So few applicants have gotten far enough along in Obamacare's enrollment process at Healthcare.gov that insurers are only beginning to be able to assess the true depth of the site's technological problems.
But there are red flags beyond the error messages that have been publicly visible. This was my takeaway from a Wednesday conversation with an insurance industry source.
As originally envisioned, Healthcare.gov (which serves the residents of 36 states) was supposed to enable individuals to shop for health insurance starting Oct. 1, 2013, just as they would shop for airline tickets on Orbitz.
But unlike Orbitz, Healthcare.gov makes consumers seeking information on their available choices go through a multi-step process to create an account and then log in and enter personal information.
Administration officials imposed these extra steps because they didn’t want consumers to see the base price of the health insurance plans offered – which are inflated by new regulations – before the system could collect their income data and calculate what they’d pay in premiums after receiving government subsidies.
Affirming what health industry consultant Bob Laszewski has written, my source said that insurers have received a relatively small trickle of enrollments through the federal website, but they are seeing problems.
Duplicate enrollments are a recurring issue. This means that the insurer is notified that somebody has enrolled in an insurance policy through the government exchange, but then receives another notice that the same person has un-enrolled, followed still later by another one that they re-enrolled, and so on.
As of now, it’s unclear whether this duplication problem is triggered by a failure in the way Healthcare.gov interacts with the systems of insurers, or if shoppers on the federal exchange are enrolling and un-enrolling themselves as they go through the selection process. Insurers can’t ascertain the ultimate choice of the shopper because there are no time stamps attached to transactions on the site.
Other potential challenges involve whether the website will be able to properly communicate with a massive federal data hub to verify applicants’ income accurately, calculate subsidies they may be entitled to under the law, and display the correct plan price.
There’s also a question of whether the federal website is properly displaying information about plan deductibles, co-payments, and benefits.
Administration officials have emphasized that Americans have until the end of next March to purchase health plans through the exchanges.
But insurers are focused on a much earlier date: Jan. 1. That’s when the insurance plans will start to become active. The nightmare scenario for insurers would be if, at the beginning of the new year, they are bombarded by complaints from consumers who, based on information displayed on the federal website, were expecting a certain set of benefits that don’t correspond to the plans to which they signed up.
This doesn't even get to the broader health policy issue. The success of Obamacare hinges on the exchanges being able to enroll enough young and healthy individuals to offset the cost of covering older and sicker patients, particularly those with pre-existing conditions.
Given that Americans with higher medical costs are more likely to endure an arduous enrollment process than healthier individuals, sustained technological problems could be devastating to the program.
Right now, there isn’t enough data available to say whether insurers are achieving the right mix of enrollees. In the past, administration officials have said that roughly 40 percent of the expected seven million enrollees need to be from the young and healthy demographic.
But they have been mum about how many people have successfully enrolled through the federal website so far, saying that they won’t be able to make that information available until the middle of November.
For now, insurers are waiting for the federal system to start sending them a more robust stream of applicants so that they can begin to comprehend the scope of the problems.
But, if the technological issues don't get cleared up in the next month (looking less likely) or if new problems arise once applicants get further along in the process (more likely), Obamacare could turn out to be a bigger disaster than even its most ardent critics predicted.