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ACA is underway: 'Orphans' and 'ghosts' are terms to know in the new year

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The new year means new issues for the Affordable Care Act.
The new year means new issues for the Affordable Care Act. - (Thinkstock)

It's Jan. 1, which can only mean two things.
1. A New Year.
2. New issues for the Affordable Care Act.

As of 12:01, thousands of Jerseyans had their policies turned over to insurance purchased through Obamacare. But will the insurance be there when it's needed? That's the question.

No one is sure what will happen when someone attempts to see a doctor or get a prescription only to find there is no record of coverage.

This much is clear: People in that predicament may soon find out they've been placed in two newly defined categories, orphans and ghosts.

Orphans are enrollees the government knows about but insurance companies have no record of in other words, they were not completely processed.

Ghosts are enrollees insurers know about but the government cannot fully account for.

Mark McClellan, who was in charge of the rollout of Medicare's prescription drug benefit, told the Associated Press there will be good and bad on the first day.

"Some people are actually going to start using their coverage Jan. 1, and that is a good thing for them," he said. "But there are going to be problems for any number of people who thought they had signed up, and it won't work right off the bat."

The good news for all: These problems have been anticipated.

A number of drug stores have said they will honor prescriptions in the first month, even without a proper insurance card. Hospitals, experienced in dealing with people without proper insurance, figure to do the same though it may be the most basic of coverage.

For its part, the federal government has released a tip sheet for consumers on what to do.

More than that, they have promised to be there for enrollees.

"For consumers whose marketplace coverage begins on Jan. 1, we're doing everything we can to help ensure a smooth transition period," Kathleen Sebelius, the U.S. secretary of health and human services, said in blog post on Tuesday.

She was one of several administration officials trying to get ahead of any difficulties.

"We are very focused on it," President Obama's top health policy adviser, Phil Schiliro, told Reuters Tuesday.

He said there "always are going to be unexpected problems whenever there is a transition.

"What we are stressing to folks is that, if they get to a provider (and) there is some confusion (about coverage), call their insurer. If the insurer is not able to resolve it, they should call our toll-free number (800-318-2596) ... and operators will be there 24/7."

Write to the Editorial Department at editorial@njbiz.com

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