President Joe Biden counts among his accomplishments the record-high number of more than 21 million people who enrolled in Obamacare plans this year. Behind the scenes, however, federal regulators are grappling with a problem that affects people’s coverage: rogue brokers who have signed people up for Affordable Care Act plans without their permission, or switched them to new ones. Is.
Fighting the problem creates a tension for the administration: How to thwart bad actors without impacting ACA sign-ups.
Complaints about these unauthorized changes — which could cause affected policyholders to lose access to medical care, pay higher deductibles, or even pay surprise tax bills, according to brokers Has – Has grown rapidly in recent months. Who contacted KFF Health News and federal employees who asked not to be identified.
Ronnell Nolan, president and CEO of the trade association Health Agents for America, said her group has suggested the Centers for Medicare and Medicaid Services add two-factor authentication to Healthcare.gov or notify consumers if an agent attempts to do so. Send text alert to. Access their accounts. But the agency told her it didn’t always have up-to-date contact information.
“We gave them a lot of ideas,” he said. “They say, ‘Be careful what you wish for.’ But if you can stop this fraud and abuse, we have no objection to taking additional steps because customers are being harmed.
Some? consumers are pursued When they respond to misleading social media marketing advertisements promising government subsidies, most have no idea how they became victims of scheme-change. The problems appear to be concentrated in the 32 states that use the federal exchange.
Federal regulators have declined to say how many complaints they have received about unauthorized sign-ups or plan switches, or how many insurance agents they have sanctioned as a result. But the problem is so big that CMS says it is working on technical and regulatory solutions. Affected Consumers and Agents has filed a civil suit in federal district court in Florida against private sector companies allegedly involved in unauthorized switching schemes.
Biden has worked hard to make permanent the increased subsidies first implemented during the COVID pandemic, along with other steps including increased federal funding for outreach that have helped fuel strong enrollment growth. biden contrary to their support That’s at odds with former President Donald Trump’s stance on the ACA, which supported efforts to repeal most of the law and presided over funding cuts and declining enrollment.
Most proposed solutions to the rogue-agent problem involve making it more difficult for agents to access policyholder information or requiring widespread use of identification questions tied to enrollees’ credit histories. The latter could be a barrier for people with low incomes or limited financial records, said Sabrina Corlett, co-director of the Center on Health Insurance Reform at Georgetown University.
“This is the knife edge that the administration has to walk,” Corlett said, “protecting consumers from fraudulent behavior while also making sure there aren’t too many barriers.”
Jeff Wu, acting director of the Center for Consumer Information and Insurance Oversight, said in a statement that the agency is evaluating the options on such factors as how effective they will be, their impact on consumers’ ability to enroll and how fast they can be implemented. Can. Has been implemented.
The agency is working closely with insurance companies, state insurance departments and law enforcement “to ensure that agents who violate CMS rules or commit fraud face consequences,” he wrote. And it’s reaching out to states that run their own ACA markets for ideas.
That’s because Washington, D.C., and the 18 states that run their own ACA marketplaces have reported very few complaints about unauthorized enrollment and plan-switching. Most include layers of security beyond the federal marketplace — some use two-factor authentication — before agents can access policyholder information.
California, for example, allows consumers to designate an agent and “log in and add or remove an agent at will,” said Robert Kingston, interim director of outreach and sales for the state’s ACA marketplace, Covered California. The state can also send consumers a one-time passcode to share with the agent of their choice. Consumers in Colorado and Pennsylvania can designate specific agents to access their accounts.
In contrast, when using private sector websites, agents can more easily access policyholder information that connects them to the federal ACA marketplace – all they need is a person’s name, date of birth and residence to enroll or change their coverage. situation is required.
CMS has approved dozens Such “advanced direct enrollment” websites, operated by private companies, are designed to make it easier and faster for certified agents to offer insurance through Healthcare.gov.
rules came into force Last June, agents were required to get written or recorded consent from clients before enrolling them or changing their coverage, but brokers say they are rarely asked to produce the document. If CMS makes changes to Healthcare.gov — such as adding a passcode, as California has done — it will require all alternative-enrollment partners to do the same.
The largest is San Francisco-based HealthSherpa, which helped drive 52% of active enrollment nationally this year, said CEO George Kalogeropoulos.
The company has a 10-person fraud investigation team, which has “seen a significant increase in concerns about unauthorized switching,” he said. They report problems to state insurance departments, insurance carriers and federal regulators “and refer consumers to advocates on our team to make sure their plans are made right.”
Solutions should be “targeted,” he said. “The problem with some of the solutions proposed is that it negatively impacts the ability of all consumers to enroll.”
Most people who sign up for ACA plans get help through agents or platforms like HealthSherpa, rather than doing it themselves or seeking help from nonprofit organizations. Brokers do not charge consumers fees; Instead, they receive commissions from insurers participating in the state and federal marketplaces for each person enrolled in a plan.
While California officials say their additional layers of authentication have not had much of an impact on enrollment numbers, the state’s recent enrollment growth has slowed down Compared to states served by Healthcare.gov.
Still, Covered California’s Kingston pointed to a decline in the number of uninsured people in the state. In 2014, when most of the ACA was implemented, 12.5% of Californians were uninsured, Will fall to 6.5% in 2022, according to data compiled by KFF. That year, the share of uninsured people nationwide was 8%.
Corlett said insurers have a role to play in this, as do states and CMS.
“Are there algorithms that can say, ‘This is a broker with outlier behavior’?” Insurance companies can withhold commissions “until they figure it out,” he said.
Kelly Schultz, vice president of commercial policy at AHIP, the trade association of large insurers, said sharing more information from the government marketplace about which policies are being replaced could help insurers recognize patterns.
CMS could also set limits on plan switches, Schultz said, since there is generally no legitimate need for multiple changes in a given month.
biden-teams-tightrope-reining-in-rogue-obamacare-agents-without-slowing-enrollment-kff-health-news
