Administration officials say ObamaCare is ready for its close-up, with enrollment in the newly created insurance “exchanges” set to start on Tuesday.
But the road to the launch has been littered with glitches and setbacks, and in all likelihood the confusion is not over yet. Setting aside the brawl in Congress over the push to defund the law, the sheer task of roughly 16 million Americans selecting a plan from hundreds of options in the coming months is poised to create a national headache.
In the latest delay, small businesses seeking to buy health insurance under ObamaCare will have to wait a couple of months before they can complete the process online, administration officials said Thursday. Small-business owners will be able to go online, compare their options and start an application, but they won't be able to finalize it until sometime in November. That would still allow the firms to get coverage for their employees by Jan. 1.
“So far the White House has issued delay after delay for parts of the law they find inconvenient,” California Republican Rep. Darrell Issa, chairman of the House Oversight and Government Reform Committee, said in response. “However, American families and individuals who will bear the brunt of the law have gotten no such relief.”
Among the biggest concerns is whether Americans will get accurate premium quotes when they go online or otherwise purchase insurance through so-called exchanges, the result of a purported glitch in the federal government software.
The Department of Health and Human Services says it is resolving such issues.
“Throughout months of testing we have worked with insurers to ensure that their plan information displays correctly online when we go live,” the department recently told Fox News. “And we have fully addressed issues as they’ve been raised. We are confident that on October 1, consumers will see accurate premium costs.”
Still, Gary Cohen, a Medicare and Medicaid oversight official, acknowledged last week before a House committee: “We may encounter some bumps when open enrollment begins but we'll solve them."
Part of the problem appears to be determining costs when including federal subsidies for Americans who cannot afford the insurance.
And earlier this week, Colorado and the District of Columbia revealed problems with their online exchanges calculating premium costs when factoring in tax credits.
The computer glitches were first reported by The Wall Street Journal.
President Obama attempted ton Thursday to reassure Americans that the law will go into effect, starting with enrollment Tuesday, despite congressional Republican’s effort to delay or undo ObamaCare. However, he acknowledge there will be problems along the way.
“It's the law,” Obama said at a rally in suburban Maryland. “And like I said, there are going to be some glitches along the way. Every law has hiccups when it’s first starting off.”
All the exchanges will offer five levels of plans from private insurance companies. But how they are runs varies from state to state.
Fourteen states and the District will have their own exchanges, 10 will partner with the federal government and 26 will default to the federal exchange, resulting in variations on expanded Medicaid enrollment and pricing.
In California, for example, the cost of insurance through the state exchange will be at least 14 percent higher for most residents, not including the elderly.
However, in New York, costs will drop roughly 29 percent, largely the result of competition among the private insurers in the exchange being infused into the already expensive regional market, according to a report released this month by the Manhattan Institute for Policy Research.
In addition, only about half of states plan, under ObamaCare, to expand Medicaid, the federal-state insurance for the poor. The Supreme Court ruled in June 2012 that states were not required to do so. The divide is largely along ideological lines, with conservative-leaning states generally keeping their tight eligibility guidelines, with such exceptions as Kentucky.
ObamaCare has already had significant setbacks.
In June, the White House announced it was delaying a major provision -- the so-called “employer mandate” that requires companies with more than 50 full-time employees to provide health insurance or pay a penalty. The one-year delay, officials said, was to give employers more time to prepare.
And in late August, the Department of Health and Human Services informed insurance companies that it would delay for several weeks the signing of final agreements with insurance providers on the federal exchange.
The department did not give a clear-cut explanation for the delay, but suggested it needed more flexibility in working with the companies and to resolve unspecified technical issues.
The estimated 16 million enrolling for coverage for all or part of next year is made up of 7 million buying their own insurance and 9 million enrolling in Medicaid or the Children’s Health Insurance Program, according to the non-partisan Congressional Budget Office.
And Americans who fail to get insurance, with some exceptions, will face a tax penalty.
Another concern is whether the so-called “navigators” -- hired by the administration to help the millions of uninsured Americans and others going to exchanges to shop for insurance -- have been adequately screened and trained to protect Americans’ identification information.
HHS says the navigators, who will not enroll applicants, must be trained and certified and will face federal criminal penalties for violating privacy and fraud statutes.
The administration will spend about $67 million in federal funds for 105 individuals and organizations -- including such groups as Planned Parenthood -- to help Americans navigate ObamaCare.
HHS Secretary Kathleen Sebelius said in announcing the grant winners last month that navigators will be just one of “many resources” available to help consumers understand their coverage options in the marketplace.
However, potential consumers are already wary about Social Security numbers and other personal ID being revealed.
In Minnesota, for example, an employee at MNsure, the state’s online exchange, accidentally distributed confidential information earlier this month on roughly 2,400 insurance agents.
MNsure officials acknowledged mishandling private information, explaining an employee sent an email to the office of an insurance broker that contained Social Security numbers, names, business addresses and other identifying information.
Jim Koester, the MNsure security manager called to fix the problem, said he was unnerved by what happened.
"The more I thought about it, the more troubled I was," he said. "What if this had fallen into the wrong hands? It's scary. If this is happening now, how can clients of MNsure be confident their data is safe?"
The Associated Press contributed to this report.