Updated, 3:29 pm EST 27 December 2013
Econintersect: Through October and November a number of state health insurance exchanges (HIXs) were cited as success stories as the federal website Healthcare.gov fumlbed the ACA (Affordable Healthcare Act) rollout. But, as technical problems with the federal system started to be resolved in December, more and more problems with state HIXs have surfaced. Some states, notably California, Kentucky and New York, have seen HIXs operate well enough to meet enrollment and insurance application targets. But many others of the 15 (including the District of Columbia) who elected to operate state exchanges have struggled with technology delays and low enrollments.
According to a Bloomberg article at the insurance industry website HIX, some of the ACA (Obamacare) success stories are:
- Almost 157,000 people in New York have signed up in private plans. (24 December 2013 email from John Emery, a spokesman for the state-run exchange)
- California has enrolled more than 400,000. (Peter Lee, executive director of the state’s Covered California exchange)
- More than 500,000 enrolled at healthcare.gov over the first three weeks of December. (President Obama 20 December 2013)
- More than 2 million people visited Healthcare.gov 22 December 2013, the day before the sign-up deadline for coverage to start 01 January 2013.
Among the states specifically mentioned with problems by the Bloomberg article are Massachusetts, Oregon, Hawaii, Maryland and Minnesota. Massachusetts already had a HIX operational prior to ACA, implemeted in 2007 under the so-called Romneycare system upon which the ACA was modelled. But the state has not had a successful conversion over to a HIX for Obamacare.
Bloomberg offers one explanation, quoting a phone interview with Daniel Mendelson, chief executive officer at Avalere Health, a Washington-based consultancy,who said:
"You really had to have somebody who understood large-scale implementation of an IT project. Many states gave their exchange to really outstanding policy people as opposed to IT people. That's not good. It will really not result in the desired outcome."
Even though New York has been cited as a successful HIX operation, The Buffalo News reports that not everything is going smoothly. From an article last Sunday (22 December 2013):
People who have tried to enroll through NY State of Health say they've frequently found the site out of service, regularly run into issues entering information into the site, spent hours on the phone to get help from someone and waited weeks to receive confirmation of coverage.
Many of the 134,622 who as of early last week had made it to the end - and the navigators hired to help them through the knotty enrollment process - describe their sense of relief with the kind of language that might someday greet a Buffalo Bills victory in the Super Bowl.
"I have crossed the River Styx and reached the Promised Land," said Mary T. Stengel, a freelance writer and editor from West Seneca, summing up how she felt when her enrollment journey was finished and her coverage was confirmed.
There seems to be some sporadic progress in the ACA implementation but the general impression is that there will be many more stumbles before anything like a fully operational system will be in place. What is obscuring the current state of affairs is a lack of detailed performance data.
Update, 3:29 pm EST 27 December 2013: The Wall Street Cheat Sheet reported today that governors are taking action against contractors who have failed to complete functional state HIXs. In addition Maryland has extended the sign-up deadline to today for coverage to take effect 01 January. Among contractors facing possible legal action are CGI (the same comapny who developed the Federal HIX, Healthcare.gov) and Oracle. Read full article at Wall Street Cheat Sheet.
- Obamacare Hits Snag in States as U.S. Site Finds Footing (Alex Wayne and Alex Nussbaum, Bloomberg, HIX: Health Insurance Exchange, 26 December 2013)
- State hits bumps but meets sign-up goals on health insurance exchange (Stephen T. Watson, Buffalo News, 22 December 2013)