It is hard to imagine a more tumultuous year for health policy in the United States than 2013. Yet 2014 and the actual start of coverage expansions under the Patient Protection and Affordable Care Act (ACA) may prove to have at least as many challenges. In this health policy update, we discuss 5 of these challenges.
The fumbled roll out of the healthcare.gov website and the mixed experiences with the various state exchanges has had the biggest impact. Although many had expected bumps in the road, no one anticipated the completely dysfunctional operation of a website as critical to the enrollment of the uninsured as that experienced by healthcare.gov. The federal website has been reasonably functional since December 2013. The website, however, was a major contributor to the far lower-than-expected enrollment in private insurance by year’s end—2.1 million (including an unknown number of people who had previously been insured but whose insurance was not renewed because it did not meet ACA requirements) as opposed to the expected more than 3 million. Maryland, Minnesota, Oregon, and other states have had difficulty with their own insurance exchanges, which has contributed to the low overall numbers. Insurers have also reported substantial problems about the accuracy of enrollee information received from the exchanges; it has been hard for insurers to send premium notices to some enrollees.