Nov. 7—Continuing signs of major problems at the new public marketplaces selling health insurance included the departure this week of a senior federal official overseeing the effort.

Tony Trenkle, chief information officer and director of information services for the Centers for Medicare & Medicaid Services (CMS), planned to resign next week, according to an internal agency memo obtained by HFMA. Michelle Snyder, COO of CMS, said Trenkle was leaving Nov. 15 after eight years with the agency to take a position in the private sector.

As CIO, Trenkle oversaw $2 billion in annual CMS spending on IT, including the minimally functional health insurance exchanges, or marketplaces, created by the Affordable Care Act.

Trenkle’s departure followed bipartisan calls for firings based on the poor performance of the federal marketplace website, which has enrolled only a tiny fraction of the millions of expected to gain private insurance coverage through it.

Trenkle will be replaced—at least temporarily—by Dave Nelson, director of the Office of Enterprise Management at CMS.

“I am truly grateful for the dedication and expertise all of these individuals have brought to CMS, and the contributions they have made to this agency over their years of service,” Snyder wrote.

Enrollments Lag

Wednesday’s announcement of Trenkle’s departure came the same day that U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius told the Senate Finance Committee that enrollments were “very low.” On Nov. 15, HHS is expected to release the first enrollment figures for the marketplaces, which began signing people up for coverage Oct. 1. HHS officials expect 800,000 to sign up by the end of the month—a pace that will not be sufficient to yield seven million enrollees in private insurance and nine million new beneficiaries in Medicaid, figures that were originally projected by the Congressional Budget Office.

The low enrollments so far have led at least one major insurer this week to cut its estimate of expected sign-ups from the exchanges in half.

James Murray, COO for Humana, said in a Wednesday call with investors that the insurer was cutting its 500,000 projected enrollments in half, due to problems with the marketplace websites. Those problems, he said, also could lead federal officials to extend the enrollment period beyond March 31—a move that Sebelius explicitly rejected Wednesday.

Sebelius also shed light the extent of the enrollment website’s problems when she said “a couple hundred” items were on a fix list. Federal officials have repeatedly said over the past week that they expect the website to become fully operational by the end of November.

Extensive Problems Remain

Enrollment problems extend well beyond the online sign-ups through healthcare.gov. President Barack Obama and other federal officials have urged consumers to use paper and telephone sign-up systems as alternatives to the federal website, which regularly freezes and crashes. But these systems share a common “back-end process,” said a CMS official, and this back-end process has experienced extensive problems, as well.

“The most urgent need is for the government to fix the back-end enrollment transactions between the government and the health insurance plans (the 834 problem),” Robert Laszewski, a consultant to many insurers, said in a blog post this week. The “834 problem” referred to a standard form of enrollees’ information that is electronically transmitted to the insurer selling the product.

“It will be impossible to conduct any kind of high-volume enrollment through the health portal's front door so long as the data being transmitted to the insurance companies is unreliable,” he said.

Publication Date: Thursday, November 07, 2013