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January 25, 2018 at 09:00 AM
HealthCare.gov managers have a problem with dead people.
Officials at the U.S. Government Accountability Office (GAO), an agency that helps Congress keeps tabs on the executive branch of the federal government, have reported that finding in a review of HealthCare.gov application, enrollment and eligibility-verification operations for the 2015 plan year.
(Related: CMS’ Health Premium Tax Credit Verification Programs Get Failing Grade From IRS)
When GAO investigators looked at HealthCare.gov records for 8 million people who received federal premium subsidies in 2015, they found that a total of about 19,000 of the subsidy users, or about one in 420 subsidy users, died sometime between filing an exchange application and the end of 2015.
About 16,000 of the subsidy users, or one in 500 of all subsidy users, died in 2015, after their coverage took effect. Another 3,000 died before their coverage took effect.
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The GAO found it was unable to verify the applications of 307,000 applicants with Social Security Administration death records, because Social Security numbers were missing from the applications or for other reasons.
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HealthCare.gov and exchange plan issuers cut off subsidies on the date of death for just 2,000 of the 16,000 2015 subsidy users who died in 2015.
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About 1,000 people, or about one in 7,700 subsidy users, died between the application date and the coverage start date, and ended up collecting at least some premium subsidy help while they were already dead.
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About 1,700 people who died in 2014 received at least some subsidy help in 2015 because HealthCare.gov helped those people re-enroll automatically without checking first to see whether those people were still alive.
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Some party other than HealthCare.gov submitted 2015 premium subsidy applications for about 300 people who were already dead before the applications were submitted.
Seto Bagdoyan, a GAO auditor, summarized the results of the investigation for Congress. A copy of his summary is available here.
HealthCare.gov and ACA Subsidies
Congress added the public exchange system provisions to the Affordable Care Act in an effort to create a web-based “Travelocity for health insurance.”
Exchange system supports said the system would help people compare high-quality health insurance policies from commercial insurers on an apples-to-apples basis, and to get the new ACA advance premium tax credit (APTC) premium subsidies.
Originally, states were supposed to set up and run their own exchange programs.
(Image: Centers for Medicare and Medicaid Services)
The Centers for Medicare and Medicaid Services, an arm of the U.S. Department of Health and Human Services, created HealthCare.gov to provide exchange services for residents of states that were unable or unwilling to provide exchange services.
