States Race to Improve Health Exchanges as Open Enrollment Nears
By: Abby Goodnough (New York Times) November 2014
WASHINGTON — Massachusetts and Minnesota have sharply increased the number of call center workers who will help people enroll in health plans through the states’ insurance exchanges. Colorado has created an online avatar named Kyla to guide consumers through the sign-up process. And Maryland has replaced its exchange, which foundered last year, with Connecticut’s successful model.
Across the country, many of the states that created their own insurance exchanges under the Affordable Care Act are rushing to complete improvements before Saturday, when a new open enrollment period begins. Though some had smooth sailing last year, a few experienced worse technical problems than the federal marketplace serving 36 states, which had a disastrous rollout.
In Maryland, where frozen screens and error messages persisted for months, the state has raced to adapt the software used by Connecticut in time. Along with Massachusetts, which has also replaced a defective exchange on a tight time frame, Maryland will draw special scrutiny in the coming weeks as consumers start testing the new systems.
Maryland officials say they are confident that things will run smoothly because they are relying on a proven model and have tested it extensively. Like several other states, they switched vendors, replaced exchange managers and spent millions of additional dollars to avoid repeating last year’s technical failures.
“It’s like a night-and-day difference,” said Dr. Joshua M. Sharfstein, the state’s health secretary and chairman of the exchange. “We have adapted software that fundamentally works.”
But the task will be more complicated this time. In addition to signing up new customers, the exchange, Maryland Health Connection, will need to re-enroll about 50,000 people who bought subsidized private coverage during last year’s enrollment period. Those consumers will lose their subsidies if they do not reapply by Dec. 18, because the exchange cannot transfer information from the old system to the new. The exchange is reaching out to them by phone, letter and email; their insurers are contacting them as well.
Dr. Peter Beilenson, chief executive of Evergreen Health Co-op, one of four insurers offering coverage through the Maryland exchange, said the new system would be “vastly better.” But he worries that consumers haunted by last year’s well-publicized failures will not try it.
“The $64,000 question is not how well it’s going to work, but are people going to come to it?” Dr. Beilenson said. “There’s a lot of cynicism and distrust, and a huge lack of knowledge.”
The new website, built by Deloitte Consulting, will have a simpler application process and allow for anonymous browsing. Last year customers had to create an account before seeing the details of insurance plans, which led to major bottlenecks — a problem that also affected the federal exchange and several other state exchanges.
Other exchanges have also tried to streamline the enrollment process and the look of their websites. Many will have more workers in their call centers this year and more enrollment events to help people through the sign-up process. California’s exchange, Covered California, is opening 200 storefronts across the state where people can get one-on-one help.
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Nevada and Oregon, which had two of the worst-performing exchanges last year, are using the federal marketplace this time. Idaho is opening its own exchange after using the federal site, HealthCare.gov, last year. In all, 37 states will rely on the federal exchange for the coming enrollment period, and 13, as well as the District of Columbia, will run their own. Of the eight million people who enrolled in private health plans under the Affordable Care Act during the first sign-up period, 2.6 million used state-run exchanges.
Managers of Vermont’s troubled exchange, which has been offline for repairs since September, are asking customers who already have coverage to avoid using the website during open enrollment to keep volume down. Asked last week whether the exchange would be working by Saturday, Gov. Peter Shumlin said, “I’ve been discouraged so many times by this website that I’ll believe it when I see it.”
Minnesota is also still fixing defects in its exchange website, officials there said. Its exchange, MNsure, has increased the number of call center representatives to nearly 300, from about 25 when it opened last fall.
In Massachusetts, more than 300,000 residents who were temporarily enrolled in Medicaid when the state exchange faltered last year will have to reapply through the new system if they want to stay covered. So will as many as 140,000 people with private exchange plans.
The exchange will have 680 customer service representatives and application processors — more than twice as many as last year — and will be able to handle 3,500 concurrent website users on an average day, said Kimberly Haberlin, a spokeswoman for the Massachusetts exchange. “We are on the cusp of standing up a product that we are confident is going to work,” she said.
Ms. Haberlin said the state did not have an estimate of how many new customers would sign up in the second enrollment period. But she pointed out that only about 3 percent of Massachusetts residents remain uninsured because a 2006 state law — the model for the Affordable Care Act — had already motivated most to get coverage.
Many state-run exchanges say they now have carefully prepared backup plans if the websites fail, including resorting to paper applications. Maryland, in an abundance of caution, is rolling out its new system gradually instead of opening it to everyone on Saturday. The exchange will hold a single enrollment fair that day where people can sign up with the help of trained counselors, but they will not be able to do so at home. On Sunday, people can start signing up by phone, and on Nov. 19 by themselves online.
Dr. Sharfstein said that since all the testing of the system was not “the same as actual use,” exchange officials thought it best to increase access to it in a gradual, controlled fashion.
But Dr. Beilenson said he worried that the phased rollout would frustrate or confuse people. “People might give up again if they go online and try four times in the first four days and can’t enroll,” he said.
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Maryland, like Massachusetts, has not said how many new customers it hopes to sign up for private coverage during the new enrollment period, which ends on Feb. 15. More than 80,000 people managed to sign up during the first enrollment period, but many filled out paper applications or got help from brokers or counselors who knew workarounds. About 65,000 remain enrolled, Dr. Sharfstein said.
To try to prevent frustration, the Maryland exchange will have 350 call center representatives this year — far more than it started with last time — and several thousand private insurance brokers trained to help people enroll. The new software allows brokers to see the online applications of people who have given them permission to do so, he said, and complete their applications.
Consumer groups that help enroll people will also be expanding their outreach. HealthCare Access Maryland, a nonprofit consumer group, is opening two new offices in strip malls, with weekend and evening hours, Kathleen Westcoat, the group’s chief executive, said. The group’s enrollment counselors have received “a fair amount of training” on the new system, she said, a major difference from last year.
“It does really seem very user-friendly and clear,” Ms. Westcoat said of the system. “You don’t know until you know, but I feel good.”
