The Affordable Care Act’s rocky rollout has made it difficult but even more important to take the long view on the historic health care law. Despite the technological travails and toxic politics, the law’s noble goal of expanding coverage remains critical to the nation’s well-being.
Yet there are times when frustration over continuing mistakes boils over even for the law’s staunchest advocates. One of those moments occurred with recent reports that human error at Minnesota’s Department of Human Services caused about 16,000 medical assistance enrollees to land in insurance limbo for up to six months. The ACA expanded medical assistance eligibility and the 16,000 who got stuck in the system applied through the new MNsure online exchange.
That questions can’t yet be answered about how many of these people actually went without insurance or racked up uncovered medical bills is exasperating. That it appears no one has been disciplined or otherwise held accountable is infuriating.
While the MNsure side of the process appears to have worked, a major snafu happened at DHS. The agency administers public medical programs.
Letters that were supposed to go out to the 16,000 people affected by this mistake did not get mailed. That’s a big problem because the letters notified these individuals that they needed to supply additional information to verify their eligibility for public medical assistance — such as income or citizenship info.
Until they provided this information, they weren’t officially enrolled. While it’s not clear how many of these individuals still wound up getting coverage — county workers may have helped them complete enrollment, for example, or they bought a plan on their own — this serious mistake potentially left 16,000 people thinking they had coverage but not having it.
To its credit, DHS has vowed to provide retroactive coverage for those who are eligible. Still, the muck-up will require effort to straighten out, not only from the Minnesotans affected but also by a DHS staff already stretched by the need for manual workarounds due to MNsure’s unresolved glitches.
DHS Deputy Commissioner Chuck Johnson oversaw the division responsible for the letters. Last week he said the process for sending them out was supposed to be automated but that it wasn’t during the chaotic winter of getting MNsure medical assistance applicants processed. Johnson said it was a process breakdown involving DHS, EngagePoint (a contractor) and state information technology staff that led to the letters not getting sent to a state center for printing and mailing.
Asked if anyone at DHS, EngagePoint or at the state information technology agency had been disciplined, DHS responded that the mistake “was not made by a DHS employee, so we can’t answer that one.’’
That answer doesn’t work for an agency entrusted with such important responsibilities. DHS had oversight responsibility not only for the letters, but for overseeing contractors. The letters didn’t go out for months. In addition, an Olmsted County official told the Rochester Post-Bulletin that counties were “screaming” that the letters hadn’t gone out.
Predictably, the law’s critics jumped at the chance to blast the ACA and MNsure. State Rep. Greg Davids, R-Preston, engaged in reckless fear-mongering with a July 3 letter (made public) to Gov. Mark Dayton. Among other things, Davids claimed that those affected were “likely to face federal penalties for not having health insurance.’’ The reality is that people on medical assistance are not likely to meet the income threshold for penalties assessed by the new mandate to buy coverage. In addition, DHS is making the coverage retroactive, which should preclude a penalty.
Davids’ letter wasn’t helpful. Nor are simplistic calls to scrap MNsure and go with the federal exchange website. DHS would still have to handle eligibility for the state’s customized public assistance programs. Its antiquated computer systems would still need modernizing — a complicated, costly job that’s happening slowly but moving forward. Using the federal exchange would be going back to the drawing board, not a step forward.
The ACA remains a work in progress, with the nation only seven months into the rollout of some of its most critical components. Time is needed to make this work. So is calm political leadership that takes the long view of the law’s mission while firmly pushing for accountability and improvement.