Consumers' experience with Obamacare has varied a great deal depending on where they live. At the Oct. 1 launch, state-run exchanges claimed most of the insurance success stories, while consumers trying to sign up through HealthCare.gov found it largely nonfunctional. Among those 15 state-based exchanges (including the District of Columbia), the experience ranged from easy to literally impossible.
Now past the initial enrollment deadline of Dec. 24 for most states, the insurance exchanges have come a long way since the beginning of October. As the next phase of enrollment begins, exchanges can learn from those that succeeded and those that went very wrong.
A state with nearly 7 million uninsured residents, California is boasting the highest enrollment numbers during the first three months of Obamacare implementation.
As of early this week, about 400,000 people had enrolled in private plans through the state's exchange, Covered California. California saw a huge surge in enrollments in December, particularly ahead of the deadline for Jan. 1 coverage. Between this past Friday and Sunday, 77,000 people chose a private insurance plan on the exchange, with a record 29,000 enrollments on Friday alone.
"We're all in the first inning of a nine-inning game," Peter Lee, executive director of Covered California, said on a press call last week. "But we're starting to see data indicative of where we're going, and data to learn from." Lee pointed out that the enrollments do not include those buying directly from insurance companies.
Lee says Covered California has not experienced the back-end problems that have plagued HealthCare.gov, which were causing insurers to receive inaccurate consumer information. Plans are billing consumers between one and three days after receipt of their application.
The deadline to pay premiums for coverage beginning Jan. 1 is Jan. 6 in California.
Kentucky is unusual as a red state that is aggressively implementing Obamacare—both expanding Medicaid and setting up its own exchange—thanks to Democratic Gov. Steve Beshear's no-partisan-nonsense approach to implementation.
As of Dec. 21, more than 100,000 Kentuckians had enrolled through the state's exchange, Kynect, with about a 75 percent to 25 percent split between Medicaid and private-plan enrollment. Over 640,000 Kentucky residents—about 15 percent of the state's population—are uninsured, with a great deal to gain from expanded coverage.
Kynect has been operating smoothly, and the back-end has not been an issue, according to Carrie Banahan, executive director of the Kentucky Health Benefit Exchange. Once applications are approved, the forms are transmitted to insurers nightly, and applicants can be billed as early as the next day.
Consumer interest and enrollment has been high in the state since Oct. 1, with a recent surge ahead of the first deadline. Since Thanksgiving, purchases of private exchange plans have increased by 121 percent. The exchange is approving around 3,000 people for Medicaid or private coverage each day, up from 1,000 and 2,000 in previous estimates.
Kentuckians must pay their premiums by Jan. 1 for coverage to begin on that date.
Runners-up: New York, Washington
The Oregon health exchange, Cover Oregon, has consistently performed worse than the much-maligned HealthCare.gov. Three months into open enrollment, the website is still a failure, and the exchange has been the slowest to enroll people in private coverage.
Oregon has relied on paper applications, which are slow to process, and the problems will leave many Oregonians without coverage at the beginning of the year. The state set a Dec. 4 deadline to submit paper applications. Once an application is approved, the individual receives an enrollment packet in the mail, and must then select a plan through the Cover Oregon website.
Officials say they have only just gotten through most of the on-time applications, following a backlog of over 30,000 unprocessed applications two weeks ago.
Around 70,000 Oregonians have been deemed eligible for coverage through private plans or the state Medicaid program. About 36,000 consumers enrolled as of Tuesday—12,000 in private plans and 24,000 through Medicaid. In October and November, a total of only 44 individuals selected private plans on the exchange.
Officials are still working to notify those who have been deemed eligible in time for them to enroll in coverage by this Friday. Most consumers whose applications were on time but incomplete have not been contacted, and they will likely face a coverage gap until they complete their applications for coverage beginning February.
Eligible applicants must choose a plan by 5 p.m. on Dec. 27 and pay their premium by Jan. 15 to receive coverage beginning Jan. 1.
The problems with the federal exchange have been well-known, because the website serves all 36 states using the federal marketplace. Fortunately, the spotlight forced repairs, and the website has been running smoothly for the most part since the administration's self-imposed fix date of Dec. 1. However, technical problems during the first couple of months prevented many who initially flooded the site from enrolling, and this set coverage goals back severely.
Enrollment during the first month was dismal, hampered by high error rates, long wait times, and website crashes. The federal marketplace accounted for only 25 percent of the 106,000 total enrollments in the federal and state exchanges in October, despite serving 36 states.
The number of enrollments through HealthCare.gov jumped in November, and dramatically in December. Around 29,000 people enrolled in the federal exchange in the first two days in December—more than in the entire month of October. Over 500,000 people enrolled in coverage through the federal exchange this month, President Obama said at a news conference Friday.
The Health and Human Services Department initially expected 3.3 million people to enroll in coverage by the end of December, and 7 million by March 31. The administration will surely miss its end-of-year goal, but the acceleration of enrollment in December is a good sign for the next three months.
Back-end problems with HealthCare.gov were still creating serious problems for insurers in December, although error rates in transmission forms dropped dramatically from 25 percent in October and November. It remains to be seen whether problems will occur when consumers begin using their insurance in January.
Individuals on the federal exchange must pay their premiums by Jan. 10 for coverage beginning Jan. 1.
Obamacare open enrollment in all states runs through March 31, 2014. Consumers must enroll by Jan. 15 for coverage beginning Feb. 1.