The Obama administration said on numerous occasions that federal officials anticipated that enrollments would accelerate as the deadline to purchase exchange insurance for coverage beginning January 1 approached. Finally, that much-extended deadline has come and gone, and the limited evidence available suggests that, particularly for the system of 36 federally-facilitated exchanges, the enrollment figures were relatively strong — at least on deadline day.
Given the problems that plagued the rollout of the federal insurance marketplaces, the fact that on December 23, ahead of the deadline, two million people visited Healthcare.gov, the website linking the exchanges of those 36 states that chose not to operate their own marketplaces, is significant. Also, in the first three weeks of the month, more than 500,000 people enrolled for coverage via the federal website, a sign the administration’s “tech surge” had its desired effect: eliminating the design flaws and software errors that kept insurance customers from signing up.
But the enrollment numbers of the 14 states and the District of Columbia, which created their own marketplaces, may tell a different story. When the insurance exchanges — the cornerstone-provision of the Affordable Care Act — launched on October 1, the federally-facilitated marketplaces suffered numerous design flaws and software errors. The rollout of the state-created exchanges were comparatively much smoother. Yet, as the federal exchanges have stabilized, the technological delays and low sign-up numbers that several state exchanges — including those operated by Maryland, Hawaii, Massachusetts, and Oregon — have experienced are becoming more apparent.
All those states, except Massachusetts, have replaced the top executives of their exchange’s board of directors. California and New York continue to be examples of successful rollouts the healthcare reform’s online marketplaces, yet the stumbles of other states will likely undermine the argument that states did a far better job setting up their enrollment systems than the federal government. Plus, the administration can little afford any further setbacks in the proper functioning of the exchange websites or in enrollments.
Heather Howard — a program director at the State Health Reform Assistance Network, which advises state exchanges — told Bloomberg that even though there has been “hurdle after hurdle after hurdle,” the struggling states “will get there,” meaning a point where the marketplaces operate smoothly. But for many states, smooth operation is distant reality.
After facing backlash regarding the state’s error-riddled website, Director of Minnesota’s MNsure exchange, April Todd-Malmov, resigned last week. While the deadline for enrollment in Minnesota was extended until New Year’s Eve, 1,100 residents must reapply due to inaccurate subsidy calculations. “MNsure must do better,” her replacement, Scott Leitz, said in a December 17 statement. On December 6, Maryland’s exchange director also resigned, while ongoing problems prompted the state’s Governor Martin O’Malley to extend the signup deadline to December 27 and hire Quality Software Services — the same unit of UnitedHealth (NYSE:UNH) who was charged by the federal government to led repair efforts to healthcare.gov.
Poor exchange performance led the executive director of the Hawaii Health Connector to announce her departure on November 26. Before leaving, she apologized. In Oregon, consumers still cannot complete the entire enrollment process online, and in Massachusetts, whose 2007 healthcare reform was the model for the Obamacare marketplaces, the new exchange system has posed problems. As of the end of November, the state’s Health Connector had enrolled only 1,100 people, while a December 12 report noted that the “overall system performance is far from where it needs to be.”
Comparatively, California and New York have strong numbers. As John Emery, a spokesperson for New York’s exchange, wrote in a December 24 email to Bloomberg, close to 157,000 people in New York have signed up in private plans. According to Peter Lee, the executive director of the Covered California exchange, more than 400,000 Californians have enrolled. The exchanges of Kentucky and Washington State have also experienced high levels of interest.
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