There is currently no way to be sure if individuals purchasing insurance through the federal exchange for Jan. 1 will be active in the insurance company claim system, so they can access care. By constantly delaying the enrollment date from Dec. 15th to Dec. 23rd and now for individuals paying their initial premium no later than 11:59 Dec. 31st, the administration has created a nightmare for the insurance companies and individuals needing care.

Those purchasing coverage from the exchange must sign-up and pay their portion of the first month's premium before the insurance company considers the policy active.  Someone making a payment on Dec 31st will not be active in the carrier system for days.  As those of us in the private insurance market well know, if you are not active in the insurance company computer system when you show up at the pharmacy to pickup a prescription, you are SOL. The pharmacy is not going to release your prescription without payment.

HHS issues last minute measures and "hopes" which they know cannot be implemented. 

    AP  (12/13, Alonso-Zaldivar) reports that as the Obama Administration tries to "minimize disruptions during the transition" in January when new coverage under the ACA takes effect, HHS Secretary Kathleen Sebelius on Thursday  (Dec 12th) announced a batch of measures to minimize disruptions during the transition." They include "recommendations, such as asking insurers to allow customers to temporarily keep filling prescriptions covered by a previous plan," (Real World: the previous plans have been cancelled either by the insured or the carrier and are no longer active in the insurance company claims computer system, so the pharmacy cannot verify benefits after the termination date) as well as requirements, including mandating that companies "accept anyone who pays his or her premium by 11:59 p.m. on Dec. 31."   The previous enrollment deadline of Dec. 15th had been delayed to Dec. 23rd.

   Wall Street Journal  (12/13, A1, Radnofsky, Subscription Publication) reports on its front page that the Administration cannot force insurers to comply with its requests, but officials expressed hope they would do so. One insurer, Allan Einboden, CEO of Scott & White Health Plan, said, "In terms of covering things when they haven't paid premiums, that we would be concerned about doing."

   USA Today  (12/12, Kennedy) reports that the changes Sebelius announced "are aimed at preventing gaps in coverage for those buying insurance through the federal and state exchanges." A gap in coverage "could cause huge problems if diabetics or those with heart disease are unable to get their medications; or if someone coming off Medicaid doesn't understand he's no longer covered and injures himself in January; or for someone undergoing cancer treatment whose coverage stops Jan. 1." (No kidding, maybe HHS should have thought about the "huge problems" before the middle of Dec. HHS has had months to consider the problems caused by a delayed rollout.)

    Reuters  (12/13, Morgan) reports that the Administration has extended the Dec. 15 enrollment deadline to Dec. 23 and said it would consider additional extensions if consumers are prevented from enrolling by "extraordinary circumstances." The Administration also established a special enrollment period for people who were unable to sign up for coverage due to problems with the HealthCare.gov website or other insurance marketplace technology. (Catch-all clause - we have no definition of "extraordinary circumstances")

      Pre-Existing Condition Insurance Plan Extended For One Month. Among the delays announced Thursday, the AP (12/13, Alonso-Zaldivar) reports that technology problems have also forced the Administration to extend for one month the Pre-Existing Condition Insurance Plan, which was supposed to expire Jan. 1. The Administration said that the extension "is meant to smooth the transition to new coverage, easing anxiety for tens of thousands of patients with serious illnesses such as heart disease and cancer." (The average individual in the PCIP incurs $30,000 in claims annually, so they will appreciate the continued subsidized coverage.)

      The Hill  (12/12, Sink) reports in its "Blog Briefing Room" blog that the extension drew praise from outside groups who said that "it ensured the sickest patients would not face a coverage gap as the administration continued to work out issues with the enrollment process." The Hill adds, however, that the decision "also seemed like it could be a tacit admission that, despite the administration's assurances, difficulties remain with the ACA enrollment process."