The health care law's honeymoon period is over.
For several years, Obamacare provided new benefits: Children could stay on their parents' plans longer, insurance companies couldn't impose lifetime benefit caps, and seniors got extra help in buying prescription drugs. But during the past two months, some consumers have been kicked off plans, and they and others are having to navigate the complexities of health care exchanges.
House Speaker John A. Boehner, Ohio Republican, said Wednesday that more people have been kicked out of their health care plans thanks to recently activated provisions than have been able to sign up in the exchanges — an equation he said underscored the problems with the law.
"When you begin to look at these hundreds of thousands of people, I think what you're going to see at the end of October are more Americans are going to lose their health insurance than are going to sign up at these exchanges," Mr. Boehner told reporters.
Consumers have reported tremendous difficulties in signing up through the federal online portal, HealthCare.gov. That has led Republicans and even some Democrats to urge President Obama to extend the enrollment period and/or delay imposing tax penalties on those who fail to sign up — thus violating the law's "individual mandate" requiring most Americans to get insurance.
As those difficulties emerge, meanwhile, Kaiser Health News reported this week that hundreds of thousands of Americans have received notices from their insurers canceling their policies: 300,000 from Florida Blue and 160,000 from Kaiser Permanente in California, in addition to thousands from other major insurers.
Analysts following the health care law said those are anecdotal figures and there is no way to know for sure whether Mr. Boehner's claim is correct about cancellations outnumbering enrollees.
Professor Timothy S. Jost, a health care law researcher, said Mr. Boehner's concerns should change as people whose plans have been canceled go to the exchanges and, in many cases, find they can get better, cheaper coverage.
"I would not be surprised if it's true that more people are losing the coverage that they have heretofore had than have so far been able to sign up through the exchanges, but I think once the exchanges are fully operational, many of those people are going to see, after the premium tax credits are applied, lower-cost insurance than what they currently have," said Mr. Jost, who teaches at Washington and Lee University School of Law.
In many cases, he said, insurance companies have to cancel policies because they no longer would be legal under the Affordable Care Act's requirements that all plans cover services such as mental health or pharmaceuticals, do not cap lifetime or yearly benefits, and include preventive services.
He said the difficulty for backers of the health care law right now is that the problems with the website are obscuring the benefits.
"Many people are going to be benefited. Unfortunately, so few people are able to get all the way to the end and see that what their premiums are, their benefits are, that's not very apparent to a lot of people right now," Mr. Jost said.
One fear among some analysts is that the problems with signing up, coupled with other factors, would make young, healthy Americans pay the tax penalty instead of buying insurance. That would hurt the economic model that assumes those younger Americans will pay into the system to offset the costs of the older and sicker Americans who will be guaranteed coverage.
The White House is urging consumers to withhold judgment, saying that the benefits to the law eventually will win over Americans who are struggling to sign up.
"Those struggles, as I said yesterday, pale in comparison to the uncertainty that a single mom, who's a breast cancer survivor, has felt every day that she's lacked insurance because she can't afford it, she's been priced out of it, or insurers simply won't give it to her because she has a pre-existing condition," White House press secretary Jay Carney said.
"That is why we have to keep focused on the end goal here, which is making this insurance available to millions of Americans who need it," he said.
Dan Mendelson, CEO of Avalere Health, which advises major health care companies, said it's too early to say how the enrollment is going and that insurance companies probably won't have a good sense of what their risk pools look like until April 2015, when a full year's worth of claims have been filed.
Despite the political rumblings from Mr. Boehner and others on Capitol Hill, he said, the insurers are looking toward a longer horizon for judging success and failure for the health care law.
"The companies that have signed up for this are in it for the long haul. They have a different utility function than John Boehner," he said. "What insurance companies want is a long-term stable market."
For now, though, the immediate political question dominating Capitol Hill is whether the exchange enrollment will be working well enough for Mr. Obama to impose the tax penalty starting in April.
The mandate begins Jan. 1, but the penalty kicks in when someone has been without coverage for three successive months, meaning March 31 is the key deadline.
Dan Schuyler, director of exchange technology for Leavitt Partners, a health care intelligence business, said that if the exchange enrollment isn't working smoothly in three weeks, there could be problems.
Right now, most consumers are still browsing the markets, not buying, he said. The problem is what happens when they switch to purchase mode. In order to hit the administration's own target of 7 million enrollees by March, that means 38,000 people must sign up every day.
Mr. Schuyler said the problems with the website feel bigger than just glitches.
"This really feels like it's a core fundamental design flaw," he said. "The administration is saying, 'We're going to work on this and we're going to get it fixed as soon as possible.' The concern is the technology vendors have been working on this for 2 years. How do you fix something in a couple of weeks that you've been developing for 2 years? I'm just not optimistic that's going to happen."
If the issues aren't fixed, he said, a significant backlog of customers will be waiting to get into plans, and some of them may not be able to enroll by the first of the year.
The White House has urged Americans to use the phone or enroll in person, but Mr. Schuyler said that is time-consuming and there is no way to enroll 7 million people over the phone by March.
As for delaying the enrollment deadline, he said, that final decision is still a few months away.
"It's way too early in the game, but I think by mid-January that's when the administration will look at the enrollment numbers and make a decision," he said.
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