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A Year Later, HealthCare.Gov Has Found Its Footing But Problems Remain

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A Year Later, HealthCare.Gov Has Found Its Footing But Problems Remain

Health Care

A Year Later, HealthCare.Gov Has Found Its Footing But Problems Remain

A Year Later, HealthCare.Gov Has Found Its Footing But Problems Remain

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  • <iframe src="https://www.npr.org/player/embed/353048433/353048434" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
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Robert Siegel talks to Marilyn Tavenner, administrator for the Centers for Medicare and Medicaid Services, about the one-year anniversary of the Affordable Care Act insurance marketplace rollout.

ROBERT SIEGEL, HOST:

Joining us now is Marilyn Tavenner, as administrator of the Centers for Medicaid and Medicare, she runs healthcare.gov. Marilyn Tavenner, thank you very much for joining us.

MARILYN TAVENNER: Thank you.

SIEGEL: From what we hear, the online exchanges are now working well on the front end, where people sign up, but not so well on the backend, where insurers should be getting information about enrollees. Why is that still problematic?

TAVENNER: Well, I think there is some confusion about what is working on the backend. In fact, insurers do get information about who's enrolled. And we exchange information back and forth with insurers and that's how we are aware that we have 7.3 million enrolled to date. The backend that has yet to be completed, that people often referred to as what we call some of the financial management package, which is not critical for consumers. But in 2015 and beyond will be critical for insurers.

SIEGEL: But does that mean that the exchange system remains, a year into its life a work, in progress?

TAVENNER: I would say it is a work in progress in terms of completing the financial management package but I'd say we've come a long way. And we have done a great deal of technology improvements, particularly around the customer experience. We've also now this year will be adding not only new enrollees but reenrollment. So there's very little left to be completed. And what needs to be completed in financial management is actually work that was not planned to come online until mid-'15.

SIEGEL: What kind of new enrollees are you targeting and how you are targeting them?

TAVENNER: So it's early on in the outreach strategy and we'll certainly get more active. But we'll be looking at enrollment by market. And so we'll certainly go back to some of the original markets but we'll be looking for new markets.

SIEGEL: But what's an example of a new market where you'll be going, looking for new enrollees?

TAVENNER: Well, I'd probably say some of the secondary markets. Let's take North Carolina - a Raleigh, a Charlotte. Maybe in Virginia, Richmond was a primary market. We may move into Norfolk and Roanoke and other markets this year. So those are some examples of close to D.C.-type markets.

SIEGEL: Some people say that next year it's going to be different because the penalty for being uninsured rises to either $325 or 2 percent of taxable income, which, by my arithmetic for somebody with $75,000 taxable income, would be $1,500 - a lot more than in year one. Is there some advantage to having people know what their tax returns are going to look like before the open enrollment period?

TAVENNER: Yes, I think you're right. The penalty does increase over time and I think you'll see us start to talk more about the penalty going into year two and into year three, where it starts to be more significant. In year one, we were just trying to introduce people to the market and help them understand the importance of being insured.

SIEGEL: Before Obamacare, it was noted that the individual market for health insurance was a very, very fluid market. And many, many people were in and out of policies in the course of a year, often depending upon their employment status.

TAVENNER: Yes.

SIEGEL: Have you seen that same kind of churning over the past year?

TAVENNER: You know, it is too early for us to know. But one thing we do know is that to have 7.3 million individuals enrolled in mid-August tells us that the churning has been much smaller than even we would've anticipated. And also, what we're seeing is more choice for consumers. In 2015, there'll be a 25 percent increase in the total number of insurers selling in the individual market. We've seen a substantial reduction in the uninsured, which tells us that the churning has probably slowed down some. But these are things that we'll learn in year two and year three and beyond.

SIEGEL: Totally apart from issue of health insurance - has there been any rethinking within HHS, or the federal government more broadly, about how you go about a big online launch of a system, whatever the system may be?

TAVENNER: We certainly made some mistakes last year. We've learned from them. I'd say that we made changes in management and that we brought on some external talent. In a six month period, we probably, you know, did something that hadn't been done before. And 7.3 million Americans have benefited from that and we look forward to year two and having more Americans benefit from this type.

SIEGEL: Marilyn Tavenner, thank you very much for talking with us.

TAVENNER: Thank you, sir.

SIEGEL: I assume you're feeling better this year at this time than you were last year?

TAVENNER: I am indeed.

SIEGEL: Good. Marilyn Tavenner is the administrator of the Centers for Medicare and Medicaid. And part of her job is running healthcare.gov. She joined us on this first anniversary of its rollout.

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