CMS Confident as HIX Deadline Nears

After stumbling at the starting line, federal officials are pushing for a strong finish in the inaugural open enrollment period for the new public health insurance exchanges. And they're offering some individuals a deadline extension.

In contrast to the fall's nearly disastrous rollout of the federal government's public exchange website, HealthCare.gov, a hopeful spring appears to be dawning.

As Monday's open enrollment deadline to obtain individual policies on the exchanges approaches, the Obama administration has reported a signup surge.

With about 800,000 people enrolling in the first two weeks of March, more than 5 million individuals have obtained health insurance policies through the exchanges, federal officials say.

On Tuesday night, federal officials confirmed that consumers who have started but not completed the enrollment process by the March 31 deadline will have the option of requesting an extension. As recently as March 12, in testimony before the House Ways and Means Committee, Secretary of Health and Human Services Kathleen Sebelius rejected the prospect of a deadline delay.

Unless there is an enrollment flood in the final two weeks of this month, the exchanges will fall well short of the 7 million enrollee goal set by Sebelius last July. But officials at the federal agency administering the exchanges are sounding a confident note about the sustainability of the new markets.

"As this historic open enrollment period for the Health Insurance Marketplace enters its final days, we've seen the momentum gathering across the country," a spokeswoman at the federal Centers for Medicare and Medicaid Services told HealthLeaders on Monday. "Since October 1, more than 5 million people have signed up for coverage through the Health Insurance Marketplace, and we're continuing to work hard to ensure that every American who wants to enroll in affordable coverage by the March 31 deadline is able to do so."

And CMS officials are expressing confidence in the new exchanges as they look to the future. On March 14, CMS released its Final 2015 Letter for the public exchanges, which set several rule changes for the exchanges next year. Also on March 14, CMS released a 278-page document which proposes more rules changes for 2015 such as protecting exchange navigators from state interference.

"Based on the experience of this open enrollment period, we are also already looking ahead to 2015 and have taken steps to provide early guidance and certainty stakeholders need to provide affordable health coverage next year and beyond," the CMS spokeswoman said.

After reviewing the lengthy document detailing proposed rules changes, a legal analyst at Wolters and Kluwer's Health Reform KnowlEDGE Center in Illinois said its title, Patient Protection and Affordable Care Act; Exchange and Insurance Market Standards for 2015 and Beyond, uses language "not typical of HHS," noting the similarity to the Buzz Lightyear catchphrase, "To infinity … and beyond!"

"If there is a message, it is 'we're here to stay,'" said analyst Michelle Oxman.

Executives at ikaSystems, a Massachusetts-based company that has been helping insurers operate on the public exchanges, say policy carriers are banking on the exchanges to become a permanent fixture of the broader health insurance market.

"We aren't betting against the likelihood that CMS and the administration are able make the exchanges 'sticky,' and, perhaps more importantly, our health plan customers believe that the move to individual markets and exchanges is here to stay," Brian Kim, senior VP for account management at ikaSystems, said Monday.

He said there is little doubt that the exchanges have taken hold, but uncertainty lingers about how the exchanges will evolve over time. "The question is really about what form they will take based on the forces that support, contest and seek to shape the exchanges."

"On that note, we necessarily take a pragmatic view, individual adoption could be modest or massive, small businesses could flock to them or move into private exchanges, the regulatory and administrative requirement changes could be minor or major. All we can do," said Kim, "is help our customers manage the ambiguity by fostering nimbleness and flexibility through solution design and modularity."