Republican committee leaders in Congress have scheduled a series of hearings on Affordable Care Act program performance.
The U.S. Government Accountability Office, a congressional agency that helps lawmakers keep tabs on the executive branch, have come out with three major ACA exchange performance reports.
Two are sequels to the GAO’s earlier accounts of what happened to undercover investigators who had fake people try to sign up for health coverage through the ACA public exchange system.
Investigators got either Medicaid coverage or the ACA exchange advanced premium tax credit premium subsidy for 17 out of 18 fake people in 2015, and they lost coverage for one when the investigator representing that fake person decided not to provide a fake Social Security number over the phone.
Investigators got coverage approval for 15 out of 15 fake people this year, but ended up having trouble making premium payments for three of the fake people.
In a third report, officials review exchange plan user satisfaction survey data, and they also give some results from interviews, and from exchange plan customer service data from the Centers for Medicare & Medicaid Services (CMS).
GAO investigators found when they interviewed people who help exchange plan enrollees with genuine customer service problems, for example, that getting information from CMS during the appeals process is not easy.
For a look at some more highlights from the three reports, read on:
1. Fake exchange applicants, 2015
The GAO tried to get exchange coverage for 10 fake people through the ACA exchange system in 2015, and Medicaid coverage through the exchange system for eight fake people.
Investigators obtained exchange plan subsidies for all 10 of the fake exchange plan applicants, and Medicaid coverage for seven of the eight fake Medicaid applicants. The only fake applicant who failed to get coverage refused to give a Social Security number of any kind to a representative from Covered California. Covered California told that fake applicant to come in to an enrollment office and apply for coverage in person.
Some state-based exchanges had no ability to determine that fake Social Security numbers provided were numbers that were impossible for an individual to have in the current Social Security numbering system, officials say.
In other cases, exchange customer service representatives helped enrollees around problems when identity verification systems turned up problems.
“In one case, the Kentucky marketplace questioned the validity of the Social Security number our applicant provided, which was an impossible Social Security number,” officials say. “In fact, the marketplace told us the Social Security Administration reported that the number was not valid. Nevertheless, the Kentucky marketplace notified our fictitious applicant that the applicant was found eligible for coverage.”
2. Fake exchange applicants, 2016
GAO investigators were able to get 2016 exchange plan premium tax credit subsidies for four out of four fake people who had not filed a 2014 federal income tax return as of August 2016, and seven out of eight fake people who had a variety of other types of problems, such as invalid Social Security numbers.