Sidebar: Enrollment Period Follow-Up

Last night I noted, in an entry about CoveredCA announcing a 5-day "start by 2/15, finish by 2/20" Open Enrollment extension period and the potential for a separate "Tax Season" enrollment period), that according to the director of advocacy group Health Access, the Affordable Care Act doesn't regulate any specific time window regarding Open Enrollment Periods.

I found this fascinating, because until that point, I had assumed that there was some sort of language in the ACA specifying, if not the exact dates, at least the total number of days (ie, something along the lines of "...not to exceed 200 days in the first calendar year, not to exceed 100 days in subsequent calendar years"). I also assumed that there would be some sort of clause allowing for the limited enrollment the rest of the year for people who have Qualifying Life Events (marriage, divorce, childbirth, loss of income, etc).

There are two main reasons for limiting enrollment to specific calendar periods: First, this allows the dust to settle so that the insurance company actuaries have several months to crunch the numbers and figure out the best way to set the following year's premium rates (not easy to do in a constantly-shifting environment).

The main reason, however, is to prevent people from trying to game the system by going without coverage for long stretches of time (avoiding paying premiums) and then suddenly "deciding" to #GetCovered 5 minutes after they're diagnosed with diabetes or their leg gets broken. Since the insurance companies are no longer allowed to deny coverage based on pre-existing conditions or ask about your medical history, there are two major tools the ACA uses to prevent that sort of gaming: The individual mandate penalty ($325/adult & $162.50/child, or 2% of your taxable income this year)...and the open enrollment period deadline.

Basically, by limiting the enrollment period to 3 months out of the year (give or take), the ACA is gently prodding you to play a game of Russian Roulette: Are you willing to bet your health/income on a 25% chance that you won't get injured/sick for the other 9 months? If you're willing to take that bet, fine...but you'll still have to pay the penalty as well.

I should note that having limited open enrollment periods are pretty standard in most large corporations for their Employer-Sponsored Insurance, as well as Medicare Advantage and Part D, so there's nothing unusual going on here. In fact, I'm pretty sure most companies have an even shorter period (1 to 2 months), rather than last year's 6 months or this year's 3.

Anyway, I figured that the insurance lobby would insist on limited enrollment period rules being baked into the wording of the ACA, in return for them not freaking out over the "guaranteed issue" requirement.

However, last night/this morning, I had an extended Twitter conversation with Ivan Williams (Senior Policy Analyst at private health insurance exchange GetInsured, who sent me the CoveredCA link in the first place) and Lisa Aliferis (the healthcare editor for KQED, which posted the CoveredCA story) about this issue. According to both of them (neither one is a lawyer, they want to stress), there doesn't appear to be any language in the ACA itself dictating how many/few days long the Open Enrollment Period can last, or regarding opening enrollment back up again at a later time. From what I (and they) can tell, it looks like this is completely up to those running the exchanges, whether you're talking about Healthcare.Gov, CoveredCA, kynect or any of the other state-based exchanges.

Personally, I find this fascinating. It suggests that, in theory, any/all of the exchanges could potentially open up enrollment year-round if they wished (which would be unwise)...or limit it to just 1 day a year (which would be plain stupid).

Of course, there's another important reason for having limited time: Deadlines are great motivators. Just take a look at The Graph for evidence of that. Those surges mid-December, mid January and (assuming I'm even remotely close to accurate) this week are all the evidence you need of how important having a deadline is.

At the same time, as long as there's no major evidence of people trying to game the system, there's also nothing wrong with extending that period, or opening it up again later on if the exchange administrations choose to do so. The point of the law isn't to leave people high and dry or to squeeze them with penalties, but to get them to get off their butts and actually enroll in coverage.

This is what made John Boehner's on-camera temper tantrum last March over the 2-week April "overtime period" announcement so idiotic. As long as the administration is legally allowed to offer an extension period, and as long as doing so results in a net benefit (900K more people enrolled from 4/1 - 4/15), what difference does it make?

The only ones who might have complained are the insurance companies...but aside from my general lack of sympathy for their "plight", the "extension period" wasn't announced months in advance. There's no way someone could "time" things so as to game the system for a 2-week period in April, especially when they didn't know about it beforehand (and especially since you still had to have at least created a user account by March 31st to qualify...similar to what CoveredCA is doing next week).

On the other hand, this is also why HC.gov and the other exchanges, along with HHS/CMS personnel, are absolutely right not to commit to any sort of a full enrollment period after Sunday...until after Sunday. If they want to announce a "Tax Season Special Period" at 12:01am on Monday, fine...but not one moment sooner.