Inspector General reports find problems with O-Care eligibility

by Ferdous Al-Faruque - 07/01/14 1:14 PM ET

Two new reports from the Health and Human Services Department’s Inspector General say the new federal healthcare insurance market is having trouble verifying whether people are eligible for the health insurance they are receiving, or the federal subsidies that help them pay their premiums.

One of the two Health and Human Services inspector general reports found 2.9 million inconsistencies in the federal marketplace.

It said the federal marketplace was unable to resolve 2.6 million of them because the Centers of Medicare & Medicaid Services (CMS) system for determining eligibility was “not fully operational.” The reports looked at the exchanges between October and December of 2013.

{mosads}Republicans have been hammering the administration over the issue, arguing many people ineligible for subsidies are nonetheless receiving them.

They argued the latest reports suggest tax dollars are being wasted on people receiving federal subsidies who should not be getting them.

“When ObamaCare was passed its chief architects told us they would have to pass the bill to find out what was in it,” said Sen. Orrin Hatch (R-Utah), Senate Finance Committee ranking member. “Today’s report confirms what we knew was not included: safeguards to protect hard-earned taxpayer dollars from an incompetent bureaucracy.”

Democrats and CMS pushed back, saying the reports do not take into account improvements that have already been made.

“It’s not news that healthcare.gov had tech and data issues at the outset, but we’ve come a long way since then,” CMS spokesman Aaron Albright said. “CMS is working expeditiously to resolve inconsistencies to make sure individuals and families get the tax credits and coverage they deserve and that no one receives a benefit they shouldn’t. We are actively reaching out to consumers to provide additional information that supports their application for coverage and verifying their information every day.”

Sen. Tom Harkin (D-Iowa), chairman of the Senate Health, Education, Labor and Pensions Committee, offered similar comments.

“It is no surprise to anyone that the first few months of the marketplace rollout were rocky,” he said. “Since then, we have signed up eight million Americans.”

The two reports found the marketplace systems were not effective in verifying inconsistencies in people’s Social Security numbers, citizenship statuses and incomes, which would all factor in to what coverage and subsidies they would be eligible to receive.

Several state exchanges saw similar issues, according to the reports.

The report said the CMS needs to issue a public plan on how and when it will fix the inconsistencies. The agency also recommends the CMS conduct more oversight of state marketplaces.