After struggling with balky information technology in the first year of open enrollment, the federal and state insurance exchanges have implemented a number of changes to make it easier for consumers to shop for plans and sign up this time. Reform supporters are hoping and praying these efforts succeed. But concerns remain about the websites' data connections with insurers.
HealthCare.gov opened for business Nov. 9 to allow consumers to window-shop for plans, and experts said the federal website is mostly improved. Last year's clumsy website required consumers to enter several windows' worth of data before getting to plans. This year, the site requires only the entry of a few pieces of information, such as ZIP code and household income. “The shopping function is quite consumer-friendly,” said Ferris Taylor, the chief strategy officer of Arches Health Plan, a not-for-profit plan based in Salt Lake City.
Joel Ario, managing director at Manatt Health Solutions, said “the Web page is much improved but still a work in progress that will require substantial improvement to achieve what consumers have come to expect from consumer websites.”
Dan Schuyler, senior director of exchange technology at consultancy Leavitt Partners, noted users can now click a button labeled “Espanol,” which automatically translates the page into Spanish.
The new HealthCare.gov prominently displays a provider directory for each plan, but the function isn't very user-friendly. Paul Ginsburg, a professor of medicine and public policy at the University of Southern California, said he found the directories clunky, relying on a visit to the insurer's website.
Meanwhile, among the 14 states and the District of Columbia that are running their own exchanges, Nevada and Oregon have switched to using the HealthCare.gov website while continuing to operate as state-run exchanges.
Oregon's exchange, Cover Oregon, switched after its disastrous rollout last year that led to the state suing software giant Oracle. Dr. Ralph Prows, CEO of Oregon's Health CO-OP, which suffered low enrollment due in part to the website glitches, said Oregon's insurers are closely monitoring the operation of the state's version of Health Care.gov. Lawmakers are concerned about getting enough enrollment to produce sufficient revenue to fund the state exchange's operation in 2015.
Other states have crafted their own solutions. Observers in Maryland, Massachusetts and Minnesota are expressing confidence that the consumer enrollment experience will improve this year, though outside observers have lingering worries.
Dr. Peter Beilenson, CEO of Evergreen Health Co-op in Baltimore, said he's confident Maryland's exchange technology will be better this time. Maryland Health Connection has implemented Connecticut's successful exchange platform. “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.”
In Minnesota, the technical and political future of the state exchange, MNSure, appears more troubled. The state's legislative auditor has released two recent reports faulting the exchange. MNSure also was hurt by the recent exit of its most popular insurer, provider-owned Preferred-One, which had more than half of the exchange enrollees.
Lawmakers warn that the exchange's financial self-sustainability could be in trouble if the exchange doesn't recapture those PreferredOne customers. The Patient Protection and Affordable Care Act requires that starting in 2015, state-run exchanges must be financially self-sustaining in their operations. Still, Republican state Sen. Michelle Benson said she thinks the consumer experience will be better than last year, though she expects that information between the exchange and insurers will have to be manually processed.
Heidi Michaels, president-elect of the Minnesota Association of Health Underwriters, said she's not feeling confident because the website's back-end functions have not worked well.
In Massachusetts, Health Connector officials are expressing confidence about the performance of their exchange, which surprised everyone with the severity of its dysfunction during the first open enrollment. Lisa McTighe, communications and outreach director for Minuteman Health, a new not-for-profit co-op plan, expressed optimism based on her plan's testing of the consumer part of the website.
But Joshua Archambault, the director of health policy at the Pioneer Institute, a conservative think tank in Boston, said he's concerned about the system's backend capabilities based on his conversations with insurers. “If somebody signs up starting on Saturday, and they have a kid or they moved or they have to change health plans during open enrollment, the state doesn't have that functionality” to change the information online yet, he said.
