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Maryland rep wants state to switch to using federal insurance marketplace


By Paul Demko
Posted: January 7, 2014 - 3:15 pm ET
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In a move that would have been unimaginable less than two months ago, a Democratic congressman from a state that has a dysfunctional state-run insurance exchange wants to let people buy coverage through the improved federal HealthCare.gov website.

U.S. Rep. John Delaney (D-Md.) wants his state to consider abandoning its state-run insurance exchange and allowing consumers to sign up for Obamacare coverage through the federal website. That would have seemed like an outrageous idea during the troubled first two months of the federal online marketplace.

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But Delaney's proposal is an indication of how much HealthCare.gov has improved in recent weeks. It's also a reflection of the problems that continue to plague Maryland Health Connection's website more than three months into the open enrollment period.

The problems on the Maryland exchange, as well as problems with the exchanges in several other strongly Democratic states that embraced the federal healthcare reform law early on, have surprised everyone. Those problems have created political problems for Democratic governors, members of Congress and state lawmakers in those states. This may be the first proposal, however, to drop a state-run exchange and shift residents to the federal enrollment portal.

On Monday, Delaney, a first-term congressman, sent a letter to Maryland's top health official seeking a description of how difficult it would be to switch over to the federal exchange. In an interview, he said he thinks there is still time to make such a dramatic change, before open enrollment ends March 31.

“We have 90 days. Every day matters,” Delaney said. “There is time to get a lot more people enrolled.”

That's not the only change being weighed to deal with the ongoing problems of Maryland's insurance exchange. On Friday, Democratic Gov. Martin O'Malley, who's been severely embarrassed by the botched exchange rollout, proposed a plan to allow individuals who tried to sign up for coverage effective Jan. 1 but weren't successful to get temporary coverage. They would be insured retroactively through the Maryland Health Insurance Plan, a state high-risk pool for people with serious pre-existing conditions that's supposed to be eliminated. It's anticipated that as many as 5,000 individuals could quality for this stopgap coverage. Legislation detailing the proposal is expected to be introduced this week.

Maryland is not alone among states scrambling to make adjustments because of ongoing technological problems with their state-run exchange. Massachusetts is providing temporary coverage, effective Jan. 1, for individuals who have been stymied by the state's problem-plagued exchange. According to Jason Lefferts, a spokesman for Massachusetts Health Connector, roughly 23,000 individuals will qualify for this temporary coverage through the state's Medicaid program. They are typically individuals who either didn't previously quality for a premium subsidy under Massachusetts's former system or didn't have insurance coverage. It is uncertain how much the program will cost the state or how long individuals will be enrolled in the temporary coverage.

“We obviously want to process people as fast as possible and get them into their permanent coverage,” Lefferts said.

In Minnesota, the state's exchange continues to have problems delivering accurate, complete information to insurers. According to Eileen Smith, a spokeswoman for the Minnesota Council of Health Plans, insurers are receiving two files on each enrollee, which they must combine in order to have a complete application. For instance, the initial file might not include essential contact information such as an apartment number or e-mail address. That reconciliation process has slowed down enrollments and created the possibility of human error.

“Anytime there has to be human intervention, it takes longer,” Smith said. “Anytime you have to type something in, there's a greater risk for error.”

Earlier this week, Minnesota Legislative Auditor James Nobles said his top priority for 2014 will be scrutinizing the exchange's operations. “MNsure has many red flags causing great concern and I would like my auditors to conduct a comprehensive audit of the program because it does not appear to be delivering what it promised to taxpayers,” Nobles told KSTP-TV.

Oregon still doesn't have a functional website where individuals can shop for coverage. Instead, that state has been relying exclusively on paper applications and direct enrollments through insurers. State officials also extended the deadline for enrollment in coverage effective Jan. 1 until Jan. 6, later than any other state in the country.

Last week, Cover Oregon's executive director, Rocky King, resigned from his post. He had been on medical leave since early December. King is at least the fourth top state exchange official to step down around the country.

“The board of directors had been in the process of searching for an interim executive director to serve during Rocky's absence,” wrote Liz Baxter, chair of Cover Oregon, in an e-mail to staff. “We will now shift our focus to finding a permanent director.”

Follow Paul Demko on Twitter: @MHpdemko


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