As the Obama Administration gets ready to reveal data this week on how many people have enrolled for insurance under the Obama health law, a quick review of those states that set up their own health exchange web sites shows that enrollment troubles aren't limited to just healthcare.gov.
One outside group estimated on Monday that about 50,000 people have signed up for private health insurance; if true, that would be only about 10 percent of the original estimate that 500,000 would enroll in the month of October.
Federal officials blame much of the low enrollment numbers on the troubles with healthcare.gov, which was to finish on Tuesday morning with a multi-day fix on the part of the web site that deals with eligibility for government subsidies.
But if you think that healthcare.gov is the only problem when it comes to internet portals for the Obama health law, that's not the case.
There is one state that is in worse shape right now than the federal health insurance portal - that's Oregon - where the state hasn't been able to even enroll anyone on line. Zero.
Now Oregon is hiring at least 400 people to deal with paper applications for health insurance, and there is no time line for when the web portal will be up and running.
To be fair, all of the stories are not bad when it comes to signing up people for health insurance.
Kentucky, Minnesota, Washington and Connecticut have received good marks for their web sites and the numbers signed on so far.
Let's take a quick look around the country:
California - Covered California highlighted a lot of statistics early on about interest in its web site, but has yet to release any figures on enrollments. Still, the Golden State's web site has seemingly been in better shape than healthcare.gov.
Colorado - With headlines about 250,000 insurance policies being canceled in Colorado, the fact that only 3,408 people signed up for health coverage in October in the Centennial State wasn't exactly what supporters of the health law had hoped for. One thing that might be turning off Colorado enrollees is that you must first fill out a Medicaid application, even if you don't qualify for such coverage.
Connecticut - The Access Health Connecticut has received good marks, even though the exchange stopped issuing news releases about its enrollment numbers early on in October. The Hartford Courant reported last week that the state exchange is actually looking at hiring new web contractors to see if they can get around some of the troubles at healthcare.gov.
District of Columbia - As members of Congress and their staffs start signing up for insurance through the DC exchange, we might get some more stories about whether it is working well or not. Last week, two insurance companies selling through the DC exchange told GOP Senators that they had enrolled a total of five people - combined.
Hawaii - Hawaii's web site didn't go live until mid-October, and so far it seems to have avoided major pitfalls, even though some controversy has been stirred by the fact that the company that built the Hawaii site (CGI) was also a main contractor for healthcare.gov.
Idaho - A deeply Red state, Idaho still went ahead and set up its own exchange, but it has had some hiccups in its operations. Last week, the Idaho exchange started looking for a contractor to set up a better way for consumers to see rate plan information; they already added on a web tool to help estimate how much in government subsidies someone might be eligble to receive.
Kentucky - If there is one state that has done well, it is Kentucky. Even though they used CGI as one of their subcontractors, the reports are that the web site has functioned without major setbacks since October 1. The one red flag has been much higher levels of Medicaid signups when compared to regular health insurance - about an 80-20 split.
Maryland - Maryland's exchange has been slow in signing up people for insurance, and has an even higher rate of Medicaid vs private insurance signups than Kentucky. The web site has also been beset by troubles: "While a number of improvements have been made, additional work is underway to make the website faster, reduce error messages, and improve reliability," state officials reported.
Massachusetts - Massachusetts has received a lot of attention because it rolled out its own insurance exchange back in 2006. The state has not yet released enrollment numbers. A story just last week in the Boston Herald said the Bay State's web site is "riddled with infuriating computer flaws."
Minnesota - The North Star State's exchange web site has had decent success so far - "We delivered on our promise," the MNsure exchange chief said last week at a news conference, reporting almost 11,000 state residents have signed up for health insurance coverage so far - but only 1,774 of those were private insurance signups.
Nevada - Nevada's exchange is another that hasn't been releasing actual enrollment numbers - officials said last week by 8,800 applications for coverage had been completed. As for the Silver State's web site, it was ripped in a story last week in the Las Vegas Review Journal, which used words like "atrocious" to describe the views of insurance brokers on how the web site works.
New Mexico - State lawmakers in New Mexico were told last week that troubles at healthcare.gov might mean low enrollment numbers for small businesses in the Land of Enchantment. Individuals from New Mexico still sign up through the federal exchange; so far 400 businesses in the state have agreed to coverage plans.
New York - The Empire State's health exchange has been talking about big enrollment numbers, but no one is quite sure how much of that is skewed by Medicaid signups. One study puts the private insurance enrollment in New York at over 13,000. The web site specifically warned customers over the weekend that they should put off until Tuesday any enrollments because of the extended work on healthcare.gov.
Oregon - Other than healthcare.gov, as of now, Oregon's health site would win the ribbon as the worst web site of the Obama health law rollout. While the site is working, the enrollment part does not, and there is no estimate on when it will be functioning. The site actually tells people not to fill out forms on CoverOregon.com with anything but the Internet Explorer browser.
Rhode Island - White Rhode Island's exchange had a somewhat troubled start, the site has been reportedly working much more smoothly. The budget though has raised some questions - an editorial in the Providence Journal last week said the $26 billion budget for the exchange "may be excessively steep."
Utah - Utah's web site is like New Mexico - it is only for small businesses (the site is called "Avenue H"), as individuals go through healthcare.gov. The director of the exchange told a group late last week that Utah is not having the same problems as other states in terms of internet enrollment.
Vermont - While better than Oregon, Vermont's health exchange has had a lot of problems, and has earned complaints from supporters of the Obama health law. One avenue of frustration has been the high cost paid to contractor CGI - the same one involved in healthcare.gov. The AP last week reported Vermont " has seen its website plagued by slow performance and errors."
Washington - The Washington state exchange has been one of the bright spots, along with Kentucky - though just like the Bluegrass State, there are issues about a high percentage of Medicaid signups when compared to private insurance enrollments. State figures from last week showed 48,324 Medicaid signups and 7,341 insurance enrollments.
Meanwhile, healthcare.gov is getting more scrutiny from Democrats in the Congress, as Sen. Kay Hagan (D-NC) is demanding a probe by Congressional investigators on what happened.
Here is a copy of the draft letter she is circulating on Capitol Hill.
Dear Comptroller General Dodaro and Inspector General Levinson:
On October 1, millions of Americans eagerly awaited the launch of healthcare.gov, a new marketplace where individuals and small businesses could easily compare quality health plans in their area and access tax credits, where eligible, to help make those plans affordable.
Unfortunately, the site crashed early that morning after receiving just a thousand visitors. More than a month later, too many visitors still find the site unusable. At every step of the user experience, site errors have prevented people from effectively shopping and enrolling in plans. Users have encountered problems creating an account, verifying the account, determining eligibility, protecting user privacy, calculating tax credits, and facilitating enrollment with private insurers if they can even access the site at all. Many states still have not received the data necessary to enroll eligible individuals in their Medicaid programs, and the accuracy of the files used by insurers to enroll customers remains an open question. As a result, what should be a 21st century digital process on the back-end has become an antiquated, paper-and-pencil effort that is not sustainable or scalable as the problems of the front-end consumer experience get resolved. In the words of Secretary Sebelius at a recent Congressional hearing, "the roll-out has been excruciatingly awful for too many people."
These problems are simply unacceptable, and Americans deserve answers and swift solutions. Taxpayers are owed a full and transparent accounting of how the vendors contracted to build the site failed to launch it successfully. We strongly urge to you undertake a complete, thorough investigation to determine the causes of the design and implementation failures of healthcare.gov that includes an examination of the following issues:
+ Ultimately, 55 contractors were hired to build the site.
+ What were the responsibilities of each contractor, the size of each contract, and what proportion of projects required under these contracts was completed satisfactorily and on-time?
+ When projects were not completed satisfactorily or on time, were payments withheld?
+ What was the initial expected cost of healthcare.gov, what is now the projected total cost of healthcare.gov, and which contractors will receive any expected increase in costs and for what work?
+ At what additional cost to the government are new or existing contractors being hired to fix healthcare.gov?
+ What authority does the Centers for Medicare and Medicaid Services have to recoup funding already expended on unfulfilled contracts, and when has that authority been exercised?
+ What penalties for future government contract work may be levied against the contractors who failed to meet their obligations under contracts to build healthcare.gov?
+ The scope and responsibilities of the marketplaces and data hub needed to run it were clear when the Affordable Care Act was signed into law on March 23, 2010. Why was the primary contract for building the site not awarded until September 2011?
+ When the contract for building the site was awarded in September 2011, it was only open to a limited number of contractors who had been original bidders of a 2007 contract for "general information technology services." In an era of rapid technological change, why was the pool of contractors for the most significant public sector technological initiative in recent history limited to an unrelated government contract from four years earlier? • What reforms to the government procurement process do you recommend to avoid future instances of incomplete and/or malfunctioning information technology products provided to the government?
These questions will help us understand how the launch of healthcare.gov went wrong, and how attempts to improve it and launch other government websites can be improved in the future.
In spite of these technical problems, the vision for healthcare.gov and its promise of quality, affordable health insurance for individuals and small businesses must be fulfilled. The website is undergoing serious and rapid repairs to make that promise a reality every day. When the site is functioning smoothly, we expect that millions of people, for the first time, will not have to worry whether they can see a doctor because of a pre-existing condition, and other important market reforms will protect the insured from the prospect of unaffordable medical bills. In the meantime, it is critical that we understand how and why the mechanism for reaching that goal – healthcare.gov – failed to launch as required on October 1, 2013.
Sincerely,
Sen. Kay Hagan
As the Obama Administration gets ready to reveal data this week on how many people have enrolled for insurance under the Obama health law, a quick review of those states that set up their own health exchange web sites shows that enrollment troubles aren't limited to just healthcare.gov. One outside ...
