Despite setbacks, state-run insurance exchanges are exceeding federal enrollment targets in California, Connecticut, Kentucky, New York, Rhode Island and Washington. But why are the states succeeding while new issues keep preventing people enrolling in health plans through the federal marketplace?
Three factors make it easier for states to succeed while federal efforts falter, according to Kaiser Health News:
- Simplicity of scope: The federal system must integrate with 36 state-specific eligibility databases, while individual states concentrate on only one.
- Proximity: Implementing Affordable Care Act portals at the state level is easier because stakeholders in the system--insurers, consumers, state eligibility departments, are close to home. And it's easier for states to limit and manage outside contractors.
- Single-point control: Creating one point of authority and responsibility with hands-on control over the exchange is simpler at the state level and results in faster problem solving.
"In any sort of large, complex implementation like this, where there is not a whole lot of time to get things done, the more closely you are working together, the less room there is for communication gaps," Benush Venugopal, an analyst with Deloitte, the primary contractor for the Washington exchange, told Kaiser Health News.
Some states rapidly implemented Plan B in the face of technical trouble. For example, after missing two deadlines to fix its website, Oregon now is using temporary employees to process applications by hand, The Oregonian reported. Hand-processing began in mid-October, but state officials said they're hiring 60 temporary workers to join more than 20 exchange workers already processing paper applications. The exchange is training more employees and talking to other state agencies about additional help, the article noted.
California is working similarly to circumvent problems with its navigator program, while the New York Health Department is updating the navigator list for its state exchange, FierceHealthPayer previously reported. "We know there have been issues in enrolling people and we are moving as quickly as we can to address them," Covered California spokeswoman Anne Gonzales told the Los Angeles Times. "We are asking counselors to make future appointments and to use paper applications when they can't access the website."