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Enrollment Surge Exposes Health Exchange's Strengths, Weaknesses

By John Reichard, CQ Roll Call

April 1, 2014 -- The administration confirmed that 7.04 million Americans applied for health insurance coverage through federal and state marketplaces by last week's deadline, and President Barack Obama took a victory lap in a recent speech celebrating the late surge.

Republicans predicted that the law's insurance exchanges would charge such high prices and work so poorly that the venture would be a bust. But the 7 million figure was announced by White House Press Secretary Jay Carney, matching an early estimate by the Congressional Budget Office that didn't anticipate the technical malfunctions that turned the launch of the federal marketplace into a near disaster.

CBO later downgraded the estimate to 6 million to account for the impact of the breakdowns. But the late surge of sign-ups beat that figure. And it meant that the total nearly doubled the 4.2 million applications that had been completed at the end of February.

Obama said in remarks at the White House that working Americans deserve the economic security brought by having health insurance, "all of which makes the constant politics around this law so troubling." He said the federal website has had "its share of problems" and critics, but "change is hard, fixing what is broken is hard, overcoming skepticism and fear of something new is hard."

Obama said the law is helping millions of Americans despite its critics and asked, "Why are they so mad about the idea of folks having health insurance?"

The debate over repeal is over, and "the Affordable Care Act is here to stay," he said. There will be more days when the website stumbles, he said, and moments when its failures make front-page news. "But today should remind us the goal we set for ourselves, that no American should go without the health care they need," has been met, he said.

The Obama administration reported record traffic to the health care law's federal insurance marketplace on the last day of open enrollment, with more than 3 million visits to the website and 1 million calls to a call center as of its evening deadline.

The long lines at enrollment centers and the flood of calls and site visits – the previous HHS one-day record was 646,000 calls on the last day of the Medicare prescription drug coverage open enrollment period – energized the White House.

"Given how gloomy I think everybody's assessment was back in the middle of November, I'd say that we're on our way to making sure that no American ever has to go without health care," President Barack Obama said on the CBS Evening News.

White House officials and their allies are planning a big get-out-the vote campaign to make sure newly insured Americans turn out cast ballots in the fall midterm elections, the New York Times reported.

But the site, despite major improvements since its dysfunctional launch, at times on the final day could not keep operating under the strain of heavy traffic. The site was down an estimated eight hours early in the day. At times, visitors were routed into virtual waiting rooms where they were told they could leave email addresses to be notified when they could again use the site. During a period later in the day the site was not able to create new accounts.

There continued to be apprehension about whether people caught in limbo would be able to get coverage, despite administration assurances they would be permitted a limited grace period if they could show they had attempted to complete the enrollment process by March 31.

And even as White House officials took heart from the latest numbers, they faced the daunting prospect of sharply building enrollment in 2015 and 2016. The Congressional Budget Office (CBO), whose enrollment projections have become a widely followed proxy for the success of the health care law, has forecast exchange plan enrollment of 13 million in 2015 and 22 million in 2016.

Senate Republican Policy Chairman John Barrasso, R-Wyo., told Fox News that the 7 million figure was meaningless. "The reality is they're not going to have that many people who actually have insurance. To me, they're hiding the ball on this. They won't tell you how many people have actually paid for the insurance. And we know in states that follow this closely, in a number of those states, fewer than six in 10 who sign up actually pay for the insurance."

Barrasso also questioned how many sign-ups were people whose policies were canceled under the health law's coverage requirements.
Health and Human Services (HHS) Secretary Kathleen Sebelius said that 80 to 90 percent of customers who sign up pay their premiums.
Despite the close of the federal open enrollment period the site will continue to operate until the start of the next open enrollment period, on Nov. 15. And a number of state-run insurance exchanges have open enrollment periods extending into April.

A new home page of the site will be posted this week that "will clearly indicate that open enrollment for 2014 is over," a Centers for Medicare and Medicaid Services (CMS) official said. It will tell consumers how to enroll if they qualify for coverage outside of the open enrollment period.

Enrollment in Medicaid and the Children's Health Insurance Program continues throughout the year, as do sign-ups for coverage in the so-called SHOP exchanges that serve small businesses under the health care overhaul. Also, consumers with "life changes" such as marriage, divorce, births, or job loss will be eligible to enroll in the marketplaces throughout the year.

The CMS official added that "the marketplace call center will continue to serve consumers 24/7 outside of open enrollment to meet their needs."

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