Healthcare Rollout Mixed On Deadline Day

Another deadline for the Affordable Care Act has been pushed back. Guest Host Celeste Headlee speaks to Kaiser Health News reporter Mary Agnes Carey and Washington Post reporter Sarah Kliff and what the decision means and how the healthcare rollout is going across the country.

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CELESTE HEADLEE, HOST:

This is TELL ME MORE from NPR News. I'm Celeste Headlee. Michel Martin is away. Coming up, it is Christmas Eve and we're going to tell you how you can spice up your holiday party, especially the drink menu. That's in a few minutes.

But first, it is deadline day, not just to get those presents, 'cause you're really late if that's the case, but also if you want to get your health insurance under the Affordable Care Act by January 1. If that sounds like deja vu that's because the administration actually pushed back yesterday's deadline by one day. They gave you an extra 24 hours. We're joined once again by Mary Agnes Carey of Kaiser Health News. And also with us, Sarah Kliff. She's been reporting for the Washington Post on the rollout of the ACA on the state level. Mary Agnes Carey, here with me in D.C., and Sarah Kliff is in Colorado. Welcome to both of you.

MARY AGNES CAREY: Thank you.

SARAH KLIFF: Thank you.

HEADLEE: So, Mary Agnes Carey, we have this deadline and I heard today some of the info on the Internet traffic. Supposedly, the website HealthCare.gov had a million visitors over the weekend with 200,000 people calling in. And yesterday, 2 million - more than 2 million people visited the website. So is it possible that they moved the deadline 24 hours 'cause everyone's been procrastinating?

CAREY: Absolutely. People always go to the deadlines and the administration wants to have successful enrollment in the health law. They want to get as many people as they can on coverage starting January the 1. So it doesn't surprise me at all that they did this extension.

HEADLEE: Because if you miss this deadline, which is tonight at midnight, right?

CAREY: Right.

HEADLEE: You have to wait till March to get covered.

CAREY: Well, you could enroll anytime between now and the end of March. If you enroll by March 31, you won't get penalized - you won't get the individual mandate.

HEADLEE: I see.

CAREY: But the thing about it is most insurers start coverage on the first of the month, which usually means you have to apply by the 15. This is sort of a rare exception - you can apply this late and get coverage on the first.

HEADLEE: I see, OK. So - but there's also a possibility that the administration is just trying to get as many people as enrolled so they can say that they're successful.

CAREY: Absolutely. This is the president's signature domestic policy achievement. As we know, HealthCare.gov, the website you mentioned, had a ton of problems. They lost a lot of October and a lot of November to difficulties with the website.

HEADLEE: Glitches.

CAREY: The glitches and the bumps. They're trying to make up for that now.

HEADLEE: So, Sarah Kliff, you're in Colorado, but you've actually been covering this rollout on many state levels, and that's been an issue. We've actually had, I think, three or four heads of department have to resign because of state - problems with their own state exchanges, right?

KLIFF: Right. You've seen a lot of variation among the 14 states that decided to do this. These are states that do not use HealthCare.gov. They built their own websites where people in their states - places like Washington, Oregon, here in Colorado - where people here will go on their own state website. And you really see huge variation where some states like Washington and Kentucky have done an amazing job, really have received a lot of praise for doing so well.

And then other states like Oregon and Maryland have had a lot of difficulty really barely getting people enrolled. And those are two states of the four that have had their heads step down as they've really had very challenging rollouts over the past few months.

HEADLEE: And you wrote an interesting piece about perhaps the worst individual exchange, which is in Guam. What's happening there?

KLIFF: So Guam and the four other American territories, it's actually even worse. They don't get an exchange. Unlike the states, if the states said we don't want to build one, the federal government comes in. Guam, the Northern Marianas Islands and the other territories, they're in a very difficult place because only certain parts of the health care law apply.

They have the requirement to buy insurance - or they don't have the requirement to buy insurance, but they do have a requirement that insurers take every single subscriber. So the worry there is if insurers have to take everyone, only the sick people show up, and prices just get extremely expensive. And it's just because of a quirk in the drafting of the Affordable Care Act that, you know, when I talk to people from the territories, they say, any other state complaining about the health care law, you don't even know what you're talking about. Things are way worse out here.

HEADLEE: All right, so ignoring the territories, is there a, sort of, a common problem? Is there a particular problem that states are having that is, sort of, in common across the board?

KLIFF: There's no one thing that seems to be the silver bullet. When I do talk to people in states - one commonality that does come up is the states that are succeeding really realized months ago this is a very difficult task. And they decided to get rid of any bells and whistles on their websites. One example of that is a provider directory, which is actually something consumers really want. They want to know if their doctor is in network.

And some of the states that are having a more manageable rollout thought, we really do want to provide a directory. We think that's a good idea, but we just don't have the capacity in this short timeframe to build it in, in year one. So we'll probably build it in, in year two. And it's a lot of decisions like that that seem to be pretty common among the states that are succeeding. Whereas the states that are having trouble tried to do everything at once, and found they really didn't have the capacity to do anything well.

HEADLEE: If you're just joining us, we're talking about the Affordable Care Act. This is deadline day. You have until midnight to get coverage through HealthCare.gov or your state exchange in order to be covered by January 1. You just heard Sarah Kliff of the Washington Post. We're also joined by Mary Agnes Carey of Kaiser Health News. So, Sarah Kliff, let's talk a little bit about the states where it's going well. And you say that I guess what's in common is that they've decided to make it as simple as possible. Is there anything else that some of these states - we hear a lot about California going well - what else are they doing right?

KLIFF: They all have a lot of political commitment to making this work. One commonality that jumps out at you is that nearly all the states, with the exception of Nevada, that ran their own exchanges have Democratic governors who are supporters of the president and supporters of the health care law. Now that's true of other states where it hasn't gone as well. But some of them had a legislature that didn't support the law.

Some of them, you know, didn't have a strong support for this law in various branches of government. So another thing I've noticed covering the states is you really see in the ones that are succeeding just huge political backing. Steve Beshear in Kentucky is a great example of this where he's the one southern governor who's been an outspoken advocate for the health care law. And I think that's also been really important to getting the resources towards these state exchanges that are succeeding.

HEADLEE: Although politically, that's caused problems for Mitch McConnell, the Republican who's running for reelection. So, Mary Agnes Carey, I wanted to ask you - you know, there's all these people saying is the ACA working? Is it a failure? And I just have to ask, isn't it way too early to be asking this?

CAREY: I think it is because numbers alone don't tell the story.

HEADLEE: Yeah.

CAREY: There are so many unanswered questions at this point - who signs up? How many sick people? How many healthy people? How many younger people? How many older people? That's all the risk pool that you hear so much about. How does that balance out and what is the experience of people in the pool? Do they find the coverage affordable? We've talked a lot about the subsidies that are available...

HEADLEE: Right.

CAREY: ...To help people buy coverage, but not everybody gets them. So if you don't qualify for a subsidy, this may be the first time you could afford health insurance, but what does it cost you? What's covered? And who's in your network of providers? Sarah was just talking about a provider directory. There's been numerous reports of insurers as they try to keep costs down in and out of these health insurance exchanges, have decided to exclude certain hospitals or certain physician groups.

HEADLEE: Right.

CAREY: In their words, they don't think their pricing is competitive enough and so on. But we're not really going to know the success or failure of this law for years to come.

HEADLEE: Sarah, is the deadline the same for states as well? We're talking about a deadline for HealthCare.gov to get coverage by January 1, but is that the same for some of these state exchanges?

KLIFF: Not always, and I'd say it's very important to check with your state if you are one of these Christmas Eve shoppers. We saw, for example, Connecticut come out yesterday and say we're sticking with the 23. We're not changing it. This was our deadline and we're going to stick with it. So the deadline has already passed in Connecticut. There were a few states, especially ones that have had troubled rollouts, that have extended the deadline past the federal deadline already.

This is Minnesota and Maryland and Rhode Island had already extended the deadline. And they all have their own specific deadlines. So I think it's very important for shoppers out there to check with their individual state 'cause there actually is a bit of variation across the country.

HEADLEE: So, Mary, how long does it take before we start to get - I mean, we're assuming that the health care law is going to need amendment, right? There's no way that they wrote a perfect bill.

CAREY: Well, there's no way that they wrote a perfect bill, but right now, there's no consensus on Capitol Hill to make changes to the law through the legislative process.

HEADLEE: Well, they're still trying to appeal it.

CAREY: Right, and so the administration does what it can do administratively like what they just did.

HEADLEE: But how long do you think it might take before we get a good idea of how the law is working and what needs to be fixed - adjusted?

CAREY: I think it'll be well into 2014, once coverage begins, right? So whoever signs up by midnight tonight, their coverage begins on January 1. We're going to see another pressure point at the end of March with that deadline.

So as people get into the system, as they experience the coverage, then we'll know - how do they experience it? Who were their providers? Do they find it works for them, it doesn't work them? And then if this risk pool has mostly sick people and not healthy people, that's going to increase rates in the exchanges for 2015. That could increase what the federal government spends on subsidies. It could increase for individuals.

HEADLEE: Well, that's varying from state to state. I mean, in some states, we're seeing a large number of healthy, young...

CAREY: Right.

HEADLEE: ...People sign up.

CAREY: And that's the thing. It's such a patchwork of activity, we're going to have to be well into 2014 before we figure out how the rollout is doing for that year.

HEADLEE: OK. So, Sarah, what about the patchwork of polling? Why are we seeing such huge variances in the polling numbers on the ACA and whether people like it or not?

KLIFF: I think it tends to swing a bit with the news. Where you see good news about it - a million people enrolled, as the president said, on Friday. And you also see really bad news about HealthCare.gov not working and all these difficulties signing up. And it's been - one thing that doesn't seem to change, though, is if you look at the Kaiser Family Foundation, they do a tracking poll every month.

And if you take that longer look, you see that the country has been very divided on the health care law for four years, really since Congress was debating it. And when you look at that longer pattern, you see that it goes up and down, but, generally, this pattern of division that is very constant and that has not changed since the health care law passed.

HEADLEE: So, Mary Agnes, with all of these millions of people clicking on the HealthCare.gov, is the website still functioning?

CAREY: It is still functioning, but there's a queuing system that kicks in when 60,000 people go on at once.

HEADLEE: Yeah. I would imagine.

CAREY: And yeah, it's working right now. And it's definitely - people are getting messages about when to return. They've also had problems on the 800 number. Sometimes people are getting messages when to call back, sometimes not. So the site is built to handle I believe it's 800,000 users a day. But, you know, depending on the volume, if you get heavy volume in the middle of the night, it might be better for folks. So that'll be the next story we're going to hear about...

HEADLEE: Yeah.

CAREY: ...All these people that tried to get in at the last minute and maybe could not.

HEADLEE: Yeah. Procrastinators, this is why you don't procrastinate. That's Mary Agnes Carey, reporter for Kaiser Health News. A news service not affiliated with Kaiser Permanente. She was here in our D.C. studios. And Sarah Kliff is a reporter for The Washington Post. And she joined us by phone from Breckenridge, Colorado. Thanks to both of you.

CAREY: Thank you.

KLIFF: Thank you.

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