Marketplaces in California and Oregon said this month that technical hurdles may force consumers to apply with a broker or counselor instead of online when the exchanges start Oct. 1. In Colorado, managers are literally working around the clock to ensure computer systems share accurate Medicaid data.
On the East Coast, exchange managers voiced concern that millions of Americans without health insurance don’t know about the new shopping hubs. Kevin Counihan, chief executive of Access Health CT, Connecticut’s exchange, even attended a concert featuring rapper Lil Wayne to get the word out to young people, then reported his progress to President Barack Obama and state officials last week in a videoconference.
“We got 500 names of people who want information,” Counihan said. “The president asked me if I had any pictures of the Lil Wayne concert. I said that I do, but my daughter has asked that they not see the light of day.”
The exchanges, a cornerstone of the 2010 Affordable Care Act, are expected to attract about 7 million people next year, rising to 24 million by 2023, the Congressional Budget Office estimates.
The health care law, the signature legislation of the Obama administration, is reviled by Republicans who have voted more than three dozen times in Congress to repeal it. It is also opposed by most of the nation’s Republican governors.
Backup Plans
In the 14 states and the District of Columbia that are building their own exchanges, staff members detailed contingency plans that would kick in if complex new computer systems crash, or fail to connect with the federal government’s data hub, which will be used to verify a consumer’s immigration status and income information.
As they supervised renovation of the space intended to house a call center for the Colorado exchange, managers tried to gauge initial demand for the service, which will offer health plans for small businesses and people who don’t receive coverage through their jobs.
“It’s a large task to convince almost 20% of the population that spending money in this way is worthwhile,” said Michele Lueck, president of the Colorado Health Institute, a Denver-based nonpartisan research center. “I tell people to think about a vacation they would want to take and then think about things they would have to take out of their budget to make it reality.
‘‘Maybe they stop getting their hair done, they stop going out to dinner,’’ she added. ‘‘Then I tell them that’s what they’re going to have to do to afford health insurance.”
Going Online
To use state exchanges, consumers will visit websites and input income, family and employment information. The portals will determine eligibility for government programs such as Medicaid, the joint state-federal health plan for the poor, or for federal subsidies for private insurance. Those not covered by public programs will see a menu of private options selected by each state. If consumers who aren’t insured don’t purchase coverage by January, they can face penalties.
In 27 states that asked the federal government to operate their exchanges, politics intervened, leading to wide variations in the choices of plans and questions about whether their marketplaces would open on time. By law, the exchanges must open by October to allow consumers to enroll for coverage that starts in January. Nine states are moving forward with state-federal partnerships for their exchanges.
New Hampshire’s Effort
In New Hampshire, only one insurance company, Anthem Blue Cross Blue Shield, announced it will participate in the exchange, which will operate under a state-federal partnership in which the state retains control over plan management and consumer assistance.
“The down side is obviously you want some competition,” said Tyler Brannen, a health policy analyst at the New Hampshire Insurance Department. “If there is only one carrier what is to prevent them from charging what they want?”
Brannen said there are only a handful of insurance carriers that operate in his state, so he was not surprised to have a sluggish initial response. And he anticipates at least one more company will begin offering plans on the exchange in 2015 -- giving New Hampshire residents some choice.
The state is playing catch-up marketing the program. The Republican-controlled state Senate blocked the insurance department from accepting a $5 million federal grant to advertise. The New Hampshire Health Plan, a nonprofit, stepped in to handle outreach activities using the grant.
Communication Issues
In Ohio, there has been little communication with federal officials about the work they’ve done on the state’s exchange, said Lieutenant Governor Mary Taylor, who also directs the state’s Department of Insurance.
Taylor, a Republican and critic of the health care law, said she is concerned the Ohio marketplace won’t open on time because there was a delay earlier this month in transferring data about the insurance plans filed in the state to the U.S. Department of Health and Human Services, and insurance companies have had trouble accessing information.
“I know they keep saying the exchange will be up and running come Oct. 1, but we have seen little evidence that that’s the case,” Taylor said.
Federal View
Ohio’s marketplace will open on time, said Alicia Hartinger, a spokeswoman for the Centers for Medicare and Medicaid Services, which is overseeing the development of healthcare.gov, the federal exchange where residents in states without their own insurance portals will shop.
In California and Oregon, officials say they’ll provide direct online access to exchanges soon after they open.
In Colorado, IT managers with Connect for Health Colorado, a nonprofit created by state law to run the insurance marketplace, told the exchange’s board on Aug. 12 their systems were not getting accurate data from the state’s Medicaid engines.
The approach the two computer systems were using to share information “did not allow some application data fields to be sent and received” between the two, said Rachel A. Reiter, a spokeswoman for Colorado’s Department of Health Care Policy and Financing.
The department and the exchange are working on a solution that would route individuals applying for assistance to a joint online application to check for Medicaid eligibility, she added.
Difficult Deadlines
“The reality is all of the technology timelines are very tight,” said Gretchen Hammer, board chairwoman for the Colorado exchange. “There are a number of the key technology aspects that remain in testing.”
Integrating new computer systems and existing Medicaid databases is a primary challenge for exchanges from a technology perspective, said Dan Schuyler, a director for Leavitt Partners, a consulting firm that is advising states on their marketplaces.
“Medicaid systems across the country use a variety of different data systems,” he added. “Some are old and outdated and many are involved in modernization projects.”
If computer systems fail to interact, it could lead to inaccurate eligibility determinations for Medicaid, said Colorado’s Reiter.
Even as they sought to reassure board members on Aug. 26 that Colorado’s exchange will open on time to serve 1 in 6 residents, or about 829,000 people, who are without health insurance, managers cautioned the new venture will likely endure growing pains.
“Our biggest concern is the amount of time we have to complete around testing and around training,” said Patty Fontneau, executive director of Colorado’s exchange. “We are going to open Oct. 1. Will there be bumps in the road? Yes. We are literally going to have people working around the clock to meet these deadlines.”
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