Ezra Klein makes a good point about next week and Obamacare implementation — the mechanics are going to be messy:
Jan. 1 isn’t likely to be a glitch-free day for Obamacare. There will be people who try to use their insurance and find they can’t, or it’s not the plan they meant to buy, or it’s not a plan that covers their doctor. But those problems will, eventually, be solved.
Here are some of the glitches that I think will pop up quickly in the first two or three weeks until they get repaired.
- Late enrollees won’t have their ID cards
Individuals who enrolled in their plans by mid-December should be seeing their ID cards by now. However people who enrolled in their plans in the last few days probably won’t get their plastic ID cards by Jan. 1. This is purely a matter of timing. Enrollment on Dec. 24 leaves four business days and five mailing days for cards to be generated and shipped. Some insurance companies generate cards in-house and might be able to meet that time frame. Other companies outsource their ID cards to vendors and the turnaround time is between five to ten business days between enrollment verification and cards in members hands.
- Network directories are fuzzy
The networks have yet to stabilize. Significant groups of doctors are still moving into and out of networks as the promise of membership may or may not be fulfilled. Directories lag actual movement so it is quite probable that a provider will be non-par in a network but listed in the directory as a par provider.
- Narrow networks
For insurance companies that used to operate on a paradigm of big, broad networks with nearly unlimited access, the change to narrow networks will produce hiccups. For instance a provider can work at multiple groups. Provider Group A and Provider Group B are both in the par general network that most employer groups use. Provider Group A may be in the narrow network, while Provider Group B may be excluded from the narrow network. Previously, the insurance company would not have cared where a member saw the par provider. Now, an Exchange member showing up to see Dr. Bob at 4 Privet Drive will pay significantly different cost-sharing than if the Exchange member saw Dr. Bob at 123 Sesame Street. This will be confusing and ties into the network directory problem above.
- 834 Errors
From what I’ve been hearing, the error rate on 834 enrollment files is down to acceptable levels. However an acceptable level of errors will still produce people who thought they have coverage not have coverage. Angry calls to healthcare.gov, the insurance company and the local newspaper will resolve these problems noisily and quickly.
There will be other common errors of implementation that will be noisy, public and a pain in the ass to fix quickly but they will be fixed quickly. These errors happen all the time for the group insurance side but they tend to get intermediated by either the HR department or the broker. For most Exchange covered individuals, there is no intermediate problem solving/problem dealing layer.