Some health coverage deadlines changed to prevent insurance gaps

December 12, 2013 at 12:00 AM EDT
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GWEN IFILL: With deadlines looming ever closer for new insurance coverage at the start of the coming year, the Obama administration announced a series of changes late today. It includes allowing individuals to pay their premiums, or even part of them, on the last day of the year for coverage starting the next day. And there will be an extension of a special insurance pool for people with preexisting conditions.

Jeffrey Brown gets the details on what people need to know.

JEFFREY BROWN: The administration also asked insurers to be lenient with late sign-ups and other problems. And all this covers as the large insurance Aetna announced that it will not extend or reinstate some individual plans that are being canceled under the Affordable Care Act.

Alex Wayne covers all this for Bloomberg News and joins me now.

And welcome, Alex.

First, a brief overview of today’s moves. Why these latest steps? What are they aimed at?

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ALEX WAYNE, Bloomberg News: Sure.

Well, the administration is trying to confront a number of problems that they either didn’t anticipate when they were working on implementing this law or that they anticipated and didn’t address in advance. So they have got a problem with enrollment. It’s a bit anemic right now.

They’re only about half the pace they need to be to get the seven million people that they said they wanted to enroll by the end of March. They have also had a problem with canceled health insurance plans. They have had apparently many more people than they thought face cancellations at the end of this year, anywhere between 1.5 to maybe four million or five million people in the country.

JEFFREY BROWN: So one of the things that they’re doing is, they’re asking insurers to give some leeway to people who miss or are late with a premium.

ALEX WAYNE: That’s right.

JEFFREY BROWN: Explain the problem there.

ALEX WAYNE: Sure.

Right now, you have until December 23rd to sign up for coverage that would be effective on January 1. The administration said today you don’t have to pay for that coverage until December 31. There are a lot of dates here. And then they…

(CROSSTALK)

JEFFREY BROWN: They keep moving.

ALEX WAYNE: Yes, exactly. They do keep moving.

They also said today that they — they basically asked insurers, please, would you allow people to pay even later than December 31? So, for example, Aetna said that people who sign up for coverage that starts January 1, they won’t actually have to pay until January 8.

JEFFREY BROWN: Now, another move was — and this was for people with very severe health conditions — was…

ALEX WAYNE: Right.

JEFFREY BROWN: … to help to give them some relief. Now, explain the — explain the problem there, and how many people are we talking about?

ALEX WAYNE: Right. It affects about 85,000 people who are very ill.

Back in 2010, when Congress passed this law, they created this program. It was called a high-risk pool at the time. Now it’s called a preexisting conditions insurance plan that is designed to cover these people until 2014, when the new coverage reforms kick in, and insurers are forbidden from denying coverage to sick people.

That program is about to expire at the end of the month. But many of these people maybe have not been able to find alternative coverage yet. The administration is concerned that they would face a coverage lapse. Their PCIP, their preexisting…

(CROSSTALK)

JEFFREY BROWN: And these are people who really need — really need it.

ALEX WAYNE: Yes. They’re sick. They can’t go a month without coverage.

JEFFREY BROWN: Yes.

ALEX WAYNE: So the administration wanted to do this to make sure they don’t — they don’t face any kind of a gap.

JEFFREY BROWN: All right, now, also in the leaning-on-insurance category is to cover people retroactively even if there has been an error in their application.

ALEX WAYNE: Right.

JEFFREY BROWN: And this is, of course, because there have been a lot of errors. Right?

ALEX WAYNE: There have been a lot of problems with the exchange so far, right?

JEFFREY BROWN: Yes.

ALEX WAYNE: So they said that people who tried to apply before December 23 and faced some sort of a glitch, a technical error or bug, will have what they call a special enrollment period to try again.

And if they succeed during that special enrollment period, whenever it is, their coverage will be effective retroactively to January 1.

JEFFREY BROWN: Now, you mentioned Aetna earlier…

ALEX WAYNE: Yes.

JEFFREY BROWN: … as a company saying today that it would move one of those deadlines. I mentioned Aetna in the introduction in a different light.

ALEX WAYNE: Yes.

JEFFREY BROWN: Tell us about — about its move — its moves today.

ALEX WAYNE: Yes.

Well, Aetna said today that there they’re not going to extend current policies for people who have coverage today, an Aetna plan today. You are going to have to sign for a new plan that meets all the requirements of the Affordable Care Act.

JEFFREY BROWN: Is this a surprise?

 ALEX WAYNE: It’s — it’s a little bit of a surprise. I believe they’re the first publicly traded big insurance company to say this.

But, already, several states have said that they’re not going to allow insurance companies to extend old plans. Some experts refer to these plans sometimes as junk insurance. Maybe they don’t cover all the benefits the Affordable Care Act requires. Some of these plans are actually good coverage, though.

Whatever the case, they’re not going to be extended in a lot of states, including California, Washington and a few others.

JEFFREY BROWN: I wanted to ask you, finally, you asked a very fraught question at this press conference today…

ALEX WAYNE: Yes.

JEFFREY BROWN: … which was whether it might be the case that on January — at the beginning of all this, whether more people actually lose their coverage than will gain coverage.

ALEX WAYNE: Yes, and they didn’t give me much of an answer.

Because of these problems they face, enrollment has been anemic for Obamacare. And all of these current plans are being canceled. They really face a situation where on January 1, more people may have lost coverage than actually have signed up under Obamacare. They wouldn’t promise today that that won’t happen. And we won’t really know until January 15, or thereabouts, when they announce how many people actually signed up in December.

JEFFREY BROWN: We really won’t know, because a lot of this still is so much in play even in the next few weeks?

ALEX WAYNE: Yes, and because the administration doesn’t give updates on enrollment, except once a month, basically in the middle of the month.

JEFFREY BROWN: All right, Alex Wayne of Bloomberg, thanks so much.

ALEX WAYNE: Thank you.