax credits and cost sharing on
time.
"We are committed to making sure they get paid in January and we
will continue to work with them on that process," she told
reporters.
The administration is planning a "workaround" for payments, said
Daniel Durham, vice president for policy and regulatory affairs at
America's Health Insurance Plans.
Health plans will estimate how much they are owed, and submit that
estimate to the government. Once the system is built, the government
and insurers can reconcile the payments made with the plan data to
"true up" payments, he said.
"The intent is to make sure plans get paid on time, which is a good
thing," Durham told Reuters.
The fix puts an additional "burden" on insurance companies, already
taxed by having to double-check faulty enrollment data from the
HealthCare.gov system.
Now, companies need to quickly put together financial management
systems to make the payment estimates, so they can be paid beginning
in January, he said.
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"They have to recognize that plans are already quite stressed and
introducing this at the last minute just adds substantial burden for
plans to deal with," Durham said.
Paying insurers on time and accurately is critical for the long-term
competitiveness of Obamacare marketplaces, said Kevin Lucia, senior
research fellow at Georgetown University's Health Policy Institute.
"I'm pretty deeply concerned about this," Lucia said at a forum
organized by the university and law firm Arent Fox.
Some large insurance carriers could "cushion" delayed payments for a
short period of time, said Lucia, a former CMS official. But that's
not the case for a group of co-ops and smaller insurance providers.
About two-dozen co-ops will start up with their first customers on
January 1 and have said they are concerned about how enrollment
delays are affecting their finances during the first quarter.
Small insurers also have a lot at stake as these new anticipated
members are expected to make up a bigger portion of their total
revenue. The individual business is only a small part of revenues at
large insurers, which focus on employer-based coverage and private
Medicare.
"They cannot survive if they don't get paid. And even the larger
carriers, it can only go on for so long," Lucia said. "The last
thing we need is for a carrier, especially a large carrier, to walk
away from this." [By Roberta Rampton and Caroline Humer]
(Editing by Christopher Wilson)
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