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.
In some cases, the investigators got around exchange verification problems by filing paper forms.
The investigators had to make promises under penalty of perjury on those forms, but they did not have to go through electronic identity checking processes, officials say.
“In some cases, our applicants presented identical information, but marketplace handling of their applications was different,” officials say.
“For example, in each of two federal [HealthCare.gov] applicant scenarios, we claimed to be lawfully present and with income at a level qualifying for a subsidy,” officials say. “In each case, we were directed to provide proof of immigration status and income, and in both cases, we did not provide any documentation. In one case we lost coverage, while in the other we retained it.”
Officials note that they were unable to analyze three of the cases fully: The investigators got approval for coverage for those three and sent insurers payments, but the insurers said they had not received payments for the three fake applicants on a timely basis.
“As a result, our coverage was not put into effect in these three cases,” officials say.”
3. What enrollees are thinking
GAO officials summarize results from exchange plan enrollee satisfaction surveys from organizations such as PerryUndem, Deloitte and Commonwealth Fund.
The New York City-based Commonwealth Fund had the most data: survey results from 2014, 2015 and 2016.
The percentage of enrollees expressing satisfaction with their coverage in the Commonwealth Fund survey program started at 65 percent in 2014, increased to 81 percent in 2015, and slipped to 77 percent this year, officials say.
The GAO also summarizes the Centers for Medicare & Medicaid Services’ own exchange user casework data.
About 1.4 million of the 1.9 million cases had something to do with plans or issuers, and about 333,000 were related to tax filings.
Another 128,000 involved eligibility issues.
Just 378 related to what CMS classifies as legal and administrative issues, such as allegations of fraud or discrimination.
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