By ROBERT PEAR
Published: June 24, 2013
WASHINGTON — The Obama administration announced new steps to expand coverage under the federal health care law on Monday, less than a week after the Government Accountability Office, a nonpartisan investigative arm of Congress, found that the federal government and many states were “behind schedule” in setting up marketplaces where Americans are supposed to be able to buy insurance.
The steps — establishing a Web site and a telephone call center to provide information to consumers — are in preparation for what the government anticipates will be a flood of people buying health insurance starting Oct. 1.
Kathleen Sebelius, the secretary of health and human services, said the call center would be in operation 24 hours a day. The phone number is 800-318-2596. The Web site, www.healthcare.gov, provides information promoting the 2010 health care law and describing new insurance options. The Web site and call center currently have only general information about coverage.
Details about the prices and benefits of health insurance plans to be offered by Blue Cross and Blue Shield and companies like Humana and Kaiser Permanente will be available later this summer. Consumers can file online applications starting Oct. 1. Coverage is to begin on Jan. 1, when most Americans will be required to have insurance.
In a statement, Ms. Sebelius said, “The new Web site and the toll-free number have a simple mission: to make sure every American who needs health coverage has the information they need to make choices that are right for themselves and their families or their businesses.”
The Congressional Budget Office predicts that seven million people will buy private insurance next year through marketplaces, or exchanges, while nine million people will gain coverage through Medicaid. By 2016, it says, the number of uninsured, now estimated at 56 million Americans, may be reduced by 25 million as a result of the law.
The federal government will be running insurance exchanges in more than half the states. The administration had said previously that the federal exchanges would be open — at least in 2014 — to any insurers that met basic federal standards.
But Ms. Sebelius, a former Kansas insurance commissioner, told reporters on Monday that “we will be negotiating for rates across the country.” She emphasized the federal role, saying that “we intend to do rate negotiation to make sure that plans are going to offer consumers the best possible choices.”
Federal officials said the negotiations would focus on rates that were much higher or much lower than those proposed by other insurers.
The Web site asks consumers for information about their household incomes, to determine if they may be eligible for federal subsidies, in the form of tax credits, to help pay premiums.
Ms. Sebelius said “we are very concerned” that low-income people in some states will not have access to either Medicaid or subsidies for the purchase of private insurance. However, she said, “there is no timetable” for states to expand Medicaid, and states that rejected the expansion of eligibility this year could reconsider next year.
The federal Web site acknowledges that some states are not expanding Medicaid. “Under the health care law,” it says, “states have the choice to cover more people.”
The Web site says that people eligible for Medicaid should not try to buy insurance in the exchange, because they will not receive subsidies. “A marketplace plan will be more expensive than Medicaid and usually won’t give you additional coverage or benefits,” it says. “You wouldn’t be eligible for any savings on marketplace insurance and would have to pay the whole cost.”
In states that do not expand Medicaid, insurance subsidies will generally be available to people with incomes from the poverty level up to four times that amount ($23,550 to $94,200 a year for a family of four). But in those states, the subsidies will not be available to some of the neediest — people with incomes below the poverty level who will generally not qualify for the new financial assistance with health insurance.
More than half of all people without health insurance live in states that are not planning to expand Medicaid.
Marketing insurance in those states “will be complicated,” Ms. Sebelius said.
Administration officials said the call center would eventually have 9,000 customer service representatives fielding calls. Consumers can also seek information in live Web chats.