White House: Could extend Obamacare deadlines again

Kathleen Sebelius, secretary of the Department of Health and Human Services
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Scrambling to get as many people as possible health coverage by Jan. 1 despite Obamacare's botched roll-out, the Obama administration ordered insurers to give customers a slight break on bill payments, and "strongly" suggested a series of other breaks Thursday.

And administration officials also warned they may again extend the Dec. 23 deadline for enrolling in Obamacare insurance plans for the start of the new year should "exceptional circumstances pose barriers to customers enrolling by that date" via HealthCare.gov and other government-run health exchanges. Those exchanges have seen drastically fewer numbers of people sign up for health plans than originally projected.

"We are providing additional flexibility to consumers across the country to ensure they have access to coverage options that begin on Jan. 1, 2014," said Health and Human Services Secretary Kathleen Sebelius, as she announced the latest series of measures.

Sebelius urged insurers to begin covering enrollees by Jan. 1, even if those people make their first premiums payment later in January. Aetna has already said it will allow Obamacare plan enrollees until Jan. 8 to make their first premium payments for plans beginning Jan. 1.

She also announced that HHS is now requiring that insurers accept payments as late as Dec. 31 for selected Obamacare plans that will begin Jan. 1, instead of leaving that payment deadline up to the insurers.

And she strongly urged insurers to accept partial premium payments for coverage that begins that day.

She also is now also urging insurers to cover people by Jan. 1 even if they select plans after the current Dec. 23 deadline set by HHS. That would include allowing people to have coverage retroactively effective Jan. 1 even if they actually sign up later in the month, which would let people who are eligible for tax subsidies to offset their insurance purchases apply them for that month.

And HHS is allowing a "special enrollment period" that will give people who had problems with the federal and state-run Obamacare exchanges more time than they would have had to sign up and get coverage by Jan. 1.

Those problems could include so-called 834 file errors, which affect the electronic transmission of enrollment forms to insurers from the exchanges—errors that could lead to delays in formal enrollments. Up to one in four of the 365,000 enrollments as of Nov. 30 had such errors, and the error rate this month still may be as high as one in 10.

In a series of suggestions designed to let consumers maintain existing relationships with doctors and continue drug treatments in January, the first month of their new coverage, HHS repeatedly said in a news release that is was "strongly encouraging" insurers to grant three specific requests.

Those included urging insurers to pay out benefits for use of "out-of-network" health providers by their customers to the same degree they do for those who use "in-network providers" in the case of emergencies. And Sebelius asked insurers to treat providers who drop out of their plan's network sometime during the open enrollment period as if they were still in the network, for the purpose of covering customers' benefits.

(Read more: Obamacare enrollment far shy of government goals)

She likewise "strongly" encouraged insurers to refill prescriptions in January that have been covered by their enrollees' prior insurance plans.

Finally, HHS will allow nearly 86,000 people who currently are in a federally run high-risk insurance pool a one-month extension to stay in that pool until Jan. 31 so they have more time to obtain replacement coverage through the Obamacare exchanges.

The insurance industry -- which in recent weeks has been repeatedly asked by the administration to help it mitigate the messes created by HealthCare.gov -- seemed ready to help out yet again, but not happy about it.

Karen Ignagni, president and CEO of industry lobbying group America's Health Insurance Plans, said, "Helping consumers obtain the secure, affordable coverage they need is health plans' top priority. With only weeks to go before coverage begins, continued changes to the rules and guidance could exacerbate the challenges associated with helping consumers through the enrollment process. Health plans will continue to do everything they can to protect consumers from potential coverage disruptions caused by the ongoing technical problems with Healthcare.gov."

Sebelius' department has been reeling from the troubled launch of HealthCare.gov, which was revealed to have scores of software-related problems after its Oct. 1 launch. Those problems crippled enrollment in the first month of operation, and lead her weeks later to extend the Dec. 15 deadline for enrolling in coverage beginning Jan. 1 to Dec. 23.

Sebelius admits flawed launch suppressed enrollment

Her announcements Thursday came a day after officials revealed improved, but still relatively low enrollment data as of Nov. 30.

On Wednesday, officials said nearly 365,000 people had enrolled in insurance plans through either the federal- or state-run health exchanges by Nov. 30, well below the 1.2 million enrollees that CMS Chief Marilyn Tavenner had predicted would be signed up by that date in a memo she wrote in September.

One of the extensions announced by Sebelius on Thursday relates to the Pre-Existing Condition Insurance Plan pool, which is run by the federal government, and covers people whom private insurers wouldn't insure because of their often-serious medical conditions.

Those people will now have health-care coverage at least until the end of January, and thus another month to try to obtain coverage through the federally run HealthCare.gov or other state-run Obamacare exchanges.

"Today, as part of our efforts to smooth the transition to the marketplaces for those seeking coverage that begins in January, we are taking steps to ensure that Americans enrolled in the federal PCIP insurance plan will not face a lapse when the new year begins," the federal Centers for Medicare and Medicaid Services said. Some states that run their own high-risk pools, and which hadn't already decided to extend them beyond 2013, are now considering a similar extension.

(Read more: Obamacare's 'perfect storm' of low enrollment, bad data)

The high-risk pools were created by President Barack Obama's Affordable Care Act to ensure that people with pre-existing medical conditions would be able to have health coverage until at least 2014, when the ACA bars insurers from denying coverage for medical reasons.

The federal PCIP was set to expire Jan. 1 because the government had expected that anyone who wanted to buy ACA-compliant insurance would be able to do so before that date from HealthCare.gov and the other Obamacare exchanges.

Health insurance analyst Robert Laszewski said the new extension of the high-risk pool could mitigate some of that harm from the problems people had logging into HealthCare.gov, and from the 834 errors, but he warned the extension is coming late in the game.

"Lots of people are going to fall through the cracks," said Laszewski, who is president of Health Policy and Strategy Associates. "This extension would seem to provide an additional month for people in the high-risk pools."

"However, this release talks about 'the option to remain' to remain in the pools. That suggests people will have a very limited amount to time to get this news and then have the responsibility to get signed up for the extra month," he said. "I expect this will lead to lots of confusion and anxiety for these people that will likely have to go through a last-minute fire drill."

U.S. Senate Majority Leader Mitch McConnell, R-Ky., said the extension was further proof of what Republicans argue is the folly of Obamacare.

"Despite the administration's promises that Obamacare enrollment is on track, this announcement is a clear admission that Obamacare is failing Americans with pre-existing conditions who are losing the plans they already had," McConnell said. "Millions of people were tossed off of the plans they already had but only a fraction of that number have been able to sign up on the Obamacare exchanges."

"How many extensions and waivers is it going to take for the administration to admit the consequences of Obamacare that are hitting millions of Americans they promised it would help?" McConnell said.

(Read more: Obamacare's big new enemy: inertia)

House Energy and Commerce Committee Chairman Fred Upton (R-MI), who heard Sebelius testify before his committee Wednesday, said, "Another day, another delay."

"When specifically asked yesterday of any looming delays, Secretary Sebelius failed to disclose anything about this or any other pending change, but here we are today," Upton said.

"Unfortunately, withholding information from the public has become the norm. Our investigation has uncovered that the administration was aware of concerns and unavoidable delays for months, but when pressed publicly they repeatedly insisted everything was'on track,'" Upton said."

The administration has known for many months that this law wa snot ready for prime time, and Americans who depend on high-risk pools would have been better served by the administration admitting their failures sooner and working with the Congress to protect these and other Americans being harmed by the health care law."

By CNBC's Dan Mangan and Jodi Gralnick. Follow them on Twitter @_DanMangan and @Jodigralnick.