Health care

More last-minute fixes to ObamaCare to avoid net loss of uninsured Americans by Jan. 1

FILE: Nov. 6, 2013: A patient care coordinator at AltaMed, speaks to a woman during a community outreach on Obamacare in Los Angeles, Calif.

FILE: Nov. 6, 2013: A patient care coordinator at AltaMed, speaks to a woman during a community outreach on Obamacare in Los Angeles, Calif.  (REUTERS)

The Obama administration’s announcement this week that Americans with cancelled insurance can enroll in bare-bone ObamaCare coverage reflects its urgency to ensure that by January 1 the total number of people with polices doesn’t decrease and to avoid another black eye in implementing the law.

The announcement Thursday was just one of several by administration officials this week that shows they are drawing closer to enrolling enough Americans to offset the estimated 4 million to 5 million who had their insurance cancelled because it failed to meet new standards in the president’s signature health care law.

Obama said Friday that more than 1 million people have enrolled since the Oct. 1 launch, after the administration said a day earlier that 3.9 million lower-income Americans have qualified for ObamaCare through the law's Medicaid expansion.

“That is a big deal,” the president said in announcing the new enrollment numbers.

The numbers show the administration could indeed close the enrollment gap, after software glitches on the federal ObamaCare website and some state-run ones resulted in a very slow start.

However, several underlying problems persist, including the accuracy of the numbers and how many of those enrolled have in fact paid for their policies.

The administration earlier this month asked insurance companies to backdate coverage for those who failed to hit the Dec. 23 enrollment deadline and accept partial payments by the Dec. 31 pay deadline, which along with other last-minute changes make clear how difficult the ObamaCare rollout has been for most everybody. But the 2010 health care law states that enrollees must pay by Dec. 31 to get coverage starting New Year’s Day.

Another major concern is the government has and purportedly continues to send insurers inaccurate enrollee information, which could create the biggest problem of all for the administration if people arrive at a pharmacy counter or doctor's office only to be told they're not in the system.

On Friday, President Obama downplayed his decision to allow bare-bone, or so-called catastrophic coverage, for the estimated 500,000 Americans who have yet to replace their cancelled insurance, and not penalize them for failing to get insurance, suggesting the change is a net to catch a small number of people who may slip through the cracks.

However, critics of the health care law blasted the change.

“The whole [of ObamaCare] was to get rid of sub-par insurance,” Robert Moffit, director of the Heritage Foundation's Center for Health Policy Studies, told on Friday. “Now you’ve got to get sub-par insurance to escape the mandate. … You couldn’t make this stuff up.”

The 1 million enrolled on the federal site and the state-run ones through the first three weeks in December compares to the mere 365,000 who had signed up through November 30, when major fixes to the sites largely were completed.

Crossing the 1 million mark was a milestone, but the administration's own estimates called for 3.3 million to enroll by Dec. 31. The target now is 7 million by the end of open enrollment on Mar. 31.

Still, was down for part of the day Friday, as technicians attempted to fix an error that occurred Thursday night when the site was undergoing routine maintenance, officials explained.

The administration cannot afford for the balky website to crash this weekend. Because of Monday's deadline to sign up so coverage can take effect Jan. 1, unusually heavy traffic is expected on the federal site and those run by states.

While still tinkering with the federal site, the administration now faces crucial deadlines within a two-week stretch.

The last day to sign up for coverage to take effect with the new year is Monday. And Jan. 1 is the day the people can start using their new policies. Starting then, the law forbids insurers from turning away people with pre-existing medical conditions. The law's mandate that virtually all Americans carry coverage also goes into place, although uninsured people can avoid a tax penalty if they pick a plan by Mar. 31.

The risk now for the administration is that ordinary people with pressing medical needs will suffer harm if the transition to coverage is fumbled. And if that happens, Health and Human Services Secretary Kathleen Sebelius will face a new round of demands for her resignation.

"Implementing the website is the relatively easy part," said Mark McClellan, who oversaw the problematic rollout of the Medicare prescription drug benefit for President George W. Bush. "Implementing the coverage itself involves a lot more things that could go wrong, and there's a lot more at stake.”

The Associated Press contributed to this report.