Feb. 27—The revelation this week that 4 million people have signed up for private insurance coverage through the Affordable Care Act (ACA) failed to resolve lingering healthcare industry concerns about enrollment shortfalls.

According to a blog post by Marilyn Tavenner, administrator for the Centers for Medicare & Medicaid Services (CMS), error rates for the technologically challenged HealthCare.gov website are low and response times are “consistently less than half a second.” Based on the latest enrollment figures, Obama administration supporters predict that the administration’s goal of 7 million sign ups by the end of open enrollment on March 31 is within reach.

But healthcare advocates said the lack of critical details on the latest enrollment figures raise important questions.

“We’re still waiting to see how many of those folks have paid the first month’s premium and how many were previously insured,” said Chad Mulvany, director of healthcare finance policy, strategy and development for HFMA.

Details Missing

The Obama administration has declined to detail how many of the enrollees have yet paid their premiums on the new plans to activate their coverage. Various studies have indicated that 20 percent of ACA exchange enrollees nationwide never sent premium payments on their new coverage, which effectively cancels the policies.

Similarly, ACA coverage of previously insured people would not count toward the law’s goal of reducing the number of uninsured, from the perspective of many healthcare providers.

Some insurers have warned that even when overall enrollment appears healthy, disproportionate shares of sicker enrollees could undermine the coverage. 

For hospitals, a significant shortfall could have consequences beyond a larger-than-expected share of their uninsured patients continuing to require charity care. Specifically, ACA cuts to disproportionate share hospital (DSH) payments were based on the enrollment projections—not actual enrollments.

HFMA plans to urge CMS to either recalculate the DSH cuts based on either a recent estimate that enrollees will total 6 million or recalculate the cut based on actual enrollments, Mulvany said. 

Rich Daly is a senior writer/editor in HFMA’s Washington, D.C., office. Follow Rich on Twitter @rdalyhealthcare.


Publication Date: Thursday, February 27, 2014