Monday, November 25, 2013

Bypassing, cont

In prior posts, most recently here, I have explored the possibility that shoppers for health insurance on the ACA exchanges might bypass the still-balky with the help of information-only comparison sites ValuePenguin and HealthSherpa. Customers ineligible for a federal subsidy can already easily get all the information they need on these sites and then enroll directly with an insurer. For those whose incomes entitle them to subsidies, however, the subsidy application has been the roadblock, as it must be submitted directly to the federal government, either through or via phone or print application.

That may be about to change. Kaiser Health News' Julie Appleby reports, "Insurers and the Obama administration are testing fixes to designed to allow insurers and web-based brokers to directly enroll consumers who qualify for subsidies under the health law."  It appears, though that the fixes require insurers themselves to route the customer's application through -- that is, in the 36 states that have forced the federal government to run their exchanges.  Direct insurer processing of the subsidy application is still only an ask:

The biggest challenge getting direct enrollment functioning has been linking insurers and brokers with the information they need to determine consumers’ eligibility for subsidies, including their citizenship status and income verification.

The way that is supposed to work in the 36 states served by the federal website is that consumers who start out on an insurer’s or online broker’s website are automatically transferred to to determine if they qualify for a subsidy, then transferred back once that information is confirmed. Often, that transfer has gotten caught up in the error messages and other difficulties that have plagued the federal website since it opened Oct. 1.

“What they need is a way … to get a subsidy eligibility determination without having to go through the whole rigmarole,” said Dan Mendelson, CEO of Avalere Health, a Washington D.C.-based consulting firm.

Administration officials said last week that steady improvements are being made to, and that waiting times and error messages are well below where they were just two weeks ago. They said they also have made progress in fixing systems designed to let insurers directly enroll subsidy-eligible customers.

While those fixes are still being tested, some industry experts say a better solution might be to allow insurers and brokers to directly connect with the “federal data hub,” the portal through which subsidy calculations are made after applicants’ information is cross checked with several government agencies, including the IRS and Homeland Security.

States running their own online marketplaces already use such a direct connection.
Appleby ends by citing an expert who claims that the federal government will not allow insurers and brokers to access the federal data hub because of security risks. If that is the case, than "direct access" simply means that the insurer might somehow be afforded a less buggy processing of the subsidy application via than individual consumers get from the same source. How does that work? It's not clear that the so-called "direct application" through the insurer, which might stall when the subsidy application is transferred, offers any real advantage to the consumer -- except insofar as the insurer might serve as advocate, possessed of means of pushing the application through that are unavailable to the individual.

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