Now Application 'Inconsistencies' Vex Health Law

RICARDO ALONSO-ZALDIVAR | Associated Press

WASHINGTON (AP) – A huge new paperwork headache for the government could also be jeopardizing coverage for some of the millions of people who just got health insurance under President Barack Obama's law.

A government document provided to The Associated Press indicates that at least 2 million people enrolled for taxpayer-subsidized private health insurance have data discrepancies in their applications that, if unresolved, could affect what they pay for coverage, or even their legal right to benefits.

The final number affected could well be higher. According to the administration the 2 million figure reflects only consumers who signed up through the federally administered HealthCare.gov website and call centers. The government signed up about 5.4 million people, while state-run websites signed up another 2.6 million.

For consumers, a discrepancy means that the information they supplied, subject to perjury laws, does not match what the government has on record.

For example, someone who underestimated his income, and got too generous a subsidy as a result, could owe the Internal Revenue Service money next year.

The seven-page slide presentation from the Health and Human Services Department was provided to AP as several congressional committees investigate the discrepancies. Most of the data conflicts involve important details on income, citizenship and immigration status – which affect eligibility and subsidies.

Ensuring that health care benefits are delivered accurately is a priority for HHS nominee Sylvia Mathews Burwell, whose confirmation as department secretary is before the Senate this week.

Responding to the document, administration officials expressed confidence that most of the discrepancies can be resolved over the summer. Nonetheless, the department has set up a system to "turn off" benefits for anyone who is found to be ineligible.

Julie Bataille, communications coordinator for the health care rollout, said many of the discrepancies appear to be due to outdated information in government files – and the "vast majority" of cases are being resolved in favor of consumers. The government is making an all-out effort to reach those with various discrepancies, which officials have termed "inconsistencies."

"The fact that a consumer has an inconsistency on their application does not mean there is a problem on their enrollment," said Bataille. "Most of the time what that means is that there is more up-to-date information that they need to provide to us." For example, for people applying for coverage this year, the latest income information on record with the IRS dates to 2012, in most cases.

The May 8 document provided to the AP said that 2.1 million people enrolled through the new health insurance exchanges were "affected by one or more inconsistency" as of the end of April.

The exchanges offer subsidized private coverage to lower-income and to middle-class people who have no health care on the job. The sliding-scale subsidies are based on income and family size, and are also affected by where a person lives. Under the law, only citizens and legal immigrants are entitled to subsidized coverage.

Because the subsidies are tax credits, the IRS can deduct any overpayments to a consumer from that taxpayer's refund the following year. Conversely, if the consumer got too small a credit, that person would be due a bigger refund.

Updated numbers provided by Bataille indicate that the total number of people affected remains about the same as reflected in the document. About 1.2 million have discrepancies related to income; 505,000 have issues with immigration data and 461,000 have conflicts related to citizenship information.

The law contemplated there would be verification problems with the new program, and it provided for a 90-day window to clear up discrepancies. During this time, a consumer's coverage is not affected.

About 60 percent of all the people with discrepancies are still within that 90-day period, said Bataille. Consumers who get a request for additional information can upload documents electronically or mail them in. The HHS request is supposed to specifically describe any information that the government needs to verify.

It may not be that easy.

The document provided to AP describes a laborious effort to try to resolve the problems, largely requiring hands-on attention from a legion of workers employed by government contractor Serco, Inc.

"Current system access and functionality ... limits the ability to resolve outstanding inconsistencies," said the document. "A phased approach is proposed, initially leveraging manual processes."

Atop the priority list are citizenship and immigration issues, then annual income.

The House Ways and Means Committee will hold hearings next week on the health care data issues. The HHS inspector general is expected to deliver a report to Congress later this summer on how well the administration is doing at preventing inaccurate payments and fraud.

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