Health Care Signups Pick Up Pace in November

Playing catch-up with a long way to go, President Barack Obama's new health insurance markets last month picked up the dismal pace of signups, the administration reported Wednesday.

Enrollment statistics from the Health and Human Services Department showed that 364,682 people have signed up for private coverage as of Nov. 30 under the federal health law. Although that's more than three times the October total, it's less than one-third of the 1.2 million people officials had originally projected would enroll nationwide by the end of November.

Crunch time is now for Obama's health care law, as consumers face a Dec. 23 enrollment deadline if they want to have coverage on Jan. 1. Yet HealthCare.gov, the revamped federal website serving 36 states, continues to have issues. Just Tuesday there was an extended maintenance outage. And some states running their own websites are also having problems.

That's created stress and uncertainty not only for the uninsured but also for consumers seeking to avoid an interruption in coverage in January. Those trying to preserve coverage include some or many of the more than 4 million people whose individual plans were canceled because they didn't measure up under the law, as well as hundreds of thousands in federal and state programs for people with serious health problems, from cancer to heart disease to AIDS.

Health and Human Services Secretary Kathleen Sebelius told the House Energy and Commerce on Wednesday that the signup trend is turning positive.

"I don't think there is any question that the flawed launch of the website put a damper on people's enthusiasm," Sebelius said. "Having said that, we are seeing very, very positive trends. We are seeing lots of people re-engage."

Another 1.9 million people have made it through the enrollment process, but have not yet picked a plan, she said. Consumers must pay their premiums by Dec. 31 for coverage to take effect at the beginning of the year.

Lawmakers have questions about how and why HealthCare.gov did not work as advertised, whether the federal website meets government security standards and how much all the repairs are costing.

In a blog post early Wednesday, Sebelius said that she has asked the department's inspector general to investigate how HealthCare.gov went off track. She wants an independent review of the contracting process, management, performance and payment issues that may have contributed to the flawed launch.

The administration report found a total of 137,204 people enrolled in the states served by the federal website by the end of November, up from 26,794 in October.

The 14 states running their own websites enrolled 227,478 people, up from 79,391 in October.

California, which is running its own program, led the nation, with more than 107,000 signups. Oregon, also running its own market, had the lowest total, with just 44 people enrolled. Florida was the leader among states with federally run markets, with nearly 18,000 signups.

Nationally, an additional 803,077 people have been determined to be eligible for Medicaid, the safety-net program shaping up as the health overhaul's early success story. That's about double the number for October. Nonetheless, state Medicaid directors are reporting accuracy problems with information on prospective enrollees that the federal government is sending them.

Although Republicans have called for Sebelius to resign, and some Democrats have urged Obama to fire those responsible, the White House has given no indication that a house-cleaning is coming. The secretary's request for an inspector general probe indicates that she realizes she has some explaining to do.

"I believe strongly in the need for accountability, and in the importance of being good stewards of taxpayer dollars," Sebelius said in her announcement. Sebelius told the committee the administration has spent $677 million on technology through the end of October.

In addition to the inspector general review, Sebelius said she has ordered the hiring of a new "chief risk officer" at the Medicare agency, which also oversees the new programs created to expand health insurance coverage under Obama's law. That official will focus on making sure technology programs work as advertised.

Sebelius also said she's ordered a retraining of her department on best practices for outside contracting.

The site went live on Oct. 1 and immediately turned into an impenetrable maze for most consumers. A two-month program of fixes directed by White House troubleshooter Jeffrey Zients stabilized the site and made it more workable, resolving hundreds of software glitches and adding more hardware to handle high demand from consumers.

Zients also found that the technical problems were compounded by inadequate oversight and coordination among teams working for the government and its contractors. That raises questions about how Sebelius and her subordinates have managed the complex program. Through the summer and into the fall, the secretary had repeatedly assured Congress and the public that the insurance markets would open for business on schedule Oct. 1.

With his poll ratings in a dive, Obama not only accepted the blame for website woes, but personally apologized for the canceled individual insurance policies. The cancellations issue is highly sensitive politically because it contradicts Obama's promise that if you like your coverage you would be able to keep it.

The president sought to calm the backlash by allowing states and insurers to extend existing plans for another year. Thirty-eight have done so, according to analysis by the consulting firm Avalere Health. But it's unclear to what extent insurers have taken advantage of the leeway granted by state regulators.

The administration had set a goal of signing up 7 million people by the end of open enrollment season March 31. HHS health reform director Mike Hash says they're still "on track" to meet it. Uninsured people who procrastinate beyond that date will face tax penalties when they file their returns for the 2014 tax year.