At the national level, the rollout of Obamacare has gone poorly. The big federal health-care exchange, HealthCare.gov, is a poorly designed, badly functioning mess.
But many states have embraced Obamacare as their own and have been working diligently on indigenous systems to enroll people through homegrown exchanges, either by enrolling them in Medicaid or helping them set up accounts to purchase health insurance. Kentucky has been an early, noteworthy, success. Washington, for its part, has already enrolled more than 40,000 state residents in the expanded Medicaid program, slashing its population of uninsured by nearly 10 percent in two weeks. No train wreck there.
Earlier this week, I checked in with Kevin Counihan, a former Cigna executive who last year was named chief executive officer of Connecticut’s state health exchange, AccessHealthCT.
Connecticut would seem to make a pretty good laboratory. It’s a highly Democratic, wealthy, small state (population: about 3.6 million). It has a relatively low rate of uninsured people, about 9 percent. And it is home to a lot of health insurance companies and professionals with knowledge of the industry. Gov. Dannel Malloy has been an avid backer of the plan. And while most of the state’s moderate Republicans are no longer in office, the land of steady habits isn’t exactly a hotbed of Tea Party Obamacare obstructionism.
Thus far, the progress has been solid, but not spectacular. Counihan says the system is noteworthy in part for what it hasn’t done: break down. “We’re the only state to have a consistently stable IT system,” he said. “Beginning two weeks ago, we’ve never been down.” The state contracted (PDF) with Deloitte to build the system for $44.1 million. And Counihan said the system was designed to be as simple and self-sufficient as possible. Rather than ping the federal data hub—which amalgamates all the income, citizenship, employment and other federal data needed to confirm eligibility—at the end of the application, the Connecticut system does so as each piece of information is entered. And it bundles the requests together. “That puts less pressure on the hub,” he said.
The state isn’t simply relying on its website. Connecticut has hired 309 internal assisters and navigators, and has trained more than 700 brokers. It is in the process of opening storefronts in population centers where people can come in to learn about their options.
Here’s the challenge. The state has about 344,000 people without insurance living within its borders. The best that can be hoped for is a reduction in that number to 70,000, Counihan said: “Even in states with universal health care and European countries with national health, there’s a 2 percent rate of uninsured.” That means the state has a goal of enrolling about 275,000 people over a three-year period. Counihan said he believes that between 50,000 and 60,000 people in Connecticut will be eligible for expanded Medicaid benefits. In addition to signing people up for Medicaid, therefore, the state will have to convince between 175,000 and 200,000 residents to purchase insurance through the exchange.
The numbers thus far are modest. By Tuesday, the website had received 166,000 hits. In the first two weeks of operation, 10,678 applications were opened, and the state processed 2,372 applications for policyholders. That figure doesn’t include dependents. So assuming the average family unit that is gaining coverage is 1.5 people, that means an estimated 3,847 Connecticut residents have now enrolled. That’s more than 1 percent of the total number of uninsured in two weeks. About half of those processed were for Medicaid. The other half of enrollees purchased policies, mostly the one offered by Anthem Blue Cross and Blue Shield. And people purchasing insurance aren’t simply going for the cheapest version: some 25 percent selected the “gold” benefits, 49 percent opted for “silver,” and 19 percent took “bronze.” Of those purchasing private policies, 60 percent were eligible for federal subsidies. About 29 percent of the enrollees are under the age of 35, but most of those gaining coverage through the exchange are between the ages of 55 and 64.
A few thousand people in a couple of weeks may not like sound like much. But Counihan said the figure is “much bigger than I expected” and that people are making too much of the numbers racked up in the first couple of weeks. Buying insurance isn’t like buying a book on Amazon.com or purchasing tickets on Stubhub. When Massachusetts rolled out Romneycare, Counihan said, the typical experience had 18 interactions—with a website, or a call center, or speaking to an assistant—before enrollment. Remember, people can start enrolling for insurance today, but the insurance doesn’t go into effect until January, and the final deadline to enroll is December 15. “I don’t write checks three months in advance,” he noted. Based on the launch of the Medicare prescription drug coverage benefit in 2006, we should expect a large increase in enrollment in the three weeks between Thanksgiving and December 15.
Counihan projected that the state will enroll about 100,000 people by the end of March 2014. “And the first two weeks of data don’t lead us to raise or lower that number,” he said. “The implementation of this program is three years.”
A few thousand people covered in a few weeks. A website that functions. A slow launch that is expected to gather steam. That may not make good fodder for a cable news segment, and this piece probably won’t get picked up on the Drudge Report. (Breaking: Functional State Exchange Signs Up State Residents!) But low-drama versions of the Affordable Care Act rollout are taking place around the country—and they shouldn’t be ignored.
