A Glitch In The ACA Marketplace No One Noticed
|By Don Sapatkin, The Philadelphia Inquirer|
|McClatchy-Tribune Information Services|
The error in the federal marketplace primarily affects households with incomes just above the poverty line in states like
The error, which The Inquirer discovered while running scores of income scenarios through Healthcare.gov, again raises questions about the site's accuracy that made daily headlines in early winter and that have cost
It also highlights what some public policy experts say is a troubling lack of transparency in the marketplace's eligibility determinations.
"It is almost impossible to work back from a decision and see what they did," said
But the official determination letters simply state the amount of your tax credit and resulting insurance premium. "I would have no idea if it's right or wrong," Solomon said.
Neither she nor other national and local health-policy analysts had noticed that the site's window-shopping tool was relying on poverty guidelines for the wrong year. Nor, apparently, had the
"This tool is intended only to be used as an unofficial estimate that consumers could use before completing their application, which is where they get their official determination,"
"While there is a small difference between the poverty levels from year to year, we will change this tool for clarity. We encourage consumers to complete their marketplace application, where they will get an accurate determination of their tax credits."
Analysts outside CMS, however, said many if not most visitors to the site probably heed the government's advice and use the tool before applying. If it responds "not eligible," they might not go any further.
"I wonder if CMS has the capacity to recontact people," said
'It doesn't help'
Most health-policy experts agreed with CMS's statement that formal applications would not be affected.
"I think this will all reconcile. But it doesn't help somebody who doesn't think they are eligible," said
He predicted the public would react to the news with a sense of deja vu: "They screwed it up again. Can't do anything right."
Though many of the website's early issues had to do with its complexity, in this case the error was simple: It's the wrong year's data.
At issue is the set of federal poverty guidelines used to determine eligibility for financial assistance. The guidelines, based on a combination of income and household size, are raised every January to keep pace with inflation. Hundreds of state and federal programs are using the new 2014 poverty levels to assess eligibility on a particular date for public benefits like food stamps and
The federal marketplace works more like commercial health insurance, and its open-enrollment period spans the last three months of last year and the first three of this year. The Affordable Care Act specified using 2013 poverty guidelines to determine subsidies this year.
Healthcare.gov is using the higher 2014 guidelines for its window-shopping tool.
In theory, tens of millions of people are getting wrong information nationwide. The new income guidelines are just 1.5 percent higher on average than the old, but the marketplace is designed so small income changes trigger corresponding subsidy differences.
And consumers whose incomes slightly exceed the high end of eligibility initially discover they are eligible for tax credits to lower their premiums. In theory, accepting a tax credit for which you're not eligible could make you liable for unpaid income tax when the
In practice, however, as people click through the website to view their insurance options, a different calculator gives more specifics -- and correctly says financial assistance is not available.
Though 400 percent of poverty is the ceiling for subsidies, 100 percent is the floor. A couple who enter an income of
If they ignored the message and clicked through to view the plans, another tool would correctly indicate they may qualify for a tax credit of
"I hadn't seen that before,"
Haile did some back-of-the-envelope calculations using data from the
But in states like
At other sites
Some states chose to run their own marketplaces. It was unknown Thursday night whether any had made the same error; a spot check of Covered California found that state-run marketplace was correct. All those states have opted to expand
Healthcare.gov is not the only website to make this mistake. The calculator at
And HealthSherpa.com, a popular site that offers detailed information akin to the government site, discovered it was using the wrong year last week, a cofounder said.
But every applicant for financial assistance must go through the federal website to get a subsidy; the main exception is if people call the 800 number, and operators there work with Healthcare.gov.
"I have to say, I probably would have made the same mistake if I were in charge," said Laszewski, the former industry executive. "But they're not supposed to make that mistake."
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