The new health insurance marketplaces run by the federal government and some states are not checking carefully enough that Americans who apply for health plans qualify for the coverage and federal subsidies to help pay for it, according to federal investigators.
A pair of reports, issued Tuesday by the Department Health and Human Services’ Office of Inspector General, conclude that “internal controls” for evaluating applications were not always effective at verifying people’s Social Security numbers, their citizenship, and whether they are eligible to buy health plans through the marketplaces because they cannot find affordable insurance elsewhere.
Such deficiencies “may have limited the marketplaces’ ability to prevent the use of inaccurate or fraudulent information” by consumers drawn to the insurance exchanges created under the 2010 Affordable Care Act, one of the reports said.
In the other report, the inspector general evaluated the marketplaces’ ability to verify the accuracy of information that consumers submit when they apply for the insurance and for financial help. By the end of last year, the report said, the federal marketplace alone had 2.9 million “inconsistencies” — gaps between the information applicants provided and various federal records. And 2.6 million of them could not be resolved because the computer system needed to do so “was not fully operational.”
As The Washington Post has previously reported, the most common inconsistencies involve applicants’ income and their citizenship.
The reports are the first to emerge from a series of reviews undertaken by HHS’s investigative arm to evaluate aspects of the new federal health insurance marketplace and 14 separate state-run marketplaces. The inspector general’s mission is to ferret out fraud and waste in the department’s programs.
Tuesday’s reports, from independent investigators within the executive branch, lend credence to the contention of the health-care law’s Republican detractors that the administration has not employed sufficient safeguards to prevent improper payments of the new insurance tax credits and other financial help to consumers under the law.
The broader of the two reports was required by Congress last year at the insistence of House Republicans, who made it a condition of the budget agreement that ended a partial shutdown of the government last fall.
Both reports were based on the marketplaces’ experiences from October through December. Those three months were part of the first six-month sign-up period for insurance under the health-care law for new health plans that became available at the start of this year. By the end of the sign-up period in early spring, 8 million Americans had chosen a health plan, 5.4 million of them in the federal insurance exchange, and 85 percent had received financial help.
The finding in the broader report was based on a random sample of 45 applications from the federal exchange and separate exchanges in California and Connecticut — states whose marketplaces have worked more smoothly than most.
Investigators looked at documents used by the marketplaces to determine eligibility for insurance and subsidies, interviewed the marketplaces’ staff and outside contractors, and watched the staff at work.
The report found different defects in the three marketplaces it evaluated. Connecticut’s exchange did not always adequately verify that applicants were who they said they were. California’s sometimes failed to compare applicants’ reported citizenship status with government immigration records. The federal marketplace sometimes failed to validate people’s Social Security numbers and, overall, did not always iron out inconsistencies between the applicants’ information and various federal records.
The separate inquiry into inconsistencies was based on information from the federal marketplace and 10 of the 14 state-run marketplaces, plus the one in the District. At the District’s exchange, about half the applicants had inconsistencies that raised questions about their eligibility. In Maryland’s exchange, fewer inconsistencies were reported, although it is unclear whether its low numbers were related to the fact that the state’s online marketplace was working too poorly at the time for many people to sign up.
Such inconsistencies are not proof that people are enrolled improperly or are getting subsidies that are too high or two low. Rather, they mean that the marketplaces cannot figure out which information is correct.
In the federal marketplace, the report said, the elaborate government computer system on which the exchange depends was doing well at resolving certain kinds of discrepancies, such as ones involving Social Security numbers or whether a person was in prison. But those accounted for about one in 10 of all the inconsistencies detected.
Congressional Republicans immediately pounced on the inspector general’s findings. “This report tells us that the administration was more concerned with appearances than getting anything in Obamacare done right,” said Sen. Lamar Alexander (Tenn.), the ranking Republican on the Health, Education, Labor and Pensions Committee. “They’ve allowed millions of Americans to enroll in a system that may be handing them the wrong subsidies . . . and they’ve left taxpayers vulnerable to fraud.”
Aaron Albright, a spokesman for the Centers for Medicare and Medicaid Services, the HHS agency that oversees the federal insurance marketplace, said that by now, about 425,000 inconsistencies have been ironed out. According to information from a federal contractor released last month by the Republican-led House Energy and Commerce Committee, about 4 million discrepancies had been detected by late May.
The agency, Albright said, “is working expeditiously” to make sure that people “get the tax credits and coverage they deserve and that no one receives a benefit they shouldn’t.” Other people inside and outside the government have said that progress is slow, relying on contractors to reach consumers one by one, by mail or phone.