Most State Health Exchanges Run Smoothly, but Some Report Issues

Although the majority of state-based exchanges have avoided the problems of the federal exchange website, some still face technical issues, McClatchy/Sacramento Bee reports.

According to McClatchy/Bee, 75% of U.S. residents who have successfully enrolled in coverage have done so through a state-based exchange. Many states that have seen successful rollouts -- including California, Connecticut, Kentucky, New York and Washington -- have seen robust enrollment since open enrollment launched on Oct. 1 and have met their projected quotas. Those states point to federal funding, early site planning and adequate testing for their success.

For instance, Covered California began developing a complex computer system for the state's exchange in 2012 and had adequate time to test the site before going live. Covered California Executive Director Peter Lee said the state is enrolling about 2,000 individuals daily and that 69% of consumers said their experience with the site had been easy.  However, the site has also undergone night and weekend shutdowns for repairs and has faced difficulties with enrollment counselors being logged out of the system.

Similarly, despite success overall, Washington's Healthplanfinder also has had technical issues, including long waits at its call center and a flawed system launch. However, the state so far has enrolled 77,000 individuals in private plans or Medicaid. According to McClatchy/Bee, the state's early decision to have the exchange build and operate its own Medicaid eligibility system, as well as implementing an "anonymous browsing" feature, contributed to the early success (Pugh et al., McClatchy/Sacramento Bee, 11/25). 

Colorado, Oregon See Significant Setbacks

However, some states have not experienced the same success. For example, Colorado has enrolled just 6,001 state residents, well below the state's lowest-level enrollment projection of 11,108.

According to the AP/Sacramento Bee, if enrollment does not pick up, the state could have trouble paying for the exchange with per-member charges. The state needs 136,300 enrollees next year to raise $6.5 million of its $51.4 million cost.

Colorado's exchange also is having trouble determining which individuals qualify for Medicaid.  According to the AP/Bee, the Medicaid application is 12 pages long and if any piece of consumer information is incorrect or missing, potential enrollees might have to wait over a month to receive their "denial" and then will be forced to purchase a private plan, which could hinder their access to coverage that begins Jan. 1 (AP/Sacramento Bee, 11/25).

Oregon has also faced significant site issues. So far, not one individual has enrolled in a health plan in Cover Oregon because of issues with the site's enrollment feature, which lawmakers partially have blamed on Oracle, the site's developer. After repeatedly delaying the feature, officials have said the earliest they think the tool could be available is mid-December. Currently, consumers trying to sign up for coverage can only do so using a paper application.

According to Politico, the state has assigned hundreds of employees to process nearly 30,000 paper applications, but so far the state has yet to process any.

Jesse O'Brien, an Oregon health care consumer advocate, said, "With Oregon having a reputation as a state that supports health reform and with a governor [who] is very enthusiastic, I think everyone was expecting we'd be in a much different position." State Rep. Jason Conger (R) called the site an "epic failure" and said the problems were "mind-boggling."

On Friday, Oregon Gov. John Kitzhaber (D) announced he has appointed two state health care executives -- Greg Van Pelt, retired CEO of the Providence Health System, and Oregon Health Authority Director Bruce Goldberg -- to oversee paper-based enrollment. He said doing so will give Cover Oregon Director Rocky King time to focus on repairing the website.

Some consumers fear that if the site is not running properly by 2014, state residents whose plans have been canceled might be unable to access coverage. Although the state's insurance commissioner has ruled that insurers can withdraw their cancellations, those plans are ineligible to receive federal subsidies (Winfield Cunningham, Politico, 11/26).