California’s Obamacare exchange criticized for not fixing enrollment, tax errors

Consumers wait to get enrolled last year during a Covered California sign-up event in Panorama City as part of the Affordable Care Act.

Consumers wait to get enrolled last year during a Covered California sign-up event in Panorama City as part of the Affordable Care Act.

(Irfan Khan / Los Angeles Times)
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In response to blistering criticism from a consumer group, California’s Obamacare exchange vowed to fix longstanding enrollment and tax-related errors that have blocked consumers from getting coverage for months and left some with unforeseen bills.

Peter Lee, executive director of the Covered California exchange, addressed the complaints at a Thursday board meeting and said more staff and resources have been assigned to resolve these lingering glitches.

“We take this very seriously. We are committed to handling appeals well and effectively,” Lee said. “We still have work to do.”


Lee said a detailed report on customer complaints and appeals would be presented at the next board meeting in October. More than 1.3 million Californians are enrolled in the insurance exchange.

The Health Consumer Alliance of San Diego, representing legal aid groups across the state, sent a letter to Covered California on Monday describing a litany of problems during the health-law rollout.

“Some of these issues have continued for some time, including issues we first raised in early 2014 without adequate resolution for consumers,” the alliance said in the Aug. 17 letter.

“Many consumers face considerable difficulties in enrolling in the correct plan with the correct level of financial assistance, even after coming to agreement with Covered California staff as to what should be done,” the group wrote.

The alliance contracts with the exchange to serve as its independent consumer assistance program, putting it in touch with many consumers hitting roadblocks during enrollment or getting access to treatment under the Affordable Care Act.

Some of the biggest problems include consumers blocked from getting health coverage for months because of Covered California’s inability to overcome computer glitches.


In one example, two consumers in Los Angeles were erroneously enrolled in exchange coverage rather than the state’s Medicaid program because of a mistake in counting their state disability insurance income. In the meantime, the consumers have had difficulty paying premiums they never should have had to pay.

The Health Consumer Alliance also described a lengthy wait for people after a “help desk ticket” is submitted to workers running the state’s online enrollment and eligibility system, known as CalHEERS.

Delays can stretch on for months with no assurances that any care people receive will be covered or reimbursed, forcing some patients to forgo treatment, according to the consumer group.

“It’s essential that consumers waiting in that help desk trouble queue get into a health plan,” said Jen Flory, a senior attorney at the Western Center on Law and Poverty, part of the Health Consumer Alliance. “We want to make sure they get the proper attention.”

In other instances, consumers have won an appeal from an administrative law judge and still wait months for their coverage issue to be resolved because of the technology issues.

The consumer group said it took 80 days for Covered California to comply with a judge’s decision in the case of a Butte County customer who was erroneously enrolled in both the exchange and Medi-Cal, the state’s Medicaid program for low-income people.


Covered California is also struggling to issue corrected tax forms for some consumers despite repeated requests. The state sent revised 1095-A tax forms to more than 100,000 policyholders in March.

People who received premium subsidies last year must file those forms with their federal tax return.

Consumers may have to repay some portion of their government subsidy as part of their tax return if their income was higher than what they estimated during enrollment. Others who qualified for more government assistance in 2014 could get a refund.

The Health Consumer Alliance said some families waiting for updated information cannot finalize their taxes, which then affects other aspects of their life such as filling out financial aid forms for college.

“We are concerned that public support for the Affordable Care Act will erode as more and more consumers encounter these types of tax problems and face exposure to Internal Revenue Service debts and penalties,” the consumer group wrote.

In surveys, a large majority of Covered California policyholders have expressed satisfaction with their health plan and the overall shopping experience.


Among Covered California members, 74% rated their coverage as excellent or good in a Kaiser Family Foundation survey published in May. Ninety-one percent of exchange customers said it was easy to get to their usual source of medical care, matching the response among people with other types of private coverage.

Lee said a small percentage of customers encounter problems and file appeals, but they can be “canaries in the coal mine” to identify systemic issues.

Last month, Covered California announced an average rate increase of 4% statewide for 2016 coverage, defying predictions of steeper rate hikes. The next open enrollment begins Nov. 1.

Twitter: @chadterhune