START OF 2018 OPEN ENROLLMENT PERIOD

Time: D H M S

Exchange Website News: The Good, the Bad & the Ugly

Four important stories about the technical situation status on various ACA exchange websites:

Idaho moving forward with state-run Obamacare exchange

Officials in Idaho say they’re undaunted by the well-documented failures of Obamacare exchanges in neighboring states and are moving  full-steam ahead with plans to launch their own web portal this November.

While executives at Cover Oregon and Nevada Health  Link abandon their state-run websites and turn to the federal exchange (HealthCare.gov), Your Health Idaho is headed in the opposite direction.

The state relied on the federal website for the open-enrollment period that ended in mid-April because it had less than 200 days last year set up its own web-exchange when state lawmakers authorized the project. It was one of two states — New Mexico is the other — that had to wait a year for its own site, and exchange officials say the delay has been a plus as they meet with other states to discuss what went right or wrong during Obamacare’s first round.

...“From our perspective, we felt like we could do it better,” said Republican state Sen. Dean Cameron, an insurance agent .

This is exactly the attitude that the Obama administration was hoping that more states would take. The whole idea was that blue states were more supportive of the law (and therefore would be more enthusiastic about taking charge of it), while red states might oppose the law...but also would have the whole "States Rights!!" mantra going on, and would therefore decide that as long as they're "stuck" with the ACA anyway, they might as well make the best of it and run their exchange themselves, rather than letting "Big Gub'mint!" run the whole show.

It didn't end up working out that way, of course. Most of the state-run exchanges are indeed for states run by Democrats (Kentucky is the sole exception), but other blue states like Delaware and Illinois stuck with the Federal exchange. Meanwhile, most of the Republican-run states abandoned their "states rights" beliefs to "wash their hands of the whole thing", so to speak, and instead dumped their exchanges on Healthcare.gov as well.

The results are kind of a mish-mash. On the one hand, several of the state-run exchanges have proved to be a disaster (Oregon, Massachusetts & Hawaii in particular). On the other hand, Healthcare.gov was itself a disaster early on; if it hadn't been for the well-performing state exchanges like California, New York, Washington, Connecticut & Kentucky shoring up the enrollment numbers in October & early November, the entire exchange project may have completely melted down before HC.gov was fixed.

On yet the third hand, given the outright hostility and vitriol towards the ACA by Republicans running Texas, Oklahoma and Florida, it's probably just as well that they left it up to the Feds. Can you imagine what a state exchange run by Rick Perry or Rick Scott would look like? Oregon's website may be a mess, but they were still able to enroll over 400,000 residents in either private QHPs or Medicaid...manually.

Anyway, in the case of Idaho, it sounds like they're exactly the model that the Obama administration envisioned: They don't like the law, but genuinely want to make the best of it by running things themselves. Should be interesting to see how this plays out both there and in New Mexico this winter.

Speaking of Oregon, that brings us to...

80,000 Cover Oregon customers will have to re-enroll

People who enrolled in Oregon's troubled health insurance exchange will have to re-enroll for coverage, as Cover Oregon transitions to the federal government.

Tina Edlund of the Cover Oregon Transition Project told the Oregon Health Policy Board this week that come November, about 80,000 Oregonians will have to log on to healthcare.gov to get their insurance.

"No matter what, people were going to have to go back. Even if they'd just stayed with Cover Oregon, they were going to have to go back and update information," Edlund said.

"You know, changes in your family, changes in your income. All of that and just like all of us have to go with our employer sponsored insurance and make up dates on an annual basis. Some of this was going to have to happen anyway."

OK, this is indeed kind of bad, but not horrific. As the article notes, anyone who had a major life change would have to re-enter some of their info anyway, and it sounds like it only impacts QHP enrollees, not the 320K new Medicaid enrollees, so that mitigates the damage. Plus, HC.gov is working so well these days that it only takes about 20 minutes to plug your info in from scratch anyway, so it's more of an annoyance than a disaster...although I'm sure the Oregon GOP is doing everything they can to make this sound like they Apocalypse.

There are, however, more troubling developments at the Federal level:

Federal ACA verification backlog not seen in Kentucky

Kentucky’s state-run Obamacare exchange does not appear to be suffering from the backlog that has affected about 2 million people who enrolled in federal exchanges but submitted information that didn’t match federal records, a discrepancy that could affect their coverage or subsidies.

The Associated Press reported Wednesday that 1 in 4 people who signed up nationwide have discrepancies on income, citizenship or other information, compared with federal records. While applicants are asked to submit additional proof, the large number has led to a federal verification backlog.

Some of those people could be getting tax credit subsidies that are too little or too big, and could lead to repayment demands or loss of coverage, the AP reported.

Now, this is a definite problem, but still isn't quite as nasty as it sounds above:

But federal officials said most discrepancies, which appear to be caused by outdated information in government files, are being resolved in the consumers’ favor.

Smart move on the administration's part. Unfortunately, there's also a serious backlog issue on the Medicaid side as well:

Long waits persist for those applying for Medicaid coverage in many states

While an unprecedented 6 million people have gained Medicaid coverage since September, mostly as a result of the Affordable Care Act, more than 1.7 million more are still waiting for their applications to be processed — with some stuck in limbo for as long as eight months, according to officials in 15 large states.

The scope of the problem varies widely. California accounts for a lion’s share of the backlog with 900,000 applications pending as of early June. The next-biggest pileup is in Illinois, with 283,000 cases, while New York has no backlog at all. All three states have implemented the health law’s expansion of Medicaid.

This is quite simply unacceptable. Get things in gear, CMS, and pronto.