eI wish we had one more year:f States are struggling
to launch Obamacare on time
By Sarah Kliff, Updated: - Washington Post
HARTFORD, Conn. — Facing tight deadlines and daunting workloads, states
across the country are scaling back ambitions for implementing the Affordable
Care Act.
At a monthly board meeting of Connecticutfs health insurance exchange,
members of the standing-room-only crowd got a reminder that they, too, were
behind schedule. The insurance marketplace they were working on nights and
weekends wonft be completely ready on time.
gIt is highly complex, itfs unprecedented and itfs not going to be smooth,h
Kevin Counihan, chief executive of the statefs exchange, Access Health CT, told
the group.
Thatfs why Connecticut — like other states across the country — has lowered
the bar, doing what it can in the time it has left before the health-care lawfs
major programs are launched Oct. 1.
Although the states are promising to provide new marketplaces for individuals
to compare and buy health insurance plans, the Web portals will be a bare-bones
version of what was initially envisioned.
And then there are the federal setbacks. The Obama administration has put off
significant aspects of the health-care overhaul as it races to finish provisions
that will give Americans more insurance options and provide many with financial
assistance to buy coverage. On Tuesday, the White
House announced a decision to delay the gemployer mandate,h a requirement
that employers with 50 or more workers provide coverage.
gIn 2011, there was this ewefre going to save the worldf mentality,h said
Rebecca Pearce, executive director of the Maryland Health Benefit Exchange. gIn
2013, it focuses more on how do we deliver on the requirements of the law.h
The District of Columbia and 15 states — including Connecticut — are building
their own marketplaces. Those jurisdictions, among the Affordable Care Actfs
most ardent supporters, took on the responsibility of building Web portals that
are at the heart of the federal health-care overhaul. Most
states, eschewing the heavy workload, left the task to the federal
government.
The White House expects 7 million people to buy health insurance or
enroll in Medicaid through these Web portals. Millions more are likely to browse
these sites for health plans and explore possible options under the federal law,
which imposes an gindividual mandateh requiring most people to obtain coverage
or pay a penalty.
In Connecticut, Counihan and his colleagues decided in January to delay about
30 percent of the Web portal functions they had hoped to have ready by
October.
gWe were beginning to slip in timing,h Counihan said. gWe were getting these
messages that we werenft going to be able to hit our timelines because of the
complexity. Some things were either requiring more time or coding than we had
expected.h
When a consumer asks to be exempted from the individual mandate, for
instance, the request will probably have to handled manually, by an exchange
worker, rather than automatically, by a computer. Technology to track those
points at which customers give up on the application process — turning away from
the Web site rather than completing the application — will also wait until a
later date.
gThis is a two- to three-year implementation wefre doing in 10 months,h
Counihan said. gI wish we had one more year.h
Across the country, other states report similar problems.
In Oregon, officials decided to delay a feature that would allow consumers to
customize searches for rating the coverage provided by insurers. And a feature
for insurance brokers to track the consumers they enroll will wait for two to
four months.
How will brokers keep track of potentially thousands of customers in the
interim? Cover Oregonfs executive director, Rocky King, suggested that they
might use gindex cards.h
gI know the agents will have all their Excel worksheets,h King said. gWefve
gone to them and said: eYoufre our priority sales force, but youfre not
necessarily the priority for how you access the system. The consumers
are.f h
Nevada officials recently delayed plans for a chat function on the statefs
Web portal.
gThe longer the process takes, the more difficult it is,h said Jon Hager,
executive director of Nevadafs Silver State Health Insurance Exchange. gIt will
affect our enrollment, so we are trying to make sure we have those items
implemented as soon as possible.h
Hager described the Web chat function as a glow-impact itemh because users
with questions will be able to reach out to a call center, which will be ready
by Oct. 1. gThe things we delay are those that we think will not have a
significant impact,h he said.
The federal government has faced multiple delays on health-care provisions
affecting employers.
The White Housefs announcement Tuesday that it would not enforce the
employer mandate until 2015 followed a setback in April, when the administration
decided to delay for a year a key function of the small-business marketplace.
Rather than allowing each employee to pick a health plan, as the law intends,
workers will have to enroll in a plan selected by their employers.
The Government Accountability Office recently questioned the federal
governmentfs ability to launch the federal exchange, which will serve the
majority of states in 2014 next year.
gWhether [the administrationfs] contingency planning will assure the timely
and smooth implementation of the exchanges by October 2013 cannot yet be
determined,h the GAO said.
For states that are setting up their own exchanges, the administration will
make sure that they are ready in October, said Alicia Hartinger, a spokeswoman
for the Center for Medicare and Medicaid Services.
gAmericans in every state will be able to shop for quality, affordable
insurance in a marketplace beginning October 1, 2013,h she said in a statement.
gWe have provided states with the flexibility they need to build a marketplace
that meets their needs, and we are working closely with them to ensure that they
are ready.h
Even after deferring some items, Connecticut officials still say they face
long nights and weekends in the office to get the new marketplace off the ground
on schedule.
At Access Health CT, employees regularly turn up during nonbusiness hours.
The office is closed Friday, the day after the Fourth of July holiday, as a way
to force employees to take a day off.
gAt 9 p.m., you would have no trouble finding someone to go out to dinner
with,h said Peter Van Loon, the exchangefs chief operations officer, about
a typical day. gCome in at noon on Saturday and you could hold a meeting.
Itfs not that people are chained to their desk. I have trouble kicking people
out.h
Connecticut has made progress. It was the first state to complete an
intensive technology test in which the statefs portal successfully connected to
a federal data hub.
But officials have learned that good news can have a downside. The state
agency spent weeks reprogramming its Web site after the federal government
shrank the insurance application from 21 pages to three.
When the Supreme Court struck down a key element of the federal Defense of
Marriage Act, Access Health CT board members cheered. Then, they remembered that
it would add to the workload: The marketplace would now need to recognize
same-sex marriages, a coding change unlikely to be ready for October.
gEverything continues to change all the time,h Van Loon told his staff at a
meeting later that day. gWefre going to have to adjust some processes around
that. If DOMA requires a manual work-around, wefll do that.h