Uninsured Find More Success via Health Exchanges Run by States
Published: October 8, 2013 - New York Times
WASHINGTON — Robyn J. Skrebes of Minneapolis said she
was able to sign up for health
insurance in about two hours on Monday using the Web site of the state-run
insurance exchange in Minnesota, known as MNsure. Ms. Skrebes, who is 32 and uninsured, said
she had selected a policy costing $179 a month, before tax credit subsidies, and
also had obtained Medicaid
coverage for her 2-year-old daughter, Emma.
“I am thrilled,” Ms. Skrebes said, referring to her
policy. “It’s affordable, good coverage. And the Web site of the Minnesota
exchange was pretty simple to use, pretty straightforward. The language was
really clear.”
The experience described by Ms. Skrebes is in stark
contrast to reports of widespread technical problems that have hampered
enrollment in the online health insurance marketplace run by the federal
government since it opened on Oct. 1. While many people have been frustrated in
their efforts to obtain coverage through the federal exchange, which is used by
more than 30 states, consumers have had more success signing up for health
insurance through many of the state-run exchanges, federal and state officials
and outside experts say.
Alan R. Weil, the executive director of the National Academy for State Health Policy, an
independent nonpartisan group, credited the relative early success of some state
exchanges to the fact that they could leap on problems more quickly than the
sprawling, complex federal marketplace.
“Individual state operations are more adaptable,” Mr.
Weil said. “That does not mean that states get everything right. But they can
respond more quickly to solve problems as they arise.”
In addition, some states allow consumers to shop for
insurance, comparing costs and benefits of different policies, without first
creating an online account — a barrier for many people trying to use the federal
exchange.
The state-run exchange in New York announced Tuesday
that it had signed up more than 40,000 people who applied for insurance and were
found eligible.
“This fast pace of sign-ups shows that New York
State’s exchange is working smoothly with an overwhelming response from New
Yorkers eager to get access to low-cost health insurance,” said Donna
Frescatore, the executive director of the state exchange.
In Washington State, the state-run exchange had a
rocky start on Oct. 1, but managed to turn things around quickly by adjusting
certain parameters on its Web site to alleviate bottlenecks. By Monday, more
than 9,400 people had signed up for coverage. The Washington Health Benefit Exchange does
not require users to create an account before browsing plans.
“The site is up and running smoothly,” said Michael
Marchand, a spokesman for the Washington exchange. “We’re seeing a lot of use, a
lot of people coming to the Web site. If anything, I think it’s increasing.”
Other states reporting a steady stream of enrollments
in recent days include California, Connecticut, Kentucky and Rhode Island.
In Connecticut, a spokesman for the state-run
exchange, Access
Health CT, said users have generally had a smooth experience with the Web
site other than “a couple of bumps and hiccups on the first day.”
By Monday afternoon, the Connecticut exchange had
processed 1,175 applications, said the spokesman, Jason Madrak.
Daniel N. Mendelson, the chief executive of Avalere
Health, a research and consulting company, said: “On balance, the state
exchanges are doing better than the federal exchange. The federal exchange has,
for all practical purposes, been impenetrable. Systems problems are preventing
any sort of meaningful engagement.”
“By contrast,” said Mr. Mendelson, who was a White
House budget official under President Bill Clinton, “in most states, we can get
information about what is being offered and the prices, and some states are
allowing full enrollment. All the state exchanges that we have visited are doing
better than the federal exchange at this point.”
In California, Peter V. Lee, the executive director of
the state-run
exchange, said that more than 16,000 applications had been completed in the
first five days of open enrollment. Mr. Lee said that while the consumer
experience “hasn’t been perfect,” it has been “pretty darn good.”
Some state-run exchanges have run into difficulties
because they rely on the federal marketplace for parts of the application
process, like verifying an applicant’s identity. Minnesota, Nevada and Rhode
Island are among the states that have reported problems with the
“identity-proofing” process, which requires state-run exchanges to communicate
with the federal data hub.
Brandon Hardy, 31, of Louisville, Ky., was one of the
first to sign up for health insurance through Kentucky’s state-run exchange, working with
an application counselor who guided him through the process last Wednesday. Mr.
Hardy, who is uninsured and has epileptic seizures
that land him in the hospital every few months, spent about 45 minutes filling
out the online application, and learned that he would be eligible for Medicaid
under the health
care law.
“It was pretty easy,” Mr. Hardy said of the process.
“What I really need is a neurologist, and now hopefully that will happen. This
is like a huge relief.”
Attempts to sign up for coverage through the federal
marketplace have often proved more frustrating.
Bruce A. Charette, 60, of Tulsa, Okla., said he had
been trying to log onto the Web site for the federal exchange since last
Wednesday, but had not been able to see the available plans or their rates.
Mr. Charette said he was asked verification questions
that did not appear to match his identity. One question, he said, asked about
the name of a pet for which he had purchased health insurance two years ago. “I
don’t have any pets,” he said.
“It’s obvious that the site is overloaded,” said Mr.
Charette, an electrician who works in the aviation industry and said he did not
have health insurance. “I am not going to stare at a computer screen for 45
minutes, waiting for a response. It looks as if the Web site is freezing up.”
Still, some groups helping people sign up for
insurance through the federal marketplace said they were finally able to
complete applications on Tuesday, a week into open enrollment.
“This was the first day that I have been able to get
onto the Web site and sign people up,” said Laura Line, corporate assistant
director for Resources for Human Development in Philadelphia, which has a
contract to help people in Southeastern Pennsylvania enroll in health plans
through the federal exchange. “We have been setting appointments and answering a
ton of phone calls now that we are able to do something.”
Katie Thomas and Jennifer Preston contributed reporting from New
York.