With millions of dollars in federal funding, a more harmonious political environment and the benefit of early planning, most of the state-run health insurance marketplaces are outperforming the clunky, glitch-prone federal website that serves the other 36 states.
Federal figures show that nearly 3 of 4 Americans who enrolled in insurance coverage through online marketplaces in October did so through the exchanges run by 14 states and the District of Columbia. That’s nearly 80,000 people, compared with roughly 27,000 on the federal website HealthCare.gov, which had a goal of 500,000 enrollees for October.
Leading the enrollment success stories are states such as California, Washington, Kentucky, New York and Connecticut.
“There’s some extraordinary efforts being made in states across the country, and it augers well in terms of the overall implementation of the Affordable Care Act,” said Ron Pollack, the executive director of Families USA, a national patient advocacy organization. “Once the federal marketplace website is fixed, I think we can expect similar” enrollment successes.
Some states owe their success to early starts of construction on their enrollment websites. But comparing the operation of the federal health insurance exchange with those of the state-run exchanges is not an apples-to-apples equation.
HealthCare.gov has 186 insurance carriers, and each offers an average of 86 different products to consumers, which Peter Lee, the executive director of Covered California, the state’s health insurance exchange, called “mind-boggling.” Covered California has 11 plans across the state, with each insurer offering 36 products.
The Golden State’s health insurance marketplace, the first created in the nation, has avoided the pitfalls that have nearly derailed the federal system, and having a head start probably played a role.
The state passed legislation approving an online insurance exchange after the Affordable Care Act became law in 2010. Two years later, California had a plan to develop a complex computer system and the time to revise and test it before taking it live last month.
Most of the problems with the federal marketplace stem from the developers’ failure to test the fully integrated system rather than just its individual parts.
“California had the ability and focus to do a very detailed plan and then build according to that plan,” Lee said.
By the end of October, about 31,000 Californians had selected plans through the exchange, and that number jumped to 59,000 by Nov. 12.
Lee estimates that 2,000 people select plans each day on the website, and he said that 69 percent of those who did so said it was easy, adding, “That belies the logic and the drumbeat in the media that people can’t get through and enroll.”
Even so, Covered California also has faced technical roadblocks – including night and weekend shutdowns for repairs, bugs in a provider directory and complaints by enrollment counselors of being logged out of the system. Some health providers in the state give the system a B minus for reliability, but they say that’s better than the failing grade the federal exchange warrants.
Washington state’s Healthplanfinder has encountered its share of problems, too, including a troubled launch and long waits at its call center. But the exchange enrolled more than 77,000 people in private plans or Medicaid in its first six weeks.
“Washington is among the states that have had the fewest issues with getting started,” said Anne Gauthier, senior program director at the National Academy for State Health Policy. “I wouldn’t say Washington is at the head of the class or that any of the others are. . . . They have all experienced issues. They are sharing information about how they are solving them. They are all making fixes and improving.”
A few early, strategic decisions are shaping up as the key to avoiding bigger troubles, according to officials at the Washington Health Benefit Exchange, the public-private partnership that runs the website and is led by Chief Executive Richard Onizuka.
The state chose early on to have its Department of Social and Health Services build its own Medicaid eligibility system to serve as an interface with the exchange. This made use of existing Medicaid eligibility data but let the exchange bypass its older computer system.
The state had set up its website to allow “anonymous browsing,” which meant that visitors to the site didn’t have to create accounts before shopping or comparing prices. Curt Kwak, the chief information officer for the Washington exchange, said he thought it had led to more people using the site.
“People weren’t afraid to go in and find things,” he said. “If they saw what they liked, boom; they applied. If they didn’t, they went on about their business.”
Kentucky also started building its website early, in October 2012. By last June, it was among the first states to submit required test results of its ability to link to the federal data services hub, which verifies applicants’ information for marketplaces in each state. As of Thursday, more than 56,000 people had enrolled for coverage; nearly 11,000 had signed up for health plans and more than 45,000 had signed up for Medicaid.
Carrie Banahan, the executive director of the Kentucky Health Benefit Exchange, said state officials also benefited from asking private-sector experts to help develop and test the program. She said Kentucky’s decision to allow people to browse health plans without creating full financial profiles had made the system easier to use.
The lack of browsing ability was a big reason the federal website malfunctioned on its Oct. 1 launch.
In Connecticut, the 14,000 people who enrolled in October are about 14 percent of its total six-month enrollment goal, said Kevin Counihan, the CEO of the state’s marketplace, Access Health CT.
“We had a much bigger start, actually, even on our first day, than I expected,” said Counihan, who worked on the Massachusetts exchange –which served as the model for Obamacare – and who’d expected similarly slow enrollments in Connecticut.
In a survey of 700 Access Health CT enrollees, 82 percent said they were likely to recommend the exchange to a friend.
Next door in New York, more than 24,500 people had selected plans and nearly 24,000 had enrolled in Medicaid for next year as of Nov. 12. Danielle Holihan, the deputy director of the state marketplace, credits the successful launch of its website a year ago and the opening of the call center two weeks before the start of open enrollment on Oct. 12.
The website logged 10 million hits on the first day and quadrupled its user capacity within three days. Now 95 percent of transactions are processed in under two seconds.
On the other hand, sign-up numbers are low in Maryland and Oregon’s marketplace has been a flop thus far, with technical problems that have stymied enrollment. But the state has had great success at enrolling 70,000 people in Medicaid, which has helped to cut Oregon’s uninsured rate by 10 percent, said Amy Fauver, a spokeswoman for the Cover Oregon marketplace.