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Rollout of exchanges marked by glitches


By Jaimy Lee
Posted: September 26, 2013 - 4:00 pm ET
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Just as President Barack Obama predicted, the rollout of the new state insurance exchanges is turning out to be bumpy just days before the exchanges open.

HHS announced Thursday that online enrollment of small businesses in federally facilitated health insurance exchanges will be delayed for one month, less than a week before those exchanges were scheduled to begin operating. The White House also announced that HHS' Spanish-language online enrollment services would be delayed until late October, though Spanish speakers still will be able to enroll starting Oct. 1 through a call center or through navigators.

Federal and state officials are experiencing information technology glitches that experts say are not surprising given the daunting complexity and speed of the task.

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But some experts pointed out that even if everything doesn't work perfectly Tuesday when the exchanges are scheduled to open, individuals, families, and businesses still will have three months to sign up for coverage effective Jan. 1, and the open enrollment period will last for six months.

Small businesses with fewer than 50 full-time employees still will be able to shop online in the Small Business Health Options Program exchanges starting Oct. 1, but won't be able to enroll until Nov. 1.

“The SHOP Marketplace for Federally Facilitated Marketplace states opens Oct. 1, 2013, when small employers can start the application process and get an overview of available plans and premiums in their area,” HHS announced. “All functions for SHOP will be available in November, and if employers and employees enroll by Dec. 15, 2013, coverage will begin Jan. 1, 2014.”

Most states running their own exchanges are planning to open their SHOP exchanges on time Oct. 1. And state- and federally operated exchanges say they are still on track to begin enrolling consumers in individual-market health plans on Oct. 1.

The federal SHOP delay has been attributed to data security concerns and is prompting criticism from lawmakers and business groups. Sen. Orrin Hatch (R-Utah) and the National Federation of Independent Business called for a delay of the individual mandate as a result of the small-business delay. But other observers say the delay won't be that consequential.

Small Business Majority, a group that supports the healthcare reform law, called the delay “disappointing” but not a big deal.

But anti-Obamacare politicians and groups were more critical. “With this latest glitch in the small-business exchanges, the case for a delay of the individual mandate alongside the employer mandate only grows stronger,” Kevin Kuhlman, NFIB's manager of legislative affairs, said in a prepared statement. “Small-business owners should not be forced to comply with a law that is clearly not ready for prime-time.”

Adding to the list of IT hiccups is a delay to the Spanish-language online enrollment tools for the ACA. In a press briefing Thursday, White House Press Secretary Jay Carney said the Spanish-language online portion "will come on sometime in October." Carney added that about 70% of the Latino population will access HealthCare.gov through the English-language portal, not the Spanish-language portal, CuidadoDeSalud.gov.

Later, when asked about the reason for the delay, an HHS spokesperson said in an e-mail that the Obama administration will roll out the Spanish-language enrollment tools to coincide with Hispanic Heritage month.

At least three state-run exchanges plan to delay the rollout of some online tools designed to help consumers as they enroll in insurance plans starting next Tuesday.

Connect for Health Colorado moved back the release of its tax calculator tool, which determines whether an individual is eligible for a premium tax credit. It delayed the release until November to continue testing the service. Until then, the exchange's 200 customer service representatives will work with consumers.

“It's just a complicated system, and we've got a very high standard for what we've wanted to do,” a Connect for Health Colorado spokesman said.

Officials in Oregon and Washington also have said there will be some delays in the rollout of certain online tools and services. While there has been concern that delays in exchange functionality could impact enrollment, others say that early technological glitches should not be used as an indicator for how many Americans will enroll.

“I don't think en masse every uninsured person is going to go online Oct. 2 to sign up for insurance,” said John Edwards, director of PricewaterhouseCoopers' healthcare advisory practice. “I would caution (against) over-reading the early statistics, whether they are positive or negative.”

For the early adopters who log onto their state exchanges in October, they may face glitches in the websites or other challenges as exchange staff and insurers continue to test for and work out any problems in their systems, experts say. These systems must bring together a variety of data sources, including income, Medicaid eligibility and legal residency status.

A PricewaterhouseCoopers study, released Sept. 25, found that about 60% of the insurance executives surveyed say technology integration and coordination of subsidies are “major barriers to implementation.” Another survey, released Thursday by KPMG, found that roughly one-third of insurance executives doubt that the exchanges will be ready Oct. 1.

But many states, including Connecticut, Hawaii, Minnesota and New Mexico—which all are running their own exchanges—say their exchanges will be fully operational next week.

“Once we go live, I'm sure there will be operational challenges, but we're trying to build in redundancies to be as responsive as possible to consumer needs,” a spokesman for the Hawai'i Health Connector said in an e-mail.

“Ideally, in building a data hub that needs this kind of information, you would put a piece together and test it extensively before public release. With our timeline, we have to build and test simultaneously.”

Follow Jaimy Lee on Twitter: @MHjlee


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