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Blog: Why Is Extending the Sign-up Time for Health Insurance Causing Such an Outcry?

Mar 27, 2014 | By Carolyn Burstein, NETWORK Communications Fellow

The Obama Administration said on Tuesday, March 25, 2014, that all those who have tried to apply but had difficulty due to a technical problem, special circumstance or a complex case, would be given until mid-April (left relatively vague for now, but dependent on the number of people involved) to enroll in healthcare in the federal marketplace. Assuming a surge in demand during the last several days before the March 31 deadline, Jay Carney, the White House press secretary, gave an additional reason “…we’re going to want to make sure that people who are already in line can finish their enrollment.”(www.nytimes.com/2014/03/26/us/policies/obama...)

Several states running their own exchanges, including Maryland, Minnesota, Nevada and Oregon have taken or, in the case of Oregon, will be taking similar steps.

The government will rely on “self-attestation” (the honor system) to determine if people can sign up after March 31. The extra time will not technically alter the deadline, but will create a new special enrollment period for a new category of people.

Consumer advocates and other groups assisting in registration had been urging the administration to provide extra time for people to complete applications, especially for those caught in a web of complexity, such as those with twin children or for those still experiencing technical difficulties, such as when the website displays inaccurate information about premiums. But along with other changes that have been proposed by the administration over the past few years, such a change will lead, unfortunately, to additional criticism from the Republicans and others who oppose the ACA.

At his weekly news conference on March 26, House Speaker John Boehner was quick to lash out at the extension, claiming that the change is “part of a long-term pattern of this administration manipulating the laws for its own convenience.” (www.kcra.com/health/boehner-rips-latest...) Yet, Boehner’s credibility on the ACA is extremely low, even non-existent, since his House chamber has passed dozens of bills aimed at either repealing or altering the health law over the past three years and he has made clear to everyone who listens that the Republicans will use the ACA as a prime campaign issue in the mid-term 2014 elections. Maybe he should be reminded of a famous saying attributed to Will Rogers: “People’s minds are changed through observation and not through argument.”

However, the Boehner strategy may backfire because the Kaiser Health Tracking Poll for March 26, 2014 shows that over 50% of respondents are weary of the national debate about the law and want Congress to keep the law and improve it based on experience with ACA. In addition, the tracking poll found that the gap between unfavorable and favorable views of the ACA is now 8 percentage points, down from a recent high of 16 points in November and January.

If the federal website is deluged with people applying at the last minute, administration officials say they want to be ready to help those people to complete their enrollment and not leave them in the lurch. This may indeed be true, but there is no way that the extension cannot be read politically. Although officials claim that Healthcare.gov is ready to handle a surge of applications, nevertheless, if the website freezes up or falters in any way just before the deadline, it would spell major political trouble for Democrats at the time they were recovering from the October 2013 fiasco. That being said, it should be admitted that from the very beginning of attempting to pass health care legislation in 2009, it has been mired in political controversy because only the Democrats voted for the passage of the ACA and they must defend it, along with supporters of health care reform.

Yes, it is true that people who do not have health insurance by March 31 may be subject to tax penalties. And the new special enrollment period will allow many more people to receive tax refunds that can be used for health care payments, especially if they have been uninsured. But the whole point of the ACA is to get people covered by health insurance. Yet, the Kaiser Health Tracking Poll has found that as late as March 26, six in ten of the uninsured are unaware of the March 31 deadline to sign up for coverage, that four in ten of the uninsured are still unaware of the law’s subsidies to help lower-income Americans purchase coverage, and half do not know about the law’s expansion of Medicaid. Is it any wonder then, that the Obama Administration is treating the March 31 deadline flexibly, politics or no politics?

In the first year of the law’s implementation there were so many technical problems initially with the website that, in spite of extraordinary outreach efforts and based on the experience of the Massachusetts state law (a prototype of the ACA), it’s only natural that people are confused, feel they do not understand the law, aren’t sure of what they are supposed to do, and that a deadline exists.

There have been numerous changes and extensions to the ACA almost from the beginning of implementation in 2013 by administrative action, by Congress and even by the Supreme Court, the latter, most famously, that state Medicaid expansion would be voluntary. Administrative and Congressional action includes modifications delaying small business implementation, extending non-compliant health plans, and accepting both military and VA health benefits as compliant with the law and account for the remainder of the changes, most of which have been efforts to clarify the law or to modify the effects of the law in special circumstances. The Galen Institute, a non-profit, health research organization has noted 38 changes or modification to the ACA thus far.

Rather than crediting administration officials with the flexibility that is required when implementing a nation-wide law that has such far-reaching potential and affects millions of diverse people in extremely complex ways, especially after a roll-out that was “technically-challenged,” the law’s opponents seem to know little about implementation success. Those knowledgeable about systemic change warn us that we should not underestimate the amount of effort involved in implementing a new system. Assuming a new system or law or complex procedure will work flawlessly and according to expectation on the first try is dangerous. Any kind of major change like the ACA must involve the participation and involvement of the consumers of the system. They have a vital role to play in commenting and trying to improve the quality of the system. There can be no cultural separation between the users and designers of the system. While this advice seems mere common sense, those with disabling biases often overlook the need for the kind of flexibility being exercised by administration officials in proposing the kind of change that includes an extension of the sign-up period for healthcare insurance.

These officials listened to consumers’ problems and frustrations, understood the elements of successful implementation and reacted in a positive and flexible way, knowing that their actions would be criticized regardless of what they proposed.