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Obamacare’s Nonexistent Appeals Process

To err is human. To dump complaints about errors into an unattended barrel is, apparently, administration policy.

So it would seem, at least, based on the current condition of the Affordable Care Act. The Washington Post reported this week that about 22,000 Americans have filed appeals with the government to try to correct mistakes they or (in most cases) the HealthCare.gov website made when processing their health insurance sign-ups. Until The Post published its article, those appeals were scanned into a computer system at the Centers for Medicare and Medicaid Services, where absolutely nothing happened to them.

Aaron Albright, a spokesman for CMS, said, “We are working to fully implement the appeals system,” according to the Post.

In the meantime, users who are dealing with errors in the coverage are stuck in limbo. Before this week, it was not widely reported that the appeals process was stalled, so in each case a confused and frustrated user wondered when to expect a response.

President Obama has promised unprecedented transparency to “ensure the public trust” and establish public participation and collaboration. As with so many of his other promises, this one gives way to reality where the Affordable Care Act is concerned.

People victimized by the botched rollout were being victimized again by the utter absence of an appeals process to allow them to get errors fixed. As with so many of health care law’s birth defects, the White House approach seemed to be to cover the problem in a thick layer of lipstick and call it beautiful.

Thanks to the Post article, though, there’s a chance things will soon get at least a little better on this front. The way the system typically works at this White House is that whatever attracts publicity, especially bad publicity, gets fixed first. Sure enough, after the newspaper story appeared on Monday, the CMS issued a statement saying it would implement a manual process to deal with backlogged appeals “soon,” pending a fully automated appeals system.

White House spokesman Jay Carney said Monday that most of the errors “are left over from when the website was not working well,” and that “it’s a portion that’s relatively small as a percentage of the number of people who have applied for coverage.” This reassurance may sound reasonable to the president and his supporters, but it is not at all helpful to the 22,000 taxpayers who cannot manage to get the proper coverage at the proper cost. Imagine how you would feel if, upon discovering an airline had lost your bag, you were told that the lost bag office is not yet operational, but not to be concerned because only a small percentage of luggage goes missing.

I expected the administration to try to make this particular story go away quickly, because it is particularly unhelpful to the efforts to salvage Obamacare’s shaky demographics. The Post article’s leading example was a 27-year-old from West Virginia who works at a nonprofit organization that dropped its employer-provided health plan. Addie Wilson and her peers - or at least her healthy peers - are exactly the Americans the administration is most eager to encourage to sign up for insurance. Leaving Wilson stuck with the choice to continue overpaying for a policy in hopes she will later be made whole or to cancel it and forfeit what she’s overpaid so far in hopes of getting a cheaper policy right away is not likely to make her a poster girl for the new health insurance exchanges.

“These little kinks should have been worked out prior to this thing being launched,” Wilson told The Post. The “little kinks” are costing her $109 a month extra toward her premiums and have set her deductible more than $4,000 higher than it should be.

The administration has so far focused its efforts elsewhere, however, presumably on building the back end of the sign-up system so insurance companies can get paid. But now that the Post story has gotten so much attention, we will see how “soon” the appeals process will get underway. The insurance companies, who are the main industry players that wanted this law in the first place, will likely just have to wait a little longer to get what they so thoughtlessly asked for.

Larry M. Elkin is the founder and president of Palisades Hudson, and is based out of Palisades Hudson’s Fort Lauderdale, Florida headquarters. He wrote several of the chapters in the firm’s recently updated book, Looking Ahead: Life, Family, Wealth and Business After 55. His contributions include Chapter 1, “Looking Ahead When Youth Is Behind Us,” and Chapter 4, “The Family Business.” Larry was also among the authors of the firm’s book The High Achiever’s Guide To Wealth.

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