New and Improved HealthCare.gov Site Reopens, With Subsidies for Now

More than a year after its disastrous debut, the federal website HealthCare.gov reopened last night, giving shoppers a few days to browse ahead of the November 15 start date for open enrollment, when consumers will have 60 days to make changes or, for some, select first-time coverage under the Affordable Care Act (ACA).

Officials with HHS promised consumers a smoother, faster shopping experience, and a check of the website found it easier to load and navigate than on opening day October 1, 2013. Last year, the Obama administration had to rescue the site with a team that included experts from Silicon Valley; their work resulted in an effort that ultimately enrolled more than 7 million people between the federal and state exchanges. That ended up being slightly higher than the original estimate from the Congressional Budget Office, but it wasn’t enough to keep HHS Secretary Kathleen Sebelius from losing her job. She has since been replaced by Sylvia Mathews Burwell.

A host of changes to HealthCare.gov greet consumers this year. Most significantly, they do not have to set up an account and answer 9 questions just to shop around; they only have to enter their zip code, much like cruising an online shopping site. HHS officials have encouraged consumers to shop around and compare coverage options and various deductible choices, and they appear to be purposely keeping expectations under control by warning there will still be few glitches here and there.

As previously reported by The American Journal of Managed Care, a survey by the Kaiser Family Foundations predicted that rates in key markets would not skyrocket on the benchmark silver plan. However, that does not mean there will not be dislocations for individual consumers from the first to second year. This almost always happens in the early years of a massive program like the ACA, as actuaries on hundreds of plans gather data on actual experience and work to properly set rates.

“Consumers can prepare for open enrollment by visiting HealthCare.gov and using the window shopping feature to see what plans will be available in their area,” CMS Administrator Marilyn Tavenner said in a statement. “Using this tool, consumers can compare plans, covered benefits, and physician and hospital networks before the Marketplace annual open enrollment period starts on November 15. New features will give consumers a comprehensive picture of the plans in their area so they can choose the one that’s right for them.”

It is not clear that either the website or the subsidies that help more than 4 million Americans buy health coverage under the ACA will be in place as we know them this time next year. Republicans will gain control of the US Senate and expand control of the US House in January, following Tuesday’s midterm elections, and party leaders have vowed to overturn the healthcare law.

While it is anticipated that some highly popular parts of the law will survive, such as coverage for pre-existing conditions and allowing adult children to stay on parents’ policies to age 26, the next budget reconciliation is expected to bring negotiations on other aspects of the law, especially the individual and employer mandates.

And on Friday, the US Supreme Court agreed to hear King v. Burwell, a case that could put in jeopardy the subsidies that allow millions of low- and moderate-income purchase insurance off the exchanges. Both supporters and critics of the ACA agree on the source of the dispute: a drafting error caused the law to state that only those living in states that created their own exchanges could get subsidies. But the IRS and staff who worked on the law say that was never the intent, and in similar cases agencies’ interpretations have typically been upheld.

With anything involving the ACA, however, opponents are unwilling to let intention carry the day if the possibility exists to unravel subsidies in 36 states. This could create a politically perilous situation for Republican governors and lawmakers in states whose low-income consumers would lose coverage because they rely on a federal exchange. A summary of surveys appearing in The American Journal of Accountable Care found that consumers were using their coverage and were generally pleased with it. It is maxim in politics that once consumers enjoy a benefit, there is a price to be paid for taking it away, and those voters who experience this loss will be more motivated than others who perhaps opposed the ACA in theory.

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