The rampant glitches that have plagued the federally-operated health insurance marketplace have been the focus of a lot of political heat. It's prompted Health and Human Services Secretary Kathleen Sebelius to fire back with a full-throated defense of the law that created the exchanges, the Affordable Care Act.
THE PROBLEM
The exchanges, or online marketplaces where people can compare and buy health insurance if their employer doesn’t offer it, opened October 1. They were immediately overwhelmed. Software problems, the inability of computer systems to talk to each other, and the sheer number of people trying to log onto the website left many Americans unable to even get into the site.
THE CRITICISM
Ten days later, Kansas Senator Pat Roberts demanded changes.
“Enough is enough," he said. "Today, I am calling on Kathleen Sebelius to resign her post as Secretary of Health and Human Services. Secretary Sebelius has had three-and-a-half years to launch Obamacare, and she has failed.”
States that created their own exchanges have had far fewer problems than the 35 states—including Kansas—who opted to rely on the federal exchange. Roberts is one of several Republicans who say Sebelius has not adequately addressed what went wrong, and how to fix it.
“The problems with the exchanges are critical, and they’re profound…and indisputable," he said. "And yet, Secretary Sebelius is not shooting straight with the American people. The system is crashing, but she continues her promotional tour, and advertising—at taxpayer expense. This is ridiculous. Americans are tired of this spin.”
Roberts capped his presentation with a sports analogy.
“When the team has a losing record, and the stakes are high, the team owners demand a new coach,” he said.
THE REBUTTAL
Sebelius had a sports metaphor of her own.
“Now, in football terms, we’re early in the first quarter," she said. "While our opponents want to declare game over, I’m confident that by the end of open enrollment we will have millions of Americans and thousands of Kansans with health security they never thought possible.”
Sebelius’ comments came in the form of an address to Kansans, posted on her agency’s website.
“There’s no doubt that the October 1 launch of the marketplace website was very frustrating," she said. "Many improvements have already been made in the last two weeks, and more are coming. But to be clear, no one has lost their chance to enroll for coverage in their early days, and no one is losing health benefits.”
FOCUSING ON THE POSITIVE
Sebelius says people will have more benefits—including seniors on Medicare, and the 86 percent of Kansans who get insurance through their employers, so they don’t need to use the exchange.
“You now have an annual wellness visit, as well as access to preventive care, like cancer and cholesterol screenings, with no co-pays," she says. "Meanwhile, costs are being held down in an historic fashion. In fact, across the country the growth in healthcare cost has been constrained to the lowest rate in nearly 50 years.”
Sebelius says the new law is even more important for the 327,000 Kansans who currently don’t have health insurance, and for those who buy their coverage through the individual market.
“Now, Kansans can choose between multiple insurance companies who have to compete for your business, based on price and service," she says. "And the rates in our state are significantly lower than predicted—and they’re also lower than rates in most parts of the country. No one will be denied health insurance because of a pre-existing condition, which happens every day in the individual market today, and women will no longer be charged more than men just because of their gender.”
LINGERING QUESTIONS
Sebelius addressed questions about the need for the individual mandate—the part of the law that says virtually everyone must buy health insurance, or pay a penalty.
“Let me give you just one example from Dr. Roy Jensen, of the University of Kansas," she says. "If you’re uninsured, and diagnosed with cancer, the research shows that you’re 60 percent more likely to die within five years than if you have health insurance. The truth is, we’re all just an accident of unexpected diagnosis away from a devastating medical bill if we don’t have health insurance.”
Of course, that’s all irrelevant if people aren’t able to complete the enrollment process between now and March 30.
HOW TO DECIDE WHAT'S RIGHT FOR YOU
Cathy Harding heads an organization helping to train and deploy so-called “navigators” to help people choose and buy the coverage they want. She says one of her navigators finally got someone completely through the process last week.
“Well, I think it means they’ve made improvements already, for sure," she says. "I think part of the initial problem was just the sheer volume of people trying to access the online forms. They were clearly overwhelmed, and, you know, that’s eased off a little bit because time has gone by.”
WHAT'S NEXT?
At this point, neither the Obama administration, nor the insurance companies selling their products to Kansans will say how many people have actually purchased insurance through the new system so far.
Harding says more than 80 navigators have been trained and certified, and another 140 are still involved in the process. As they come on board to offer assistance, and the kinks get worked out of the computer systems, Harding expects the pace of enrollment to pick up.