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June 2012
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STRANDED ACA coverage gaps latest problem-list entry

After a few months of respite, problems with the Obamacare websites appear to be creeping back into the news with regularity again.

A week ago on this page we discussed a backlog in resolving millions of "inconsistencies" in applications in the Obamacare insurance exchanges and the potential problems they present in the areas of fraud, incorrect subsidies, and chaos at tax time.

This week comes a front page story in the Wall Street Journal about thousands of people who have bought or modified insurance on the exchanges, paid premiums, and then found they were not covered due to computer systems not processing the data properly or in timely fashion.

Granted, in percentage terms the numbers are relatively small given that millions have enrolled in the exchanges over the past nine months. But some of the individual accounts are nonetheless unsettling.

The WSJ details the experience of Robert Rolain of Las Vegas, who signed up and paid his first premium last October for a Nevada Health Co-Op plan with coverage to begin March 1. In November a tumor was found on his wife's brain, and doctors suggested surgery. Rolain said he took his wife to an oncologist in March and was astonished to be told he did not have insurance coverage even though he had paid for it.

Rolain said he and his wife postponed the surgery for two months until they finally received notice that his wife was covered. She had surgery May 14 and died June 30.

"She wasn't so far along when they found the spot. Now the doctor said it had spread up the whole left side of her head," Rolain said.

Rolain is now one of 150 plaintiffs in a class action lawsuit filed against the Nevada exchange and Xerox Corp., which helped set it up. The lawsuit contends that thousands of people remain uninsured despite signing up through the exchange and paying premiums.

The WSJ article details similar "coverage gaps" for people who signed up with exchanges in Massachusetts and California, causing people to either delay treatment or pay out of pocket for services that should be covered by insurance. The problems appear to stem from delays in insurance companies receiving information necessary to write coverage from the state exchanges due to technological problems. The WSJ says the Health and Human Services inspector general is examining such operational problems in multiple state exchanges.

Only time will tell whether the coverage gap problem will broaden or improve over time. It stands to reason that many people who are affected may not have discovered the problem yet.

As we have noted in the past, many people who have had private insurance have had their share of coverage issues and disputes with insurers. But such experiences appear to pale in frequency and magnitude to what people are running into with the various glitches and flaws in the Obamacare exchanges.

For those who really think a government-run, single-payer health care system would be better than the current system, these problems should serve as a cautionary tale.

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