As deadline looms, health care limbo

CHICAGO – Rachel Arai is a 38-year-old stay-at-home mom with a second child on the way in February. Her family has never been without health insurance, coverage her family views not as a luxury but as a necessity.

She and her self-employed husband, Devin Stites, want to buy a policy for 2014, but like millions across the country, they've found themselves in limbo: With just days left to select coverage that will kick in Jan. 1, they lack the information needed to make a decision on what policy to buy.

The family has health insurance through Blue Cross and Blue Shield of Illinois. But they've been eager to see if they can get a better deal, and possibly a tax credit, through the new Illinois health insurance exchange set up as part of the Affordable Care Act.

The problem: Blue Cross hasn't told them how much they'll have to pay for their existing plan in 2014. And HealthCare.gov, the federal website where consumers in 36 states, including Illinois, are supposed to be able to compute their subsidy amount and buy health insurance, has been largely inoperable for many consumers, including Arai.

As the Dec. 23 deadline to obtain insurance coverage approaches, frustration is mounting across the country for people who fear they'll have little time to assess their health care options or, at worst, not be able to sign up for a plan in time because of the bumpy rollout of the health care law.

There's not much Arai and her husband can do, aside from wait and hope they get the information they need in time to ensure no gap in coverage.

"I'm really frustrated at this point, (and) I don't have hours and hours to try and get pricing on my health insurance," she said. "I'm nervous about the situation, but my hands are kind of tied. I don't know what to do, and my husband is beside himself."

For people with chronic conditions or those who require ongoing medical treatment like Arai, the loss of coverage – even for a month – could create a big financial hardship.

How the family and others like them ended up in this pickle is largely a reflection of the technological meltdown that rendered the website all but unusable in its first two months, a reordering of the insurance market spurred by the health care law and the policy reversal that followed.

New regulations under the health law that required all new policies to cover a list of 10 essential health benefits, including prescription drugs, hospitalization and maternity care, with no extra charge. That spurred insurers across the country to cancel plans for millions of Americans with private coverage, including about 185,000 in Illinois.

Massive public outcry erupted, prompting the White House to change course. President Barack Obama announced in November that states could allow insurers to offer existing policies for one more year, even if they didn't meet the new standards.

Blue Cross, the state's largest insurer that issued the majority of plans on the individual market last year, decided it would go along. But it has yet to communicate 2014 rate information to Arai and other customers.

"Every week I call they say next week. The email I got earlier this week said next week. Everything is next week, but next week never seems to come," Arai said.

Lauren Perlstein, a spokeswoman for the parent company of Blue Cross and Blue Shield of Illinois, said the company will notify its members soon of adjusted 2014 rates that reflect new taxes and fees associated with the health law.

In a letter sent two weeks ago to customers, the insurer said it would tack on an additional 4.1 percent to premiums reflect those new fees, plus another unspecified rate adjustment to account for 2014.

The insurer advises them to compare their current plan to new 2014 plans on its website to ensure they're getting the coverage that is right for them.

Other insurers that sold individual policies in Illinois this year also will offer those plans next year, including Health Alliance, which said it will increase rates on extended plans by 21.8 percent effective Feb. 1.

Humana is offering renewals for small group plans, but still hasn't made a decision about individual policies, a spokesman said. Aetna said Thursday it would not offer old plans next year.

State and federal officials have urged consumers to keep trying to access the website, which is working far better in December than in its first two months of operation. They also encourage those who need help sorting out their options to contact one of several dozen community groups across the state that have a combined 1,500 trained helpers who can help people navigate the process of signing up for coverage.

That's little consolation for Fran Schlesinger, 45, of Naperville, who has spent more than 20 hours trying to sign up for coverage on the federal website, including at least seven hourlong calls with federal call center helpers, to no avail.

After her husband lost his corporate job in 2011, her family of six has purchased coverage on the individual market. Their current policy, through UnitedHealthcare, will cost more than $1,000 a month starting in January, up from about $900.

She estimates the family will be eligible for a hefty federal subsidy to buy an insurance policy on the exchange, but the one time out of dozens that she was able to get through the application process, she inadvertently entered an erroneous income figure. The system kicked her application into Medicaid, the state-federal insurance program for those with low-income or the disabled

Once she realized her mistake, she made four calls to the federal help line, spending an hour on the phone with a helper each time. But she's still unable to remove or correct her application, leaving her locked out of the system and unable to compare the private policies her family intends to buy.

"At this point, I've thrown up my hands and said I can't deal with this anymore," Schlesinger said. "I feel like I'm in one of those hamster wheels, where you cannot get off."

Pam Lefkowitz, 53-year-old Lincolnwood self-employed IT consultant, called the entire process "the biggest nightmare."

After two months of failed attempts, the finally was able to view health plans on HealthCare.gov Dec. 2. She didn't like what she saw.

Although she'll qualify for a monthly tax credit of about $91 if she buys a plan through the exchange, the policies offered carried higher total out-of-pocket costs than her old plan from Blue Cross and Blue Shield, which she would prefer to keep, depending on how much it costs.

She received an e-mail last week from the insurer saying it would renew that plan and send her information this week on how much it would cost in 2014. As of Thursday afternoon, the letter had not arrived.

"I'm in a holding pattern," Lefkowitz said. "I'm not doing anything until I hear from Blue Cross."

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Even for enrolled, obstacles remain

Even those who have signed up via the health exchanges are running into red tape and roadblocks.

The website also has had a number of back-end issues that affect the way it notifies insurance companies of their new enrollees. The federal government said last week that about 10 percent of the enrollment forms HealthCare.gov submits to insurers have errors, including incorrect information, duplicate forms and, in some cases, missing forms.

That's down from an error rate of about 25 percent in October and November, before a host of significant repairs were made to the website, officials said. Even so, the continued issues raise the specter that some people who believe they are enrolled in a health plan may show up to a doctor's office or a hospital and find that insurers have no record of their application.

Administration officials and insurance companies suggest that anyone who enrolls in coverage via the federal website call their insurance company to confirm they've signed up. For the plan to kick in Jan. 1, enrollees also are required to pay their insurer the first month's premium by Dec. 31.

In a nod to the ongoing sign-up problems nationwide, federal officials announced several steps Thursday aimed at helping people who get stuck in health care-law limbo. The Department of Health and Human Services said patients enrolled in special insurance plans for people with pre-existing conditions would be able to stay on that coverage until the end of January.

–Peter Frost and Chad Terhune of the Los Angeles Times

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(c)2013 Chicago Tribune

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