The ACA and Legal Practices (#7) / Only four months until year 2 enrollment starts

July 9, 2014

health-care-lawThis is installment #7 in a series of blog postings on the Affordable Care Act (ACA) and legal practices.

The second enrollment period for the Health Benefit Exchanges is scheduled to begin on November 15, 2014. Efforts are being made to improve the chances for a good Year 2 experience.

The initial enrollment period for the Exchanges (October 1, 2013 to March 31, 2014) turned into a major crisis. Flaws in the federal Exchange almost brought about a collapse of implementation efforts.

A high-profile team of experts was able to move in and put enough fixes in place to enable enrollment to proceed after a few months.

And even then, problems have continued with enrollee experiences, and with errors in information transferred to insurance companies.

All-in-all, however, it may be concluded that the federal Exchange, and several of the state Exchanges, were able to claim a reasonable success for Year 1.

Even so, revisions in software and information linkages to the Internal Revenue Service (IRS) and insurance companies remain under intense pressure.

The Year 2 enrollment period will likely be held to a higher performance standard. There will be a presumption that things should work out  better during the second time around.

The Department of Health and Human Services (HHS) is moving on several fronts to try and help this happen.

The second enrollment period is shorter (3 months) than the first enrollment period (6 months), and more enrollees are hoped for and expected.

So it is possible that more enrollees will have to purchase insurance in a shorter time allowed for operations.

If all enrollees from Year 1 come back to reenroll for Year 2, and many new enrollees are added in, high volume could tend to “crash” the Exchanges.

So, HHS has added in an “auto-renew” feature. Policyholders from the first time around who intend to keep the same policies, and whose income and household size have not changed, can renew without reenrolling. The marketplace will automatically reenroll these individuals. (See www.healthcare.gov/blog/).

However, this will not work when situations have changed, or enrollees want to search for better or cheaper alternatives (as is being recommended by some advisers).

Also, the IRS is still struggling to improve income matching with enrollee applications. Unless the software-matching problems are fixed, the number of unresolved issues may escalate during Year 2.

Insurance companies are still trying to finalize their data bases for Year 1, and may experience more difficulty with cleaning up after Year 2.

There will likely be less public tolerance for enrollment problems in Year 2.

The Year 2 results may be an improvement over Year 1—or lead to another crisis.

Attorneys who are advising clients about the ACA may want to watch carefully as the Year 2 enrollment begins. The Year 1 problems led to a variety of changes in schedules and rules. A high level of Year 2 problems is likely to lead to similar adaptive efforts.

More information about small-business employers and the ACA may be found in recent books on the ACA and on the health care system, and on the ACA Blog, also written by the author of this series.