Obama's tarnished health care law at a crossroads

WASHINGTON (AP):

All things good, bad, and unpredictable come this year for President Barack Obama's health-care overhaul as the law's major benefits take effect, along with an unpopular insurance mandate and a risk of more nerve-wracking disruptions to coverage.

The changes bring big improvements for some, including Howard Kraft of Lincolnton, North Carolina. A painful spinal problem left him unable to work as a hotel bellman. But he's got coverage because federal law now forbids insurers from turning away people with health problems. "I am not one of these people getting a policy because I'm being made to," Kraft said. "I need one to stay alive."

What's good for millions like Kraft is secured through what other people see as an imposition: requiring virtually every American to get covered, either through an employer, a government programme, or by buying a plan directly.

But the biggest health-care headlines early in the year could come from continued unpredictable consequences of the administration's messy roll-out.

online registration

The consumer-facing side of the HealthCare.gov website now appears to be largely fixed - with experts estimating that two million people have enrolled. But on the back end, insurers say they are still receiving thousands of erroneous sign-ups from the government.

That means early in the year patients who signed up could go for a medication refill - or turn up in the emergency room - only to be told there is no record of their coverage.

One of the main worries now is over certain error-tainted enrolment records that insurers call 'orphans' and 'ghosts'.

Orphans are sign-ups that the government has a record of, but they do not appear in insurer systems. Insurers say those customers never left the government's orphanage to go and live with the carrier they selected.

Ghosts are new customers that the insurer does have a record of, but mysteriously the information does not appear in the government's computers.

errors reduced

The Health and Human Services department says the rate of such errors has been dramatically reduced, and insurers agree. The catch is that the volume of sign-ups has also surged, which means even with a lower error rate the number of problem cases keeps growing. And there is no automated way to clear up mistakes; it has to be done manually.

"Some people are actually going to start using their coverage January 1, and that is a good thing for them," said Mark McClellan, who oversaw the roll-out of Medicare's prescription drug benefit - a programme that also had its share of issues. "But there are going to be problems for any number of people who thought they had signed up, and it won't work right off the bat. It would be particularly disruptive for people in the midst of treatment."

Anticipating disruptions, major drug store chains like CVS and Walgreens have announced they will help customers who face coverage glitches, even providing temporary supplies of medications without insisting on up-front payment. Many smaller independent pharmacies are also ready to help.

Obama had envisioned that the arrival of the Affordable Care Act's major benefits in 2014 would be like a national seminar, showcasing his philosophy that government can and should smooth the rough edges of an unforgiving economy for struggling working people.

The goal was that in a midterm election year, Democrats would be able to point to millions of newly insured Americans, thanks to subsidised private plans and an expanded version of Medicaid. Media reports would feature compelling cases of people literally handed a lifeline.