GAO: CMS isn't checking whether PPACA exchange hub works

Because of health and financial privacy concerns, managers of the public health insurance exchange system "data services hub" have been collecting too little information to analyze how well it is doing.

The hub is supposed to help HealthCare.gov and state-based Patient Protection and Affordable Care Act (PPACA) exchange programs determine whether individual applicants are eligible for exchange plan subsidies, by comparing the information applicants give with information from the Internal Revenue Service (IRS) and other services, Seto Bagdoyan, a director at the U.S. Government Accountability Office (GAO), writes in a new report.

The Centers for Medicare & Medicaid Services (CMS) has no way to tell how many times agencies give relevant information through the hub in response to an exchange request, or how often agencies respond by saying no relevant information is available.

By design, CMS told GAO investigators, "The data hub does not store individual transactional data that could be collectively analyzed over time."

CMS officials told the GAO that, "for policy reasons, the agency did not want the data hub to become a data repository itself, and, in particular, a repository of sensitive personal data."

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GAO could find data on how the exchange system handles known conflicts, or inconsistencies, by comparing the information applicants provided on their applications and the information coming from the verification sources.

CMS appears to have left inconsistencies for about 431,000 applications submitted in 2014 unresolved, Bagdoyan says. Those applications came from people who received about $1.7 billion in exchange plan subsidies.

Bagdoyan notes, for example, that CMS has decided against trying to resolve stand-alone Social Security number conflicts, in part because most Social Security number inconsistencies appear to be related to questions about citizenship or immigration status that will be resolved through other processes.

The GAO investigators found thousands of applications with stand-alone Social Security problems, Bagdoyan says. He says failing to resolve those inconsistencies could hurt IRS efforts to determine whether taxpayers have reported exchange plan premium tax credit information properly on their tax returns.

In another new GAO report, on the Consumer Operated and Oriented Plan (CO-OP) program, John Dicken, a GAO director, says CMS developed a formal "escalation plan" framework for handling CO-OP problems in November 2014.

The U.S. Department of Health and Human Services (HHS), the parent of CMS, issued CO-OP startup loans to 23 CO-OP organizers.

Only nine of the 12 CO-OPs that have already closed were subject to CMS escalation plans, Dicken says.

Meanwhile, nine of the 11 CO-OPs that are still in operation have been subject to escalation plans.

GAO investigators also found that, as of June 30, 2015, four of the 11 surviving CO-OPs had not yet enrolled at least 25,000 people. CMS officials have estimated that a CO-OP probably needs a minimum of 25,000 enrollees to cover its fixed costs, Dicken says.

See also:

CMS hints at CO-OP rescue changes

Watchdog: IRS deployed PPACA system before completing full security checks

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