WASHINGTON (AP) — Many of the 8 million Americans signed up under the new health care law now have to clear up questions about their personal information that could affect their coverage.
A government watchdog said last week the Obama administration faces a huge task resolving these "inconsistencies" and in some cases didn't follow its own procedures for verifying eligibility.
Two reports from the Health and Human Services inspector general marked the first independent look at a festering behind-the-scenes issue that could turn into another health law headache for the White House.
The inspector general found that key personal details submitted by many consumers — such as annual income and citizenship — do not match records the government has on file.
It also found shortcomings in the internal safeguards used by the federal insurance exchange and some state marketplaces to check the accuracy of consumer information.
Those personal details are critical because they determine whether an individual is eligible for taxpayer-subsidized health insurance, as well as subsidies for monthly premiums.
Digging out from under the data problem is one of the top challenges facing newly installed HHS Secretary Sylvia Mathews Burwell.
The administration says it is doing just that. Spokesman Aaron Albright said more than 425,000 inconsistencies have been resolved so far, more than 90 percent of those in favor of the consumer. The administration is hoping to clear up the majority of cases this summer, but may yet have to resort to an extension allowed under the health law.
The inspector general found that the federal insurance exchange reported a total of 2.9 million inconsistencies with consumer data from Oct. 1, 2013 through Feb. 23 of this year.
At the time, the administration had limited technical capability that would have let officials resolve roughly 330,000 of those cases. Only about 10,000 were actually cleared up within the period. Albright said the situation is much improved.
The inspector general said several states running their own insurance markets were having similar problems.
Most discrepancies dealt with citizenship and income information supplied by consumers that conflicted with what the federal government has on record.
The inspector general said efforts by the administration and states to clear up questions were complicated by lingering computer problems, including outages at the federal data hub, a key system that pings agencies like Social Security and the Internal Revenue Service for verification.
The inspector general's inquiry was requested by congressional Republicans as a condition of ending the budget standoff that partially shut down the government last fall. Republicans say they are concerned that people who are not legally entitled to the law's government-subsidized health insurance could nonetheless be getting it.
"This report is one more example of just how flawed the president's health care law is," Senate Republican Leader Mitch McConnell said in a statement. "Whatever one's opinion of Obamacare, the American public deserves to know that their tax dollars are allocated appropriately and that public officials take their responsibility to accurately and faithfully apply the laws enacted by Congress seriously."
The inspector general stopped short of drawing sweeping conclusions.
"Inconsistencies do not necessarily indicate that an applicant provided inaccurate information ... or is receiving financial assistance through insurance affordability programs inappropriately," the report said.
However, the watchdog office called on the administration to publicly explain how and by what date it will resolve the data problems in the 36 states where Washington is operating new insurance markets.
In a written response, Medicare chief Marilyn Tavenner said the administration concurs with the recommendations and is working on a plan, calling the problems "not surprising."
The inspector general also found that:
— Early on, the government's eligibility system was "not fully operational." As a consequence, even if a consumer supplied the appropriate documentation, officials were not able to close the case.
— States running their own insurance markets had a mixed record of dealing with eligibility problems. Of the 15, including Washington, D.C., seven said they cleared up problems without delay. Four said they were unable to resolve inconsistencies.
— Most of the data discrepancies in the federal market had to do with citizenship and immigration status. Only citizens and legal immigrants can receive coverage under the law. Income was the next category, in many cases because the most recent tax returns on file with the IRS were for 2012 and reflected outdated information.
— The federal insurance exchange didn't always verify Social Security numbers through the Social Security Administration, as required by its own internal safeguards. The California marketplace didn't always verify citizenship and legal presence through Homeland Security.
Last month, The Associated Press reported that 2.1 million people enrolled for coverage under the health law had at least one data discrepancy as of April 28. That information came from an administration document provided to the news service.
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Posted on Tue, July 8, 2014
by Ricardo Alonso-Zaldivar, Associated Press