Charles Gaba at ACA Signups looks at the lost insurance at work Special Enrollment Period (SEP) for Healthcare.gov.
I’ve estimated that even during the off-season (that is, outside of the official annual ACA Open Enrollment Period window), around 7,000 – 9,000 Americans typically enroll in ACA exchange coverage each and every day via Special Enrollment Periods (SEPs)…. around 2/3 do so because they lost their current coverage…and the vast majority of those cases involve employer-sponsored insurance
SEPs are typically a 60-day enrollment window during which you’re eligible to #GetCovered via your state’s ACA exchange if you have a Qualifying Life Experience (QLE), such as losing your existing healthcare coverage;…
Starting in 2017, however, under the Trump Administration, CMS started requiring everyone who wanted to enroll via a SEP to upload documentation of their QLE…and then it had to go through the verification process, in which someone at CMS would give it the OK…
That’s six million people who are going to be desperately scrambling to jump through all of the hoops which CMS is placing in front of them for no legitimate reason whatsoever.
That’s one hundred times the number of people who would typically enroll in “lost my coverage” SEPs via HealthCare.Gov in a typical two-week period.
The current SEP rules and organization of Healthcare.gov is set up to handle a small fraction of the expected number of people eligible.
Chris Briem at the University of Pittsburgh has been tracking Pennsylvania unemployment claims filings:
OK, low (only in that relatively sense) Pennsylvania UI claims for Saturday do not appear to be part of a trend. Big jump up to +65K initial UI claims statewide on Sunday (https://t.co/MwVKNLHauo). 5th biggest daily # thus far and cumulative since March 15 now over 1.1 million. pic.twitter.com/xHP9GIdCmh
— chris briem (@chrisbriem) April 6, 2020
No.. Pennsylvania is not leading the way in unemployment compensation claims because things are worse here as is the common presumption in the media, but because the state has made investments in IT that means the system is no longer dependent on decades old COBOL code!! https://t.co/7mvCf29ya2
— chris briem (@chrisbriem) April 4, 2020
Privately, Republicans admit that the $77.9 million system that is now failing Florida workers is doing exactly what Scott designed it to do — lower the state’s reported number of jobless claims after the great recession.
“It’s a sh– sandwich, and it was designed that way by Scott,” said one DeSantis advisor. “It wasn’t about saving money. It was about making it harder for people to get benefits or keep benefits so that the unemployment numbers were low to give the governor something to brag about…”
The new online system was part of a series of changes designed to limit benefits. The ultimate goal — which it delivered on — was to lower unemployment taxes paid by Florida businesses. A 2011 analysis done by the Florida Legislature estimated that the changes pushed by Scott would save businesses more than $2.3 billion between 2011 and 2020.
The legal availability of benefits is merely the first step of people actually being able to use needed benefits. The decisions and systems that allow for the determination of benefit eligiblity can either be readily made accessible or an incredible hurdle designed to kneecap as many people as possible before a positive determination. The 2nd COVID law that was mostly negoatiated between Speaker Pelosi and Sectretary Mnunchin had strong language that prevented many administrative barriers from being raised or maintained if they are designed to keep people off of Medicaid. A general SEP for the ACA on Healthcare.gov has far fewer paper work validation requirements than the lost insurance SEP. Trying to force a 100,000 people through a 6,000 daily work flow won’t end well. Pennsylvania is managing its unemployment filing surge because its IT system has been recently updated while plenty of other states either have updated systems that are designed to deny claims either directly or indirectly or are operating off of legacy code bases that can’t handle the surge.
Administrative friction will create social burns.