By Jane Norman, CQ HealthBeat Associate Editor
April 30, 2013 -- Federal officials all the way up to President Barack Obama sought to reassure Americans last week that they won't be befuddled by the application forms for the new health insurance exchanges, as the Centers for Medicare and Medicaid Services (CMS) unveiled revised, slimmed-down versions of the documents.
Responding to criticism of a proposed application form that ran for 21 pages in its paper version, CMS officials said the application has been "simplified and significantly shortened."
Now there are three versions. One is a "short form" for individuals who don't get their insurance through the workplace and don't have dependents. A second one that's somewhat longer is for families. A third is for people who won't be applying for federal subsidies to help pay for their health insurance policies.
All three versions will be used in the states with federal marketplaces or partnerships. States that run their own exchanges will be allowed to apply to modify some parts of the applications, a CMS official said, speaking on background. No more changes are expected prior to the launch of exchange enrollment on Oct. 1, the official said.
At his news conference last week, Obama said the first application didn't work. "We put together, initially, an application form for signing up for participation in the exchanges that was initially about 21 pages long, and immediately everybody sat around the table and said, 'well, this is too long,' " Obama said. "Especially in this age of the Internet, people aren't going to have the patience to sit there for hours on end. Let's streamline this thing."
One change that was made was in numbering pages. In the 21-page application's paper version, the cover page was counted as Page 1. In the short form, it's unnumbered.
Initial reviews of the revamped applications from health policy experts were warm. "There's not much they could cut but they did condense some things," said Tricia Brooks, a senior fellow at the Center for Children and Families at the Georgetown University Health Policy Institute. "Is it perfect? No, but it's getting there."
"It certainly is easier to read," said Karen Pollitz, a senior fellow at the Kaiser Family Foundation and a former CMS official, though she said she didn't see any huge differences in the way the overall application is structured.
Selling Job Still Needed
The question of complexity is an important one as CMS moves toward open enrollment and launches campaigns with private partners to educate people about how to sign up for insurance. Even some Democrats, such as Senate Finance Chairman Max Baucus, have expressed worries, and Republicans are keeping up a steady drumbeat of criticism about the rollout of the law (PL 111-148, PL 111-152).
Obama said the application and other issues related to full implementation of the law in 2014 do not apply to most Americans, who already are insured.
"And their only impact is that their insurance is stronger, better, more secure than it was before," he said. "That's it. They don't have to worry about anything else." Those who will feel the impact are Americans without insurance or those who are paying high prices in the individual market, Obama said.
CMS officials said that it's proof that implementation is moving along. "This is another step complete as we get ready for a consumer-friendly marketplace that will be open for business later this year," Marilyn Tavenner, CMS acting administrator, said in a statement.
Praise also came from Enroll America, the private organization helping sign up consumers, and from Families USA, another advocacy group active in enrollment.
Pollitz said the family application is particularly important because it may involve the enrollment of numerous individuals and also asks for detailed information about employer insurance coverage. She said CMS clearly tried to clarify, for example, who can or cannot be counted as a member of a family for purposes of qualifying for subsidies. The online version will be easier because it will let people skip over irrelevant questions, she said.
But an appendix that asks many questions about health insurance offered by an employer remains fairly complex and much of it probably will have to be filled out by the employer, Pollitz said. That includes questions such as whether the insurance plan that's offered "meets the minimum value standard," which means it has to pay for at least 60 percent of total allowed costs.
The application also asks consumers if they are on Medicaid, which is an insurance plan even though people often don't realize the program is considered insurance, Pollitz explained.
But both Pollitz and Brooks said that the way the law is written, consumers have to be asked these questions to determine their eligibility for tax credits or Medicaid, and there's not much that could be done to make it easier.
Applying Will Take Time
Brooks said the section on employer-offered coverage also means that consumers will not be able to fill out the application in one sitting, though they may be able to get through much of it if they are advised in advance to bring along relevant information. At some point, applicants will have to ask their employer's human resources department or the insurer for help.
The question then arises what happens if an employer is not cooperative, or gives out wrong information. Brooks said then it will be up to the exchange to verify the information that's provided. "If you can't answer these questions that should not prevent you from submitting the application," she said.
Brooks said she anticipates further changes once the first enrollment season is over. "This may be pens down for Oct. 1 but I don't think this is pens down forever," she said.
Obama said there will always be fixes to be made. "And the last point I'll make—even if we do everything perfectly, there will still be glitches and bumps, and there will be stories that can be written that say, oh, look, this thing is not working the way it's supposed to, and this happened and that happened," he said. "And that's pretty much true of every government program that's ever been set up."