The Obama administration said Friday that there could be problems with the enrollment records for a quarter of all the people who signed up for health insurance through the federal marketplace in October and November, raising questions about whether consumers will get coverage in time to pay for their medical care next month

In some cases, the government did not notify insurers of people who enrolled online at HealthCare.gov. The government refers to these people as “C.M.S. orphans” because the consumers successfully completed the application process and selected health plans, but the government did not send the information to the insurers…

In other cases, Ms. Bataille said, the government sent more than one enrollment notice for the same person to an insurer. And in some instances, she said, the information sent was incorrect. A child may have been listed as a parent, a name may have been misspelled, or an address may be wrong.

Moreover, officials said, some people who signed up for a health plan are listed in insurance company records but not in the government’s records. In those cases, consumers may have canceled enrollment in a health plan, but the government failed to inform the insurer.

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One striking thing about the new White House Obamacare promotion campaign is that so far it hasn’t had much to say about the central focus of Obamacare, which is helping Americans buy affordable health insurance

What is indisputable is that the aspects of Obamacare the White House cites most often in its promotional campaign — the pre-existing conditions policy, or the estimated 3.4 million young Americans who can stay on their parents’ coverage until age 26 — involve numbers that are far smaller than the tens of millions of people who will likely face steeper costs, nearly unpayable deductibles and sharply limited doctor choices under Obamacare. (In addition to the 10-million person individual market, some experts believe such problems are coming soon to the 45-million person small-group market.)

And that is why the White House sales campaign focuses on the same things Democrats said in 2009, and 2010, and 2011, and 2012. Back then, the burdens of Obamacare had not yet become a reality for most Americans. Now they have, and the administration does not have a good answer for the millions who will struggle under the new system. No wonder the president is talking about something else.

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Mike Horrigan is a lifelong Democrat with heart problems who supports President Obama’s health care law because he expects it will help many people obtain better insurance, including himself.

But under the new law, the Affordable Care Act, Mr. Horrigan’s coverage by a state high-risk insurance program was eliminated, then replaced by a more expensive plan. His wife’s individual plan was canceled for being substandard, then suddenly renewed — also at a higher price…

Kathleen LeFleur, a broker who works with people who have individual plans at Employee Benefit Advisors, an insurance agency here, said many of the callers to her office had two things in common: confusion and anger. “They are confused before they call,” she said. “After they call, they’re not confused anymore. They’re angry.”…

Calling the increases “unreasonable,” Ms. Horrigan acknowledged that they may be necessary to make the new system work.

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“I was really troubled when Ted Cruz complained. That really hurt me to the core,” [Harry] Reid said. “The only people complaining are those who don’t like the Obamacare. I followed the law.

“And I will also note that there are 150,000 million different families that get their health care through their employees,” Reid said. “So should all federal employees, although under Obamacare, my insurance costs me about $4,500 more that it did before. Yes, because it is age-related and it wasn’t like that before.”

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There also will be fewer choices in the new health order. Blue Shield is restricting access to close to half of its doctors and a quarter of its hospitals in the individual market [in California] — and Blue Shield spokesman Steve Shivinsky told The Orange County Register these providers “had to agree to cut their rates” to get into the network.

In Southern California, the Los Angeles Times reported, Health Net individual policyholders will have access to less than a third of the doctors on employer plans.

Peter Lee, executive director of Covered California, told the San Francisco Chronicle that all but three of the 12 state exchange providers limit doctors and hospitals…

When employers cut off providers, the market can respond. When states and the federal government restrict access, they begin to make every health plan into a health maintenance organization.

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Is our health care system ready for the influx of newly insured patients?

Not yet. “If you do the math, it just doesn’t work,” says Matt Salo, executive director of the National Association of Medicaid Directors. “There is no way we can meet all this new demand with the existing workforce unless we radically change the way we deliver health care.”

American physicians have flooded into subspecialties in recent decades, leaving a dearth of internists and family practitioners to help people manage their health. Some 55 million Americans already live in what the government calls primary care shortage areas. It would take 15,000 primary-care doctors just to fill the current gap, and 45,000 to care for the people will gain health coverage by 2025. Even under the rosiest scenarios, the number won’t rise by more than 6,000—and it may actually decline. “As the demand for adult primary care explodes,” health care experts Thomas Bodenheimer and Mark Smith write in the November issue of Health Affairs, “the capacity to provide that care is shrinking.”

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But even if it were true that we could get better treatment at a lower cost by restricting peoples’ choices, people would still hate having their choices restricted. Americans love choice! There is a reason that the abortion-rights movement has framed itself around the concept of choice and keeping medical decisions between a woman and her doctor, rather than around a more straight feminist argument about the life limitations imposed by an untimely pregnancy.

If narrow networks could give everyone in the country access to health-care outcomes no worse than 90 percent as good as the folks with the best doctors at 75 percent of the price we’d pay for broader networks, the health-care wonks would jump on that deal as an unbelievable bargain. But I think it’s pretty clear that average folks don’t think like health-care wonks.

Rationally, you should get the policy with the highest possible deductible and coinsurance, because more comprehensive insurance basically just means that you’re prepaying the deductible in advance. But people hate those policies. The most bitter union fights are usually when management tries to increase the copays and deductibles on health insurance — even though the union knows exactly how much this is costing, because they’re basically making a dollar-for-dollar trade of wage compensation for health insurance premiums. That’s what the membership wants.

So even if narrow networks actually were better, people would resist them. And they’ll fight with every fiber of their being when you tell them to take their kid with leukemia to a community hospital rather than the top-notch children’s hospital nearby. Expect the fight over doc shock to be bitter and long — and to end when insurers cave and start adding pricey doctors back to their networks.

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