At midnight Monday, the official deadline arrives for Americans to sign up through the new federal health insurance exchange for health plans that begin Jan. 1. But, without any public announcement, Obama administration officials have changed the rules so that people will have an extra day to enroll, according to two individuals with knowledge of the switch.
Over the weekend, government officials and outside IT contractors working on the online marketplace’s computer system made a software change that automatically gives people a Jan. 1 start date for their coverage as long as they enroll by 11:59 p.m. Christmas Eve.
The switch is the most recent rule change — some by government officials, and at least one by the insurance industry — as a milestone approaches for what has been a tumultuous three-month start of the long-awaited opportunity for Americans to buy new health plans under a 2010 law intended to reshape the nation’s health-care system.
For the first two months of the sign-up, a federal Web site, HealthCare.gov, had so many software and hardware defects that many consumers who wanted to select insurance were frustrated by error messages. And administration officials held off on a planned campaign to urge people to take advantage of the opportunity for new insurance.
At the start of this month, Obama administration officials announced that the Web site was largely working smoothly and began to urge consumers to sign up for coverage before the Dec. 23 deadline. The full open-enrollment period extends through the end of March, but the first deadline is for people who want coverage to start on New Year’s Day — the date it becomes available.
The change means that anyone who completes an enrollment by the end of Christmas Eve can get coverage starting Jan. 1, even if they do not begin an application until Tuesday.
One individual familiar with the unannounced extension said that it is, in part, intended as a buffer in case the Web site has trouble if a last-minute surge of insurance-seekers proved more than the computer system could handle. According to the two individuals, both of whom spoke on condition of anonymity about a matter that is not public, the one-day extension is automatic, built into the software, and cannot be overridden by individual insurers if they object.
Asked to explain the reason for the extension — and why it was kept secret — officials at the Centers for Medicare and Medicaid Services, the federal agency overseeing the health exchange, at first declined to respond. Then CMS officials issued two statements, the second rewording the previous one. In the first statement, Julie Bataille, director of CMS’s office of communication, said the official deadline for signing up for Jan. 1 coverage remains Monday, but she added: “Anticipating high demand and the fact that consumers may be enrolling from multiple time zones, we have taken steps to make sure that those who select a plan through tomorrow will get coverage for Jan 1.” The second statement omitted any mention of an extra day, referring only to a “fail-safe.”
An administration official, speaking on the condition of anonymity, said computer systems had been programmed to accept consumers who try to enroll through Dec. 24, “proactively recognizing that we need to be prepared to handle heavy online traffic or other technical issues.”
In recent days, insurance industry leaders have protested other 11th-hour rule changes by the administration. They include a decision late last week by the Department of Health and Human Services to offer an exemption from a requirement that most Americans have insurance as of Jan. 1. The exemption applies to people whose health plans are being canceled because the policies failed to meet new federal benefits standards.
On Monday morning, one insurance industry official, informed by The Washington Post about the quiet deadline extension, criticized the move. “Making yet another last-minute change to the rules by shortening an already-tight time period in which to process enrollments makes it even harder to ensure people who have selected a plan are able to have their coverage begin in January,” said the official, who spoke on the condition of anonymity because the change has not been made public.
HHS Secretary Kathleen Sebelius this month asked insurers participating in the federal marketplace to grant several kinds of flexibility to customers — including allowing them to sign up for health plans in January and make the coverage retroactive to New Year’s Day. Many insurers have refused to go along. But the insurance industry’s main trade group, America’s Health Insurance Plans, last week made its own policy change, saying that anyone who signed up by Dec. 23 would be given until Jan. 10 to pay their first month’s insurance premium.
During December, enrollment through the federal marketplace has increased significantly from a meager start during the first two months — but it still lags behind the Obama administration’s expectations. As of Sunday, the total enrollment through the federal marketplace was roughly 890,000, according to government figures that have not been made public. That compares with about 137,000 who had signed up by the end of November, and about 227,000 more who had signed up by then through the 14 state-run marketplaces.
In contrast, a Sept. 5 HHS memo, obtained this fall by the Associated Press, projected that the enrollment nationally would hit 3.3 million by the end of December.
Around the country Monday, people signing up for coverage, and workers called “navigators” who have been trained to help them, were largely unaware that they suddenly had an extra day. Navigators reported that they were being inundated with walk-in clients and phone calls from people anxious for their insurance to start next month — many of them people, including some who are very ill, who had started applications in the fall but found themselves stymied by the computer system.
Navigators in Illinois and Kansas reported that the Web site worked relatively smoothly, but not entirely. Some consumers were placed in online queues — a relatively new feature of HealthCare.gov for periods when the site has more traffic than it can handle; rather than being allowed to apply on the spot, the system collects information to notify people by e-mail when they can return.
An administration official said this queuing began at about 11 a.m. Monday and was intermittent, as traffic ebbed and flowed through the day.
Others had difficulty getting their identities verified or were booted out of the system while shopping for plans. Navigators said that such logistical complications — Monday or in the past — seemed to be prompting anxiety among some people, including those with pending medical appointments.
For example, Caitlin Zibers, a patient navigator at Health Partnership Clinic in Olathe, Kan., was planning Monday afternoon to help enroll a young man who had called in the morning saying he desperately wanted insurance because he needs a liver transplant and is scheduled to see a specialist in late January. Two other people whom Zibers attempted to help Monday morning encountered messages on the Web site that the system was overloaded and that they should try later.
Elsewhere in Kansas, navigators were having more luck. Valorie Libertus, a navigator in Emporia, Kan., said she had barely sat down at her computer at 8 a.m. when her first client of the day arrived and told her, “I hear this is where I need to be for insurance.” Within 30 minutes, the woman was enrolled in coverage and on her way to work.
Libertus said she and her colleagues at Flint Hill Community Health Center were so inundated with appointments and walk-ins that they were expecting to work far past the 5 p.m. closing time and would probably still need to turn people away.
Told about the extra day, she said she was relieved. “If we can squeeze a few more in tomorrow, I’m happy to do it,” she said. “We didn’t know, but that way we can push a few more in, bring a few more people in our doors.”
Beyond the unannounced extension through Christmas Eve, senior administration officials have pointed out during the past two weeks that rules under the law allow a “special enrollment period” for customers who tried and failed to meet the regular deadline.
One official, who asked not to be identified to discuss ongoing operations, told reporters Thursday that health officials “are working through that guidance right now in terms of how that would work for consumers, so that all those who make a good-faith effort to get enrolled by the deadline will get the effort for them to get covered and get it right.”
The administration has also hired an additional 800 people to handle calls from consumers seeking to enroll on the federal exchange, bringing the total number of call center staff to 12,000 in 17 sites across the country.
The official federal sign-up deadline, Dec. 23, is the same as the deadline in some of the 14 states running their own insurance exchanges. But a few states have decided to give their residents more time.
Maryland and Oregon, for example, extended the deadline until Friday. Washington state announced individuals had until Jan. 15 to sign up on its exchange, but only if they had started their applications by 11:59 p.m. Monday and encountered problems completing them.