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New Errors Indicate Technological Problems Extend Issues Already Identified

Insurers say the federal health-care marketplace is generating flawed data that is straining their ability to handle even the trickle of enrollees who have gotten through so far, in a sign that technological problems extend further than the website traffic and software issues already identified.

Emerging errors include duplicate enrollments, spouses reported as children, missing data fields and suspect eligibility determinations, say executives at more than a dozen health plans. Blue Cross & Blue Shield of Nebraska said it had to hire temporary workers to contact new customers directly to resolve inaccuracies in submissions. Medical Mutual of Ohio said one customer had successfully signed up for three of its plans.

The flaws could do lasting damage to the law if customers are deterred from signing up or mistakenly believe they have obtained coverage.

"The longer this takes to resolve...the harder it will be to get people to [come back and] sign up," said Aetna Inc. Chief Executive Mark Bertolini. "It's not off to a great start," he said, though he believes the marketplaces are "here to stay."

The new troubles for the Affordable Care Act arrive as Washington's attention is expected to sharply shift toward scrutiny of the site's rocky rollout, whose problems had been overshadowed by a two-week brawl over the government shutdown and debt ceiling.

Pressure is rising on the Obama administration to fix the problems. A number of Republicans have urged Kathleen Sebelius, secretary of the Department of Health and Human Services, to resign. Prominent Democrats, including House Ways and Means ranking member Rep. Sander Levin (D., Mich.), have called for fixes to be accelerated. The White House has said it has full confidence in Ms. Sebelius.

HHS, which is running all or part of the marketplaces in 36 states, has repeatedly declined to answer specific questions about its handling of the rollout, including specific glitches, enrollment figures, or its plans to fix the problems.

"We know that people are enrolling in coverage and the system works. As individual problems are raised by insurers, we work aggressively to address them," HHS spokeswoman Joanne Peters said Thursday.

Health-department officials have pressured insurers to refrain from commenting publicly about the problems, according to executives at four health plans, who asked not to be named. The HHS declined to comment.

In prolonging the battles over the budget and debt ceiling, "all Republicans did was give [President Obama] great cover for the complete screw-up on the opening of the exchanges," said Gail Wilensky, a Medicare director in the administration of George H.W. Bush and UnitedHealth Group Inc. board member.

But the persistence of the technological problems could force a steeper political price for the Obama administration as Republican lawmakers redirect their focus. The GOP-led House Energy and Commerce Committee announced Thursday night it would hold a hearing next week on the rollout of the law and called on HHS to "voluntarily" make officials available after the secretary's staff said she couldn't come. Ms Peters, the HHS spokeswoman, said the department intended to be "responsive" to the request.

Under the law, most Americans would have to buy coverage starting next year, or pay a fine.

Insurers say the federal health-care marketplace is generating flawed data that is straining their ability to handle enrollees, in a sign that technological issues go further than traffic and software issues. Christopher Weaver reports. Photo: Getty Images.

Supporters of the law said they were frustrated by the lack of answers from the administration. "I wish they would explain what the technical problems are and how they intend to fix them," said Timothy Jost, a law professor at Washington and Lee University and a longtime defender of the overhaul.

The latest round of problems has emerged after a technical bottleneck that blocked many potential customers from accessing the marketplace began to clear this week. People familiar with the development of the exchange said some technical problems improved this week.

Of 209,000 users who began to register on healthcare.gov on Monday or Tuesday of this week, just over one-quarter finished the process, according to an estimate made by the analytics firm comScore for The Wall Street Journal. In the first week, only 10% did so. The estimates are based on a sampling of Internet users tracked by the company.

As more of those users attempted to sign up for plans this week, insurers began noticing problems with enrollment data. For now, they say they are largely able to manually correct the errors. But as enrollment increases - up to 7 million consumers are expected to sign up in the next 5½ months - that may not be possible, they worry.

Scott & White Health Plan in Temple, Texas, has received 25 enrollees from the federally run exchange so far. "There are some missing data elements that are requiring a lot of research on our part," said Allan Einboden, the health plan's chief executive. "If we'd received 5,000 and they all had to be worked, that's a lot of extra administrative costs," said Mr. Einboden, who said he expects the problems to be fixed.

After realizing that some applications listed up to three spouses in a single family, Blue Cross & Blue Shield of Nebraska, which has about 50 health-law enrollees, had to "stop those enrollments from going through the automated process," said Matt Leonard, the insurer's sales manager. "It takes an automated process and turns it into a manual process," he said.

At Priority Health in Michigan, health-plan staff are calling new customers to confirm each of their "couple of dozen" enrollees accurately picked the plan, said Joan Budden, chief marketing officer, after realizing some had enrolled in multiple health plans, likely owing to user error linked to slow healthcare.gov response times. "Sometimes they pushed the [submit] button three times," Ms. Budden said.

Sioux Falls, S.D.,-based Avera Health Plans has called each of its 21 incoming customers to make sure the data are correct. As consumers struggle to navigate healthcare.gov, some health-plan executives worry that only the sickest - those who most expect to need insurance - will persist in seeking coverage. If younger consumers who are on the fence about buying coverage find the process too onerous, insurers may end up with too few healthier members to offset the costs of less-healthy enrollees.

Tara Seidenberg, a 48-year-old paralegal from suburban Houston with multiple sclerosis, says she is likely to put up with all kinds of hurdles to buy coverage. After days of failed attempts to sign up on healthcare.gov, she is taking a break to wait for the glitches to resolve. She takes medications that cost $4,600 a month and her current coverage won't be available next year. "I'm pretty much guaranteed to try it again," Ms. Seidenberg said.