Up to half a million people who have signed up for health care under the Affordable Care Act could lose coverage or have to pay more due to problems with their paperwork, according to a report from the Los Angeles Times.
About 115,000 people haven't verified their citizenship or immigration status, and 363,000 people haven't verified their income, the report said.
"With the hurried push at the end of the enrollment period, it's likely that many didn't read the fine print regarding sending in their documentation," said Shana Charles, director of health insurance studies at the UCLA Center for Health Policy Research. "Also, there may be some small percentage that misrepresented themselves, and would find that they no longer qualify for their subsidies or coverage."
Some of the people at risk may not yet have all the paperwork they're required to submit, according to Sherry Glied, dean of New York University’s Robert F. Wagner Graduate School of Public Service.
"I think it is likely mostly people in complicated immigration situations," Glied said. "These might be people with appeals pending, or people whose immigration paperwork hasn't gone through, and others."
"Most of these cases have been resolved -- about 88 percent -- but some have not," Glied added, referring to the fact that the 115,000 people still at risk are left over from 966,000 original cases. The government resolved 851,000 of those, according to a report from The Washington Times.
At this point, some of the unresolved cases may be due to people giving up, Glied said.
"It sounds like done a lot of outreach, but it's always possible to do more," she said. "It's possible that some people aren't responding because they do not qualify and see no reason to submit paperwork that will simply confirm that fact."
The issue could also come down to politics, according to Bruce C. Vladeck, senior adviser at Nexera, a health care consulting firm.
"I don’t think this is a problem of reaching out," Vladeck said. "I think it’s partially a problem of the inadequate state of various federal government databases, and the often-confusing state of immigration law and administrative processes."
"On the broader level, because the Republicans made it such an issue over so many years, the Affordable Care Act was designed to absolutely minimize the political risk that undocumented people might get coverage, and created a lot of new bureaucratic hoops to prevent it," he added.
Another part of the problem is that people may have trouble finding the information relevant to their cases, Charles said.
"The information exists but is confusing to access," she said.
It's also important to put the numbers in context, Glied stressed.
"I don't think this is a public information issue," she said. "It's an unfortunate situation, involving fewer than 1.5 percent of all the people who signed up in the marketplaces. In many ways, it's more difficult to target information to such a tiny group."