Anything more ambitious, such as a new, national “risk pool” similar to the temporary coverage given those with existing illness starting in 2010, would probably require Congress to pass a new legislation.
“Since Congress can’t agree on big things like debt ceilings and a budget,” said Copeland, “I don’t know how this is going to get solved.”
Q: What’s the worst-case scenario for those unable to sign up?
A: Millions, including those with existing illness, could have trouble getting coverage. The administration may be working on a plan to have consumers contact insurers directly, but some worry they could end up buying the wrong policies if they don’t see the full online menu.
“We have had concerns about direct enrollment,” said Judith Solomon, vice president for health policy at the Center on Budget and Policy Priorities, which supports the law. “Consumers won’t have the full ability to shop in the short term.”
Those who do obtain insurance could have trouble gaining online premium subsidies, which so far are available through the government portals.
If computer breakdowns disproportionately deter the young and healthy from joining the ranks of the covered, insurers could lose money. That could set the stage for premium spikes and the kind of instability in the individual insurance market that the health law was supposed to solve.
Q: What about the law’s safety valves for unexpectedly large claims in the early years?Measures to compensate insurers with high initial expenses are supposed to keep them from making it up with higher prices for the first three years.
A: Because a quick solution for signup bottlenecks seems increasingly unlikely, those buffers could become more important. Even with extremely low first-year enrollments, some experts argue they could keep prices stable until portals are fixed for a smooth launch in 2015.
“In the long run, our view is that the exchanges and the entire ecosystem are going to be fine,” said Bryce Williams, a health benefits and technology consultant at Towers Watson. “But you’d have to talk about a two- to three-year horizon.”
Successful websites and signup efforts in big states such as California and New York will show that the online marketplace can work and should lead to acceptance elsewhere despite short-term problems, said James Morone, a political science professor at Brown University who specializes in health policy.
“Bottom line: No, they won’t be working” soon, Morone said of many marketplace portals. “And double no, they are not going away.”
Q: How badly do Web failures threaten other aspects of the Affordable Care Act?
A: The health law didn’t just offer commercial insurance on the Web. It expanded Medicaid for low-income consumers in states that chose to accept it. Because the programs have years of enrollment experience, Medicaid expansion is progressing better in many states than efforts to expand access to private insurance.
Thu, Nov 14 2013