ACA Exchange Enrollment Begins, Despite Government Shutdown

By Jennifer Larson, contributor

October 2, 2013 - The federal government shut down, but the implementation of the Affordable Care Act rolls on.

When Congress was unable to reach an agreement on a funding bill to allow the federal government to continue to operate into the new fiscal year by midnight on September 30, a shutdown went into effect.

The government shutdown created a major pitfall for the U.S. Department of Health and Human Services (HHS). The department decided it had to furlough more than half of its employees, even though it is faced with the task of running the new federal health insurance exchanges open for enrollment in the states other than the 16 that have chosen to run their own marketplace.

Some of the HHS agencies that announced furloughs for a significant numbers of employees included the National Institutes of Health (NIH), which announced it would have to furlough approximately three-quarters of its employees. About 65 percent of the Centers for Medicare and Medicaid Services’ (CDC’s) employees have been furloughed, as well.

However, the American Hospital Association (AHA) reported the news from CMS that Medicare Administrative Contractors will continue to process and pay Medicare fee-for-service claims during the shutdown. In addition, “States continue to have funding for Medicaid and the Children’s Health Insurance Program due to the advanced appropriation enacted in the fiscal year 2013 appropriations legislation,” the AHA noted in a daily email news briefing.

The shutdown coincided with another problem that developed on Tuesday, October 1.

Many consumers were waiting for October 1 because it marked the beginning of open enrollment for people seeking health insurance coverage via the marketplaces, or insurance exchanges, that were prescribed by the Affordable Care Act (ACA). Kaiser Health News reported that the Congressional Budget Office expects approximately 14 million Americans (of the roughly 48 million Americans who are currently uninsured) to get coverage in the first year, through Medicaid expansion or the exchanges. The open enrollment period will last through March 31, 2014, although anyone who signs up by Dec. 15 should begin receiving coverage on January 1.

However, the interest seemed to overwhelm the system.

Numerous media outlets, including Bloomberg and Kaiser Health News, reported that so many people tried to access the new health insurance exchanges’ website that it crashed. Several states’ insurance portals were still down late Tuesday afternoon. Others were running very slowly or, as in the case of Colorado, were so inundated with traffic that they were temporarily unable to let users set up new accounts. Connect for Health Colorado eventually was back up and running later in the day.

Pres. Barack Obama appeared to be unfazed by the glitch, saying on Tuesday, “Like every new law, every new product rollout, there are going to be some glitches in the sign-up process along the way that we will fix.”

He also echoed the remarks made earlier this week by HHS Secretary Kathleen Sebelius when he said, “I don’t remember anybody suggesting Apple should stop selling iPhones or iPads, or threatening to shut down the company if they don’t,” Obama said, noting that one million people visited before 7 a.m. on the opening day.

Some associations expressed relief that the enrollment period for the exchanges had arrived without being derailed by the shutdown.  However, many also expressed concern for the long-term repercussions of the shutdown.

For example, Judith Lichtman, senior advisor for the National Partnership for Women and Families, noted, “While the government shutdown did not keep the health insurance marketplace from opening, the harm it is causing has serious consequences for women and families, communities and our economy. While members of Congress worry about how a shutdown affects them politically, families are worrying about how to make ends meet, pay the bills and simply survive.”

And Darrell G. Kirch, MD, president and chief executive officer of the Association of American Medical Colleges (AAMC), released this statement: “The AAMC is profoundly disappointed that Congress was unable to come to an agreement to avert a government shutdown. While the nation’s teaching hospitals and their medical school physicians will continue care for all patients who need their services, physicians conducting medical research and training the next generation of doctors will begin to feel the impact of a shutdown almost immediately.”

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