Looking Back, Some Obamacare Glitches Didn’t Matter. These Four Still Do.

For months, headlines screamed that the problems with HealthCare.gov and other insurance exchange websites would cripple the Affordable Care Act’s rollout.

And early enrollment figures seemed to bear out that pessimism: only 248 sign-ups on the first two days after HealthCare.gov opened for business. Just 27,000 the first month.

But fast forward one hundred days, and the sign-up figures start to tell a different story. More than 3 million people have used the exchanges to pick a private plan, and as Sarah Kliff noted at the Washington Post‘s “Wonkblog,” there’s a good chance that enrollment numbers will hit their January target. (HHS projected that about 1.1 million people would sign up for insurance in January, and there were roughly 800,000 sign-ups about halfway through the month.)

And while customers may have been frustrated and scared off from using HealthCare.gov and other websites initially, they’re coming back in droves.

In New York, about 75% of exchange customers used the state’s website — which suffered its own share of start-up glitches — to purchase health insurance through the end of last year. That’s above the 70% mark that HHS expected. (It’s also notable that enrollment in New York’s exchange has consistently exceeded HHS projections, so this isn’t just a measure of the customers who were persistent enough to get through.) In California, more people signed up for exchange plans in the first two weeks of 2014 than in the first two months of Covered California’s rollout last fall.

The ongoing focus on exchange enrollment has been driven by both politics and policy. (And counting sign-ups is seen as a simple, if convenient scorecard to gauge the rollout’s success.) But some of the initial fuss may have been overstated, analysts now say. A recent Robert Wood Johnson Foundation report suggests that the ACA can survive low enrollment and a less-than-ideal patient mix in this first year. 

“While the troubled launch of the ACA’s Marketplaces clearly undermined early enrollment,” authors Linda Blumberg and John Holahan write, “website improvements, policy strategies already in place, enrollment incentives, and competitive pressures in insurance markets are likely to blunt the implications in 2015 and beyond of this difficult start.”

But several lower-profile problems (and persistent glitches) continue to trouble the exchanges’ rollout, causing headaches for health providers and patients. Here’s a quick look at four of them.

Provider directories are out-of-date: Customers are signing up for plans because they think their doctors or certain hospitals are included but later are surprised to learn that’s not the case, Victoria Colliver reports for the San Francisco Chronicle. Peter Lee, the director of Covered California, acknowledged that the exchange’s site may include misinformation but said staff are standing by to help. “If our directory or the directory of the health plan is wrong and a consumer wants to change plans, we’ll work with them to make sure they can do so,” Lee pledged last week.

Plans moved customers without their knowledge: Hundreds of California residents were shifted into plans that they didn’t pick — despite selecting different plans on the Covered California exchange, Charles Ornstein writes at ProPublica. The confusion stems from the customers’ initial plans being discontinued under the ACA’s minimum coverage requirements, which prompted insurers to automatically shift them into new plans; the insurers are promising refunds.

Insurers still coping with lagging data, payments: Health insurers say they’re continuing to sort through the wave of sign-ups that they received at the end of December, including “phantom files” that don’t contain accurate information. WellPoint on Wednesday said that as recently as this week it was still receiving data files for sign-ups that took effect on Jan. 1.

Not all exchange websites are fixed: When tracking enrollment as a share of the marketplace-eligible population, as the Kaiser Family Foundation does here, it’s clear that states that chose to run their exchange websites are seeing much better results. (Meanwhile, states like Hawaii, Maryland and Oregon have had persistent troubles with their sites and are lagging behind the national average of 7.8%.) And on this measure of performance, the nation’s worst is Massachusetts, having gotten just 2.1% of its eligible population to sign up. The Bay State may have led the way with its 2006 health reforms, but the much-troubled reboot of its Health Connector site is causing persistent problems for would-be customers and insurers, too.

Around the nation

Here’s a quick review at what else is making news on the road to reform.

The State of Obamacare: In a series of video interviews hosted by healthinsurance.org, Harold Pollack and The New Republic‘s Jonathan Cohn discuss the technical details of the ACA enrollment mix, the specifics of plans listed on the exchanges and other takeaways about the law’s rollout.

Which insurers are capitalizing on the exchanges? The Huffington Post‘s Jeffrey Young takes a state-by-state look at which health plans have seen the biggest volume gains.

Obamacare will reduce inequality. A new Brookings Institution study suggests that the ACA’s coverage expansion will end up indirectly boosting the average income of the poorest Americans, Clara Ritger notes at the National Journal.

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