States respond to fears of Jan. 1 health coverage lapses

The Obama administration’s high-wire act to repair HealthCare.gov now includes a safety net: the states.
States such as Indiana, Wisconsin and Iowa are trying to insulate residents from potential dropped health insurance coverage. Worried that the Obamacare tech woes could persist long enough to leave people — including vulnerable populations — uncovered Jan. 1, they’re extending some existing insurance programs, severing their enrollment systems from the feds, and seeking greater protections for people who might be stuck if the website isn’t working as promised by the end of November.

Indiana has already put millions of state dollars on the line to cover 6,800 of its sickest residents through January. These people were supposed to leave a longstanding state“high-risk” insurance pool and have access to new Obamacare insurance options — but without a functioning enrollment system, they could be cut off Jan. 1.

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“The State of Indiana will ensure that these Hoosiers, who are facing significant health care challenges, maintain their health coverage until the problems with the federal Marketplace are resolved,” Gov. Mike Pence said in a statement. “While problems enrolling are an inconvenience to some, they could be a matter of life and death for these Hoosiers.”
Some of those high-risk patients, Pence pointed out, are struggling to schedule 2014 medical appointments without proof of future insurance coverage.
In Detroit, officials have delayed for a month a plan to cut health care for 7,500 early retirees and put them into the Obamacare exchanges, according to local news reports.
In Iowa, Gov. Terry Branstad, a Republican, is touting his administration’s moves to extend a farm bureau insurance program for 70,000 residents through 2014. He’s also worked with Wellmark Blue Cross Blue Shield to preserve coverage for residents through next year.
“Certainly there are Iowans who are seeking the [Obamacare] exchange,” said Michael Bousselot, a Branstad health adviser. “They are insulated … they’re not forced into it this year. That’s a key differentiation — giving people time so they know the choices that are coming.”
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Bousselot said Branstad anticipated tech problems on the federal exchange and ordered Iowa to build its own eligibility system for the state’s lowest-income enrollees, who are eligible for Medicaid. This has largely spared them from the tech challenges in states relying on HealthCare.gov.
The disastrous rollout isn’t only raising alarm among some Republicans.
Wisconsin Democrats sometimes sound less patient than their GOP counterparts. Sen. Tammy Baldwin this week warned a top Obama administration health official that thousands of vulnerable citizens could be cut off from coverage at the end of the year, the result of Gov. Scott Walker’s decision to forgo an Obamacare-funded expansion of Medicaid. Walker’s plan actually slims down the state Medicaid rolls and moves 92,000 low-income people into insurance plans on the glitch-ridden federal marketplace.
Milwaukee Mayor Tom Barrett, who was Gov. Walker’s opponent in a 2012 recall election, recently encouraged Walker to delay plans to shrink Medicaid until March 31, when the six-month Obamacare enrollment period ends. Barrett says the state law included a temporary safety valve in case the exchange isn’t working properly.
“I am simply asking you to delay the changes to BadgerCare to ensure that the health and well-being of some of the most vulnerable people in our state are protected in this time of uncertainty,” he wrote to Walker last week, using the state name for the low-income program.
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Walker administration health officials are urging patience.
”There is a sense of frustration about the fact that the site did not meet the expectations. But we need to be patient. We continue to talk with the federal government,” said Kevin Moore, Walker’s deputy health secretary.
There’s special concern among states for at least 200,000 people with pre-existing conditions who will be dropped from high-risk pools scheduled to close. The pools were supposedly made obsolete by the health care law because insurers can no longer deny their members coverage or charge them more on the account of the their health conditions.
But state directors of these high-risk pools worry that the broken Obamacare website could mean the most high-need are the most at risk for going without any insurance after the new year. Tanya Case, who heads Oklahoma’s high-risk pool and chairs a national association of state high-risk pools, said the Obama administration’s promise to fix HealthCare.gov by Nov. 30 doesn’t offer a lot of reassurance.
“For someone to assume everyone can apply at the last moment does not seem realistic to me in that there will be a percentage of individuals in which there are going to be issues with the data they provide and it will take time to sort it out,” Case said. “That might be fine for someone who does not have insurance currently, but if you are a member of a state high-risk pool that is closing December 31 … you need coverage effective Jan. 1, 2014.”
The risk pool association met Wednesday, with HealthCare.gov at the top of the agenda.
Though states running their own enrollment systems have generally fared better than the 36 states relying on the federal enrollment website, they’re not immune.
Ongoing website problems in Vermont’s exchange prompted Gov. Peter Shumlin to extend through March state programs that were scheduled to shut down. The two insurers selling in Vermont’s exchange in 2014 also agreed to extend existing policies through March 31.
“We’ve had some bumps along the way with our technology,” said Vermont health reform director Robin Lunge. “That was creating a lot of anxiety for Vermonters, and the governor quite frankly was concerned that people were so anxious about coverage. He wanted to give people assurances that we were going to do everything we could to ensure that folks could remain covered.”
Likewise, in California, one insurance company bowed to pressure from the state insurance commissioner to maintain coverage for residents through March 31, the end of the first Obamacare enrollment period.