Investigators from the U.S. Government Accountability Office (GAO) have criticized the HealthCare.gov public exchange system for being too quick to enroll fake people with obvious application problems.
But B. Ronnell Nolan, the Baton Rouge, La., agent who serves as president of Health Agents for America (HAFA), says she and colleagues are seeing what may be an even more serious problem: a HealthCare.gov program inability to help real people, who may have real conditions, such as pregnancy or cancer, stay covered.
The U.S. Department of Health and Human Services (HHS) set up HealthCare.gov to provide public health insurance exchange services for states that are unwilling or unable to set up and run their own Patient Protection and Affordable Care Act (PPACA) exchange programs. Federal law and HHS regulations have set many requirements for HealthCare.gov users. Exchange users must be in the country legally, for example, and PPACA exchange plan premium subsidy tax credit users must have income levels within specified maximum and minimum cut-offs.
Even when an agent helps consumers submit HealthCare.gov applications, and the applications include the agent’s producer number, HealthCare.gov does not normally tell agents about problems with the consumers’ applications, application documentation or coverage, Nolan said.
HealthCare.gov is citing application documentation problems as a reason to cancel the exchange plan tax credits of hundreds of thousands of people throughout the country. Agents are telling Nolan they have many clients who appeared to have accurate, well-documented applications and are now finding out, when they seek medical care, that their coverage was canceled months ago.
In one case, for example, one of Nolan’s clients, a pregnant woman, learned that her coverage had been canceled but swore she had not received a cancellation notice. The client’s account in the HealthCare.gov system says the coverage had been canceled in February, Nolan said.
The client is a naturalized immigrant. Nolan said she had taken care to include citizenship papers with the woman’s application. The HealthCare.gov system said it had canceled her coverage because she had failed to upload documents proving that she was a citizen.
The woman had paid her monthly premiums all along, without realizing her coverage had been canceled, Nolan said in an e-mail interview.
“The insurance company will not refund her the premiums she paid during the time she didn’t have coverage (who knows why), and she is due next week without health insurance,” Nolan said. “I am sitting here about to cry, not wanting to call her and upset her so close to her due date.”
When consumers learn from doctors’ offices that they have no coverage, they ask agents to help them file appeals and upload the documents needed to get their coverage back, Nolan said.
“You have a timeline of 90 days to appeal, and, if you are a day late, they deny your appeal,” Nolan said.
See also: What if you disagree with an exchange?
Sen. Tammy Baldwin, D-Wis., a PPACA supporter, has asked HHS Secretary Sylvia Burwell for help with clearing up constituents’ problems with HealthCare.gov documentation requests.
She said HealthCare.gov document processing delays seem to cost more than 67 constituents their exchange plan coverage.
“In addition, my staff has had difficulty coordinating with [Centers for Medicare & Medicaid Services] staff to help constituents navigate these issues,” Baldwin wrote in her letter. ”It is unacceptable for individuals to be losing access to health coverage or premium tax credit assistance due to administrative mismanagement, and it is critical that these issues be addressed immediately.”
Representatives from HHS were not immediately available for comment on coverage cancellation concerns.