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Physicians caught in politics of ACA enrollment data


Based on industry data collected through April 15, the GOP-led House Energy and Commerce committee estimates that only 67% of healthcare exchange enrollees have paid their premiums.

Though the White House estimates that 8 million people signed up for insurance through healthcare exchanges from October 2013 to April 2014, some Republicans in the U.S. House of Representatives are disputing the number of enrollees who have paid their premiums.

The GOP-led House Energy and Commerce committee sent requests for enrollment payment data to each insurance company featured on the Healthcare.gov website, and from responses gathered as of April 15, only 67% of healthcare exchange enrollees have paid their premiums. The committee says that because the White House did not capture payment information as people signed up for insurance on Heathcare.gov, it had to solicit the information directly from health plans.

"“The administration continues to leave too many questions about its health care law unanswered," House Energy and Commerce Committee Chairman Fred Upton (R-MI) said in a statement. "What can we expect premiums to be next year? Will more people lose the health care plans they have and like? These are the questions that will impact the American people the most and they deserve answers.”

Representatives from Aetna, Cigna, the Health Care Services Corporation (HCSC), Wellpoint, America’s Health Insurance Plans (AHIP), and the Blue Cross Blue Shield Association were invited to speak in front of the House committee on the status of enrollment on Wednesday, May 7.

Aetna and the HCSC, which operates Blue Cross Blue Shield plans in five states, submitted testimonies on Wednesday stating that the number of enrollees who have paid premiums are well over the committee estimates. Aetna reported payment rates "in the low-to mid-80% range." The HCSC reported that as of April 1, 83% of their enrollees have paid premiums. In March, Politico reported that 15% to 20% of healthcare exchange enrollees hadn’t paid insurance premiums; a percentage that White House officials also corroborated.

Next: Why enrollment payment estimates differ


Clare Krusing, director of communications for AHIP, adds that many states with high enrollment rates, such as California, have yet to report final enrollment numbers and were not included in the House committee’s data. There are many other factors that cause skewed enrollee payment numbers including:

  • state plans with flexible first-month premium dates;

  • enrollment changes due to customers terminating plans or reporting life changes;

  • duplicate enrollments; and

  • retroactive changes that may not be accountable until after June 1.

"Health plans are doing everything they can to ensure that consumers know they need to pay for coverage. At any point in time, enrollment may vary as consumers transition into new coverage options as a result of changes in family circumstances," Krusing says.

Physicians are caught up in the politics of the situation, because patients who have enrolled in health plans, but have yet to pay premiums, may still make appointments. Due the 90-day grace period that is included in the Affordable Care Act, physicians take on the majority of the risk of nonpayment from patients.

In March, the American Medical Association, which has been advocating against the 90-day grace period provision, provided several resources for physicians to assist them will collections if patients receive services and don’t pay their premiums.

Next: Related ACA content


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