Nasty Surprise May Await People Who Thought They Enrolled In Obamacare

Unresolved technical problems on HealthCare.gov could lead to a rude surprise at the doctor's office next month for patients who think they successfully used the website to sign up for health insurance. They may find they're not insured after all.

HealthCare.gov, the federal online portal for health-insurance shopping in more than 30 states, has improved after more than a month of intense fixes, and enrollment is accelerating. But insurance companies are still getting information on their would-be customers that is garbled and incomplete, and in some cases they are getting no information at all. President Barack Obama's administration is scrambling to repair the faulty system, but scant time remains until the Dec. 23 deadline for consumers to choose a health plan that will be in place Jan. 1.

The result could be an untold number of consumers remaining uninsured despite completing the enrollment process -- another embarrassing chapter in the rollout of the Affordable Care Act, Obama's signature health care reform law.

The Obama administration insists the enrollment glitches will be fixed in time to prevent any troubles next month, but won't disclose the extent of the problem. Nor will it guarantee that any patients who fall victim to these problems won't be exposed to medical bills if they get sick or injured.

"I doubt very seriously the insurance company or the government is going to say, 'Oh, don't worry, We'll take care of it.' I think that's going to fall solely on the patient," said Reid Blackwelder, a doctor in Kingsport, Tenn., who is president of the American Academy of Family Physicians. "I wouldn't count on anybody else jumping in and bailing everybody out."

In an unusual joint press release on Wednesday, the Centers for Medicare and Medicaid Services and the largest national trade groups for insurers, America's Health Insurance Plans and the Blue Cross Blue Shield Association, emphasized their collaboration in addressing the problem. “Ensuring that all Americans who need coverage are properly enrolled is a top priority for all of us. We are working together closely to resolve back-end issues between health plans and HealthCare.gov," the statement said. "We will report on our progress.”

Insurance companies could smooth over difficulties during the first month of new coverage by paying the expenses of people who believed they were enrolled. But that would subject the companies to potentially big costs for patients who get expensive services without having yet paid a premium, or who may not be their customers at all.

Moreover, insurers may be reluctant to bear the brunt of another technical failure after having already shouldered responsibility for fixing other Obamacare problems.

Insurers grumbled last month after Obama asked them to renew health policies that had been canceled for not meeting Obamacare standards. The White House has also proposed that insurers cover the cost of birth control for workers whose employers object on religious grounds. And the administration has delayed the launch of the payment system that will transfer government subsidies under Obamacare to insurance companies.

"You'd be counting on the goodwill of the insurance company. I'm not sure how long that's going to last," said Leslie Norwalk, who was a senior official at the Centers for Medicare and Medicaid Services under President George W. Bush and is now strategic counsel at Epstein Becker Green in Washington.

Patients who show up at a doctor's office, hospital, pharmacy or elsewhere without insurance cards in hand will have to rely on the kindness of those providers, Timothy Jost, a professor at Washington & Lee University School of Law in Lexington, Va., wrote in an email.

"It is likely that there will be problems, probably a lot of them, with confirming coverage, but providers are used to dealing with insurer screw-ups and hopefully will be patient," Jost wrote.

HealthCare.gov users who go through the enrollment process to the end are prompted to connect with their new health insurance provider to make payments, which are due Dec. 31 for coverage that begins in January. Consumers who don't take action or believe they can wait for a bill from their insurance company could find themselves in the lurch next month, especially if the company has no record of their enrollment because of the technical problems.

The White House says it is incumbent on individuals to double-check that they have coverage.

"If consumers are not sure if they are enrolled, they should call our customer call center or the insurer of their choice so that they can be sure they’re covered by Jan. 1," White House press secretary Jay Carney said Monday. The administration is reaching out by telephone and email to consumers who have begun or submitted applications via HealthCare.gov, in order to advise them of the steps they must take to confirm their enrollments.

Insurance companies receive daily uploads of data about new enrollees. Despite progress since Obamacare marketplaces launched on Oct. 1, as many as one-third of enrollments submitted through the federal system contain errors, The Washington Post reported on Monday.

The administration says that error rate isn't accurate, but won't reveal how many of the submissions -- called 834 forms -- are incorrect. The White House maintains that most of the problems have already been fixed and that the rest will be resolved in time to prevent hardships next month.

The George W. Bush administration faced a similar dilemma in January 2006, when the Medicare Part D prescription drug benefit launched. Enrollees across the country visited drugstores only to find their benefits weren't in place.

"That was a point of crisis because every one of those became a story," said Michael Leavitt, who was Bush's secretary of Health and Human Services at the time.

A frenzied effort to guarantee patients' access to medications followed, while the Bush administration worked to correct the technical bugs, said Leavitt, now chairman of Salt Lake City-based Leavitt Partners, a consulting firm that has advised states on ACA implementation. "It became our problem with the system, not the consumer's problem," Leavitt said.

The Obama administration likewise needs to protect patients, Leavitt said.

"The federal government caused this, and they're the ones who are going to have to take responsibility for it," he said. "There's an obligation to make certain that people have not been seriously disadvantaged in their health by this."

Unlike during the Medicare Part D snafu, the Obama administration has no funding stream to tap to pay for medical expenses incurred by patients who encounter problems. Nevertheless, Leavitt predicted his successor, Health and Human Services Secretary Kathleen Sebelius, would take unilateral action to avoid a backlash, as the administration has on previous occasions.

"The secretary of health does not lack authority in this situation," he said. "I can't tell you the exact authority with which she would act, but you just look at the number of things they've already deferred and the way they've found flexibility, they're going find the authority."

HuffPost readers: Do you plan to try HealthCare.gov or a state-run health insurance exchange website in December? Tell us about your experience -- email jeffrey.young@huffingtonpost.com. Please include your phone number if you're willing to be interviewed.