After struggling with information technology in the first year of open enrollment, some states that chose to operate their own Obamacare insurance exchanges are hoping and praying that this year is different.
A few, including Nevada and Oregon, have decided to switch to using the federal HealthCare.gov website for the second year of open enrollment, which starts Saturday and runs through Feb. 15, though they will continue to operate as state-run exchanges. But a few states have chosen to try their own solutions. Experts and officials in Maryland, Massachusetts and Minnesota are expressing confidence that the enrollment experience will improve this year.
But the big question is how much better will they be? The issues are centered in three areas: the state of the technology underpinning the exchange websites; the quality of the outreach and marketing to win over uninformed or skeptical consumers; and whether political changes will undermine the exchanges' future.
Dr. Peter Beilenson, CEO of Evergreen Health Co-op in Maryland, a new not-for-profit health plan based in Baltimore, said he's confident the exchange technology will be better in Maryland, which has implemented Connecticut's successful exchange platform. In the first open enrollment, severe problems with Maryland Health Connection contributed to his plan signing up only 450 individual-market enrollees. “I've been on (the website) at least 12 times in the last day just to do the shopping,” he said. “I think it will be much, much, more effective this year than last year.”
That confidence is shared by Maryland state officials. At a board meeting Wednesday, Isabel FitzGerald, the state's information technology secretary, said “the only thing left is to go live on the 15th.” She acknowledged there might be some glitches with the code but said that she was generally confident.
Beilenson said the so-called back-end function that provides information to insurers is “much, much better tested than last year. We were literally screaming last year that you have not tested it enough. Our people, who are very cynical about it, feel much, much more confident this year.” He added that the 834 forms to insurers will work well in addition to improved traffic testing.
While Maryland Health Connection's consumer-facing website design isn't perfect, he thinks it's better this time around. The Maryland website now displays an in-network provider directory.
“Last year, the only thing that appeared was the premium,” he said. “No one had any idea what they were buying.” As a result, he believes many consumers selected plans that didn't fit their financial and medical needs, only to drop them later. By contrast, the website now has more specific information about premiums and cost sharing. And for consumers who are eligible for a federal premium subsidy, it shows the cheapest silver plan available.
Kathleen Westcoat, CEO of HealthCare Access Maryland, a not-for-profit navigator organization that helps consumers enroll, agreed the website is much improved. Her navigators have had a lot more training on the exchange website this year than last, when the state's exchange programmers were working up to the last minute. And the navigators are reporting a more consumer-friendly experience.
But Beilenson worried that he's not seeing any marketing so far this year. Last year, he said, there were jingles for the Maryland exchange running in the media every 15 minutes. This year, he hasn't seen much promotion through the mass media or social media. “I would be shocked if there's significant knowledge of this in Maryland,” he said. “The average citizen in Maryland only knows that this thing didn't work last year.” He suspects exchange officials are adopting a wait-and-see strategy: if the exchange is working well, then they'll make a media push to promote the exchange.