July 16, 2013
It is likely that many individuals and organizations will need to call on attorney assistance to deal with the new Health Exchanges. However, the nature of the assistance that will be required is changing as implementation of the Affordable Care Act (ACA) shifts from initial high-tech “hopeful thinking” to a more-subdued low-tech “reality”.
This shift will affect attorneys as they represent clients dealing with Exchange-related problems. Dealing with the initially-envisioned super-computerized application processing centers would have raised one set of issues; dealing with the manual/computer support processing centers that seem more likely to prevail will raise a different set of concerns.
Indicators of this shift include postponement of the large-employer mandate until 2015, which has resulted in disputes over interpretation.
Announcements of cutbacks in all nonessential data-handling efforts have also been the subject of comment regarding employer-based insurance and individual income. However, routine checking of self-reported information is still expected in many cases.
Further, personnel staffing is set to jump. The contractor is to help “sift applications” and “help determine who is eligible”; “tasks include intake, routing, review and troubleshooting….”
There is now a reasonable strategy emerging for the Exchanges, due to a very tight schedule:
- Focus only on essentials and minimum requirements for operations on October 1, 2013.
- Simplify regulations to reduce the load.
- Postpone as many issues as possible until 2015.
- Shift from complex software to hybrid manual/computer operations wherever possible.
For highly-computerized centers, external communications would tend to be with agents sitting at computer screens and responding based on the information presented there. For hybrid centers, communications can be with administrative workers who use computer resources for support.
There are many advantages if attorneys make a point of learning the processing procedures of local Exchanges. If an application is lost, or “hung up”, or processed with errors, different approaches may be used to locate and work the problem. Efforts by attorneys to become familiar with local processing procedures may have a significant payoff for clients.
For an extremely automated center, typical issues might be: “What can an agent tell me?” “How does the software work?” “What about glitches?” “Can I get a printout for my client? And “How do I get into the appeal process?”
For a hybrid semi-automated center, the issues may be: “Who may I contact?” “How can I get access to the procedure manual in use?” “How can I communicate with a worker?” “How can I fix the problem?” and only then, “What about an appeal?”
This is #3 in a series of weekly Obamacare Reports. More on these topics may be found in a recent book by the authors. For more on the ACA take a look at the other entries in The Obamacare Reports series.