Oregon is still using paper applications to enroll people in coverage under the Affordable Care Act.
Monday is the last day Americans in most states will be able to enroll in Affordable Care Act health exchanges if they want coverage to start in January. But technical problems have foiled sign-ups from the start, which led an otherwise obscure number to become a big deal in 2013.
The government code for electronic files — 834 — came up a lot in the news this fall. What is it? The 834 forms are read by computers, not humans. They give insurance companies basic information about customers — name, contact information, social security number — so the health plans can enroll consumers. It's critical they get to insurers accurately so insurance plans can bill for premium payments and start coverage.
"It's remarkable that this obscure decades-old data file format has actually been so much in the news this fall," says Larry Levitt, a health industry watcher with Kaiser Family Foundation. He says 834's would never have gotten this kind of attention had HealthCare.gov actually worked smoothly at launch.
"There was a bit of [a] hidden problem with these 834 files [in October and November], so even when people could get through the system and actually apply for coverage and pick a plan, it turns out that much of the information was never making it to the insurance company," Levitt says. "In the first couple of months as many as 15,000 people simply didn't even exist in the 834 files. That problem seems to have gone away."
The 834 files may be sending clean information now, but for the previously missing or inaccurate files, reconciling the data entered into HealthCare.gov with information insurance plans received started early this month.
"We are in the process of actually hand-matching individuals with insurance companies," Health and Human Services Secretary Kathleen Sebelius said on Capitol Hill in early December.
The rush to finish matching files and process the enrollments still coming in had some people panicked about gaps in coverage. That's because an administration rule said consumers were required to send in their first month's premium payment by the end of December for coverage to start in January. But given the thorny back-end problems with the 834's, health insurance plans have extended the payment window to Jan. 10.
"They wanted to make sure consumers could have peace of mind, that they could enjoy their holiday break with their families and not worry that their payment did not make it there by Dec. 31," says Robert Zirkelbach, who represents the insurance industry group America's Health Insurance Plans.
President Obama says he expects the mismatched files and missing information will be fixed in time for people to get their coverage in January.
"Then I think all eyes will turn to January," says Levitt. "To make sure people who think they have coverage actually are insured and can go to the doctor, go to the pharmacy, and get services."