Health insurance exchange suffer from faulty internal controls

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HHS report identifies internal controls as a problematic issue

health insurance exchange problemsInsurance exchanges throughout the U.S. have faced technical struggles for the past several months, but a new report from the Department of Health and Human Services may have identified the reasons behind one of the most problematic aspects of these exchanges. Insurance exchanges have been having trouble adequately determining whether or not those seeking federal subsidies are actually eligible for these subsidies. The subsidies are offered by the federal government and exist as a way to make insurance coverage more affordable to consumers.

Internal controls make it difficult for exchanges to effectively regulate themselves

According to the Department of Health and Human Services, the problems that exchanges are having in verifying people’s eligibility for subsidies has to do with “internal controls.” These controls are meant to govern exchanges, working as a sort of regulatory structure, but they have been unable to perform as intended. This means that many people that are not eligible for subsidies are receiving financial aid for the health insurance coverage they have obtained through exchanges.

Problems with exchanges highlight the faults of health care reform

The findings by the Department of Health and Human Services has renewed some of the controversy surrounding the Affordable Care Act. Longstanding opponents of the federal health care reform law suggest that the failure of exchange’s internal controls is yet another symptom of flawed legislation. Before the Affordable Care Act was passed in 2010, the reform’s architects had suggested that the problems of the legislation would not be fully realized until it was in full effect. Now, the problems of the health care reform law are beginning to become apparent.

Some exchanges have trouble verifying the lawful presence of those living in some states

Verifying eligibility for subsidies is not the only problem exchanges are having, of course. The California health insurance exchange is also having a problem verifying the lawful presence of people living in the state. Illegal immigrants are not eligible to receive insurance coverage through the state’s exchange, but the exchange’s internal controls have made it nearly impossible to enforce this particular regulation effectively.

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