HealthCare.gov, the federal health insurance exchange, is a disaster. One month out from launch, the mother ship is still grounded and looks like it will be for some time yet. The state-level stories, however, are quite different. The Washington Post reported last week on four states—California, Connecticut, Kentucky, and Washington—that are doing pretty well at getting citizens signed up. The same seems to be true for Arkansas and Rhode Island, based on data through the first four weeks of enrollment.
The 16 states that chose to create their own exchanges have online insurance marketplaces that are independently developed, and locally hosted and operated. Consumers living in the other states go to a single federally hosted webpage, HealthCare.gov.
State-based exchanges have their share of glitches but have pretty much gotten the technology right. What they didn’t get quite right was the human factor: Both interest and demand for information about the possibility of affordable health care is “more than most states anticipated,” says Angela Sherwin, program director of the Executive Master of Healthcare Leadership program at Brown University. “Enrollments are slower than desired, but states with their own exchanges are running more smoothly in general than the feds, and they may be able to react to demand and tech issues more quickly.”
That’s true in Arkansas, a partnership state that made a concerted effort to enroll people using good, old-fashioned paper applications. The Insurance Department even set up a booth at the state fair and had staffers wander around handing out enrollment cards. “We talked with more than 25,000 people, and about 400 people sat down and filled out applications,” says Heather Audirsch Haywood, public information manager for the Arkansas Health Connector Division of the Arkansas Insurance Department.
Arkansans did try to use the Health Connector, the state website that drives traffic to HealthCare.gov. On Oct. 1, 13,470 unique visitors tried the site. That daily number has dwindled since, but the site had 66,762 visitors through Oct. 26. There have been 2,500 calls to the call center.
“We are fortunate to have workarounds like the call centers and in-person navigators to assist people,” says Cindy Crone, deputy commissioner of the Arkansas Insurance Department. The Arkansas Human Services Department also conducted an outreach program to 65,000 food stamp recipients to tell them they were eligible for Arkansas’ Medicaid expansion/private option program, and 30,000 responded. “That was pretty incredible,” Crone says.
Rhode Island built its own exchange and got off to a rocky start because of unexpected demand. “On the first day, we crashed for an hour or two because of the volume,” says Dara Chadwick, Chief, Strategic Communications and Media Relations, HealthSource RI. “We added some servers to boost capacity, and it’s been relatively smooth ever since,” though they did experience ID verification issues, as most of the other state exchanges did, caused by problems on the federal end of things.
As of Oct. 26, HealthSource RI has logged 89,310 unique visits, 9,687 accounts created and 3,762 completed and processed apps. The contact center registers nearly 17,000 calls or walk-ins. “We are pleased with the interest we have seen and surprised at the number of walk-ins to our Contact Center,” Chadwick ways.
Things are also “going OK” out in Washington state, says Richard Onizuka, CEO of Washington Health Benefit Exchange. “We have had our bumps like everybody else, but we are pleased the system is operational.” Those bumps include long wait times, again due to higher-than-anticipated volume. The Seattle Times reported that instead of the expected 2,500 calls a day to the call center, the actual number has averaged about 6,000 and gone as high 10,000 calls. That has resulted in wait times of about 25 minutes. Emails have also flowed in at the rate of about 500 a week. “We are ramping up resources, adding 20 new staffers today [Oct. 28] and another 50 in the next few weeks,” Onizuka says. “We want to get wait times down to less than a minute.”
Another setback involved the miscalculation of tax credits that affected about 8,000 people. “It was a miscommunication about monthly income vs. yearly income,” Onizuka says. “we put in a fix pretty quickly.”
So, one month into this thing, what does this mean? Frankly, no one knows. As with other states, Rhode Island has no real way to judge the numbers. “We have nothing to compare it to, whether it is good or bad,” Chadwick says. Out West, Onizuka recently made a presentation to the state legislature, including a section on “lessons learned.” One of the things I told them was, we didn’t know what we didn’t know,” he says. “This is a new world for all of us. We don’t know what normal is.”