Deadline Extension Isn't Altering ACA Advocates' Enrollment Strategies

Federal officials may have announced an extension this week for individuals who were in the process of enrolling in health plans through the federal insurance marketplace, but Texas advocates of the federal health reform law are still pushing individuals to finish the process by the original deadline. Meanwhile, opponents of the law criticized the Obama administration for its decision, saying it's another example of how the health law is severely flawed.

The extension could give individuals in Texas — where roughly one in four individuals are uninsured — additional time to complete their enrollment process through the marketplace if they were unable to do so before because of technical complications or a potential last-minute enrollment surge, as the Obama administration attempts to meet its expectation of enrolling 6 million Americans through the Affordable Care Act. The law requires most individuals to sign up for health insurance this year or face financial penalties.

Individuals who had begun to apply for health insurance on healthcare.gov but were unable to finish by Monday can qualify for an extension if they attest during the application process that they have tried to obtain insurance before the deadline, federal officials said Wednesday during a conference call. Officials will rely on an honor system — they will not verify or investigate such assertions.

“Just like election day, if you’re in line when the polls close, you get to vote,” said Julie Bataille, director of communications for the Centers for Medicare and Medicaid Services. “We won’t close the door on those who tried to get covered and were unable to do so through no fault of their own.”

John Davidson, a health policy analyst at the Texas Public Policy Foundation, a conservative think tank, said he was surprised that federal officials would rely on an honor system for a national system that involved millions of applicants.

“It’s a testament to the ways in which the law was not fully thought out and not ready for prime time,” Davidson said, adding that the extra time used for enrollment could drive up premiums next year because older individuals or those who had recently fallen sick, and not young adults, were more likely to use the extension.

The Obama administration has said that young adults — who are often healthier than older individuals and have fewer medical costs — should make up about 40 percent of individuals who sign up for health insurance through the marketplace to keep premiums down by offsetting the costs of older, higher-risk patients.

Despite the extension, federal health reform advocates working in Texas said they were encouraging individuals to enroll and choose a plan in the marketplace by Monday.

“It’s good news for Texans that people who have started the enrollment process and run into challenges … will be able to get affordable health insurance. But this doesn’t change the focus on March 31,” said Christine Sinatra, state communications director for Enroll America, a nonprofit group promoting the federal health reform law.

Enroll America’s efforts have included regular phone banks to follow up with individuals who might have begun their application process at one of the group's enrollment events but did not complete the process.

The Texas Organizing Project, a group that advocates for low-income Texans, is taking a similar approach, focusing on reaching out to individuals and getting them to enroll by Monday. But the announcement of the extension decision, ahead of "deadline weekend,” could reduce the rush to get through the entire process this weekend, said Tiffany Hogue, health care campaign coordinator for TOP.

“It does help to come out before this deadline weekend to let Americans know that as long as they start the process before before 11 p.m. on the 31st, they’ll be able to finish,” Hogue said.

At the start of March, 295,000 Texans had selected a coverage plan in the federal marketplace. The state has roughly 6 million uninsured residents.

Federal health reform advocates have said that enrollment efforts have been hamstrung by the lack of support the ACA has received from the state’s Republican leadership, which decided to not expand Medicaid eligibility under the health law to cover low-income adults, and additional regulations on navigators issued by the Texas Department of Insurance. Republican leaders say Medicaid is broken and needs to be fixed, not expanded. And critics of the health reform law say that the low enrollment numbers are due to the high cost of the plans available through the marketplace.

The Obama administration’s extension announcement was met with criticism of the continuous delays it has implemented by conservatives who have largely objected to the federal health reform since it became law in 2010.

Gov. Rick Perry slammed the extension decision, criticizing the president for not “adhering to his own disastrous health care policy.”

“Whether it’s deadlines or red lines, it’s clear we can’t trust President Obama to back up what he says,” Perry said, adding that Obama’s policy decisions were riddled with “a feckless, meandering and muddled strategy.”

White House officials had previously indicated that there would be no extension beyond the March 31 deadline, but the decision to grant additional time for those who were unable to complete the application came amid a final enrollment push.

Bataille of the Centers for Medicare and Medicaid Services reiterated on her conference call that the current open enrollment period would close March 31 and that individuals must have attempted to enroll in the marketplace before the deadline. Bataille was unable to provide a timeline for how long individuals would have to request the extension or how much time individuals who had enrolled in the marketplace would have to select their plan.

“It’s difficult for us to know how long a line we may have,” Bataille said. “It could take a few days, or it could take a week or so.”

While the Texas Hospital Association celebrated the extension decision, Ted Shaw, the association's president and CEO, called for an additional extension not limited to those who had begun enrolling in the marketplace.

“The administration’s decision to extend the enrollment period is good not only for those who have attempted to enroll but should also apply for those who have yet to begin the enrollment process,” Shaw said. “Considering the problems the industry experienced with the marketplace rollout, we believe an extension of 30 to 90 days is more appropriate for all who have yet to obtain coverage through the system.”

Most individuals who do not sign up for insurance during the current open enrollment period could face a financial penalty when they file their taxes next year and will not be able to enroll in the marketplace until the next open enrollment period in January 2015.

Disclosure: At the time of publication, the Texas Hospital Association was a corporate sponsor of The Texas Tribune. (You can also review the full list of Tribune donors and sponsors below $1,000.) 

This story was produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.