Investigators from the U.S. Governmental Accountability Office (GAO) took a close look at the Affordable Care Act public exchange system, at the request of Democratic congressional leaders.
Democratic congressional leaders asked for the GAO investigation out of concern that the administration of President Donald Trump might be trashing the exchange system
GAO investigated hard, gathered data, and talked to people from 23 different stakeholder groups, and found something interesting: Many unexpected things are happening at the ACA public exchange system.
In some ways, in spite of all of the administration’s moves to kneecap some ACA subsidy programs, such as the ACA cost-sharing reduction program and, briefly, the ACA risk-adjustment program, Trumps HealthCare.gov system might be working better than Trump’s HealthCare.gov.
Brokers, business groups, benefit plan administrators and insurers have been organizing the old, pre-Internet version of health insurance programs for decades.
In the 1990s, America’s Health Insurance Plans (AHIP) proposed setting up health insurance purchasing coalitions as an alternative to proposals calling for the federal government to offer all Americans a government-run “public option plan.”
Democrats in Congress added their version of the AHIP proposal to the legislation that created the ACA. The goal was to give consumers a way to shop for plans, on an apples-to-apples basis, through state-run, web-based supermarkets for health insurance.
The exchange system also administers the ACA premium tax credit subsidy system.
The Centers for Medicare and Medicaid Services (CMS) and its parent, the U.S. Department of Health and Human Services (HHS), formed HealthCare.gov to provide ACA exchange services for residents of states that were unable or unwilling to provide the services themselves.
Today, 11 states and the District of Columbia have their own, locally run ACA public exchange programs.
HealthCare.gov handles enrollment and account administration for the residents of 39 states.
What the GAO Found
Here are five things GAO investigators discovered about how the public exchange system has been working:
1. HealthCare.gov seems to be much healthier.
On Oct. 1, 2013, when the ACA public exchange first opened for business, some states were unable to get their exchange enrollment systems to do anything much.
The HealthCare.gov became famous glitches.
The Trump administration’s first ACA open enrollment period was the enrollment period for 2018 coverage, which ran from Nov. 1, 2017, through Dec. 15, 2017.
During the 2018 open enrollment period, HealthCare.gov seemed to work much better than it worked the year before, according to GAO data.
Investigators found, for example, that HealthCare.gov up time increased to about 98% of the time during the 2018 open enrollment period, from 90% for the 2017 open enrollment period.
The amount of HealthCare.gov system downtime fell to 22.5 hours, from 61 hours.
The amount of time managers had to turn on the “waiting room system,” because the site was overloaded, fell to 2 hours, from 56 hours.
The average HealthCare.gov call center wait time fell to 5 minutes, 38 seconds, from 9 minutes, 34 seconds.
2. HealthCare.gov sales of gold plans did great.
The total number of people who enrolled in coverage through HealthCare.gov fell to 8.7 million in 2018, from 9.2 million in 2017.
But sales of “gold plans” — plans that cover about 80% of the actuarial value of the ACA essential health benefits package, or standard benefits package — increased to about 528,000 for 2018, from about 304,000 for 2017.
The share of HealthCare.gov exchange plan enrollees with gold coverage increased to 6%, from 3%.
That’s partly because most exchange plan users use the ACA advance premium tax credit program to reduce what they pay out of pocket each month for exchange plan coverage.