Concerns linger about enrollment glitches as millions start new health coverage

January 2, 2014 at 12:00 AM EDT
On Jan. 1, health coverage under the Affordable Care Act kicked in for millions of Americans, but concerns remain about whether people who bought new insurance will encounter issues with their enrollment. Jeffrey Brown talks to Julie Appleby of Kaiser Health News for an update on the latest milestone in the rollout of the law.

JUDY WOODRUFF:  January 1 marked the first day of coverage for many Americans under the Affordable Care Act.

Jeffrey Brown updates the health care law’s rollout. 

JEFFREY BROWN:  Earlier this week the Obama administration released official enrollment figures showing that 1.1 million people had signed up for health insurance using the federal exchange, with more than 975,000 of those coming during the month of December.  Another 900,000 people registered through the individual state exchanges, for a total of 2.1 million, a quick surge, but short of an early administration estimate that 3.3 million people would sign up by the start of 2014. 

Julie Appleby of Kaiser Health News joins me now for an update. 

And welcome back. 

JULIE APPLEBY, Kaiser Health News:  Thank you. 

JEFFREY BROWN:  First, after all that’s happened, it’s probably useful just to remind people what actually happened when this all kicked in?  What were the important changes? 


This is a key date because it was a milestone in a way.  A lot of the key provisions of the health care law kicked in, so things like insurers can no longer reject people who have medical conditions.  They can no longer charge men — or women more than men.  They can no longer set annual or lifetime dollar limits on coverage. 

So a lot of these things went into effect.  The other key thing that went into effect yesterday is that starting this year, Americans who don’t have coverage could face a penalty fine if they don’t get that coverage by March 31. 

JEFFREY BROWN:  And now the overall numbers that I just referred to, we saw this jump in the last month, last weeks, actually.  How is all that being read? 

JULIE APPLEBY:  The administration had a press conference earlier this week, and they touted the fact that 975,000 people signed up for coverage in December. 

And that’s a big number.  They say that shows that they resolved many of the problems that were plaguing their Web site since it started in October.  But that number is still well short.  You know, even when you add them all together, you have got 2 million people between the federal exchange and state exchanges.  When you add those together, as you mentioned, we’re still short of what the administration was estimating they would have by this time. 

And we’re still short of that seven million that they are hoping to get by the end of this year. 

JEFFREY BROWN:  What about the mix of people signing up?  How much can we tell at this point, especially young people, right? 

JULIE APPLEBY:  Right.  Right.  That’s a key thing. 

We want to know how many young people are signing up because they are presumably going to offset the cost of the older people.  Reporters have asked the administration many, many times for information on the age, the health status of folks signing up, whether they have had insurance before.  And we just don’t have that information.  They haven’t given it to you us yet. 

Now, some states have posted this information.  So, in California, for example, in November, they said about 22 percent of the people signing up were younger people, ages 18 to 34.  And that tracks pretty closely with their share of the population in that state.  But that was November.  We don’t know what’s happened since then. 

Many health policy experts are telling reporters that it’s not simply the age that’s important.  They want to get people — insurers and actuaries want to get people signed up who are healthy.  So, they could be older healthy people as well.  But we will just have to wait, I think, until the end of March to really know a little bit more about the final number. 

JEFFREY BROWN:  What about — there had been a belief, even a concern that there would be like a surge, a flood of appointments, right, and people going to the doctors right away?  What do you know about that?  What do you know so far, I know it’s early, so maybe a lot of this is anecdotal, about things like that, things about surprises people may have found when they tried to use their insurance?

JULIE APPLEBY:  This is the big concern.  What’s going to happen in January, right?  Will people show up at the doctor, or the hospital, or the pharmacy and find out they’re not enrolled?  Will they be able to get an appointment?

JEFFREY BROWN:  Thinking that they were enrolled, but for some reason — yes. 

JULIE APPLEBY:  Thinking they were enrolled, and for some reason, they aren’t. 

The White House is very worried about this, because if people don’t pay their premium, their first month’s premium, they are not officially enrolled.  And many people have until January 10 to pay that premium, but not all cases. 

So the White House is saying, call your insurer, make sure you are enrolled.  But this is going to be a key thing.  How will this play out in January?  What is going to happen with folks?  This is going to play into the narrative as we go forward this year as to how well this law is working out. 

JEFFREY BROWN:  I saw that there were some pharmacies that are offering extended supplies of prescription drugs to tide people over during this uncertain period; is that it?

JULIE APPLEBY:  Well, both Walgreens and CVS say that they’re going to help some folks who perhaps don’t have their permanent I.D. card yet from their insurer or are still caught up in some of the technical difficulties in getting enrolled with some transitional coverage, a 15-to-30-day supply, in certain circumstances.  So those two pharmacies say that they will help some folks. 

JEFFREY BROWN:  Now, in the meantime, one provision involving contraception has been — well, it was put on hold really by the Supreme Court.  Tell us about that. 

JULIE APPLEBY:  Right, right.

Under the law, employers are required to cover contraceptive as preventive care, without a co-pay for the enrollees.  This is obviously been very controversial, particularly among some Catholic institutions.  So some religiously affiliated employers were offered a compromise. 

And this compromise basically says that they don’t directly have to pay for this contraceptive coverage.  They can certify that this is opposed to their religious beliefs and the insurer will then cover that for their employees.  A number of religiously affiliated groups, including this group of nuns that brought this case before the Supreme Court, said that that is an inadequate compromise, because, in effect, it still requires them to say that, you know, we are authorizing contraceptive coverage, so they have brought this to the court. 

The court has said, we’re going to temporarily stay this for this group of nuns and a few other groups.  And they have given the Obama administration until tomorrow to respond. 

JEFFREY BROWN:  And, very briefly, as you say, we’re going to watch — I mean, this battle continues, right, with every side watching what happens right now through January, certainly. 


We’re going to hear a lot.  So this law is very broad and complex, so there are some people who have gotten coverage, they’re paying less.  Some have gotten a subsidy.  Some have gotten coverage who have never had it before because they had a medical condition.  So we’re going to hear those stories.

But it’s also true that we’re going to hear people who are paying more, whose doctor is not in their networks, who are surprised by the size of the deductible they have to pay, and they are going to be unhappy.  So we’re going to hear those stories as well.  This is going to be a battle I think we’re going to hear the rest of the year, particularly as we get closer to the November elections.  And — and we will have to stay tuned. 

JEFFREY BROWN:  A battle of health care stories, huh?

Julie Appleby of Kaiser Health News, thanks so much. 

JULIE APPLEBY:  OK.  Thank you.