Published on April 7, 2014

Troubled state healthcare exchanges cite enrollment success

By Paul Demko, Crain News Service

WASHINGTON (April 7, 2014) —  Several officials from troubled state insurance exchanges April 3 focused on damage control, seeking to put a positive spin on their efforts when they trudged up Capitol Hill to testify about their operational problems.

Ongoing state health exchange struggles prompted a congressional hearing on April 3 by a pair of subcommittees of the House Committee on Oversight and Government Reform.

Only 14 states and the District of Columbia opted to build their own online health insurance marketplaces for 2014, while the rest relied on the federal HealthCare.gov website for enrollments. Some state exchanges continued to experience problems, even as HealthCare.gov largely recovered from its disastrous rollout.

Exchange officials from a half dozen states were summoned to the Hill for the hearing. California stood out as a state that has been hailed as one of the Affordable Care Act’s (ACA) biggest success stories, with more than 1.2 million individuals enrolled in private health plans by the end of March. But Hawaii, Maryland, Massachusetts, Minnesota and Oregon have all struggled.

While officials from those states acknowledged “glitches,” “problems,” “challenges” and “regrets” during the hearing, they largely sought to put a positive spin on their experiences. In particular, they repeatedly highlighted the number of individuals who had been able to acquire coverage, despite substantial sign-up roadblocks.

(Crain News Service photo)
Dr. Joshua Sharfstein, secretary of Maryland’s Department of Health and Mental Hygiene, said more than 300,000 individuals have signed up for coverage since that state’s exchange opened.

Dr. Joshua Sharfstein, secretary of Maryland’s Department of Health and Mental Hygiene, pointed out that more than 300,000 individuals have signed up for coverage since that state’s exchange opened. The bulk of those individuals were deemed eligible for Medicaid or the Children’s Health Improvement Program.

Maryland officials had initially set a target of 150,000 enrollments in private plans for the 2014 sign-up period. But that figure was revised downward to 75,000 after problems with the exchange rollout. Final figures are not yet available, but roughly 65,000 Maryland residents had signed up for commercial plans by the end of March. Individuals who had begun the enrollment process but ran into problems will be granted additional time to finish signing up for coverage.

Rep. Jim Jordan (R-Ohio) accused Maryland officials of cooking the numbers. “Defining the standard down is what it looks like to me,” Jordan said. He further pointed to an Associated Press report that found roughly 73,000 Maryland residents had received cancellation notices because their insurance coverage didn’t meet the requirements of the Affordable Care Act. The implication was that more people potentially lost coverage than signed up for private plans through the exchange.

But Dr. Sharfstein questioned the legitimacy of that comparison, pointing out that many individuals were allowed to keep their non-compliant plans after the federal government relaxed the rules, and that a substantial number of individuals purchased coverage outside of the exchange.

“You’re comparing apples to oranges,” Dr. Sharfstein said.

On April 2 the board overseeing Maryland’s insurance exchange voted to scrap its troubled website and adopt the technology platform developed by Connecticut. Maryland officials had previously terminated the state’s $193 million contract with its prime technology contractor, Noridian Healthcare Solutions, owing to chronic problems.

On the opposite coast, Oregon officials are weighing whether to abandon the state’s disastrous online marketplace in favor of the federal exchange for the 2015 open enrollment period. A state-commissioned report released last month concluded that the health insurance exchange project was plagued by shoddy contracting and poor communication. Several top state exchange officials have subsequently resigned under pressure.

In Massachusetts, which served as a model for the ACA, more than 200,000 individuals have been thwarted in trying to sign up for health plans that comply with federal coverage requirements, because of state website problems. Instead they’ve been allowed to keep their current coverage through at least June.

Nevada class-action lawsuit filed

A potential class-action lawsuit has been filed in a Nevada District Court seeking damages for individuals who unsuccessfully tried to purchase coverage through the state’s insurance exchange. It is thought to be the first such litigation in the country.

Plaintiffs believe that there are more than 10,000 individuals who paid premiums but failed to receive insurance coverage who could eventually be included in the lawsuit, according to the complaint. Defendants named in the lawsuit are the state of Nevada, Xerox and the Silver State Health Insurance Exchange.

Louisiana legislators seek enrollment details

A half-dozen Republican members of Louisiana’s congressional delegation sent a letter to Health & Human Services Secretary Kathleen Sebelius on April 3, seeking details about federal exchange enrollments. Specifically, they wanted to know how many Louisiana residents have signed up for coverage through HealthCare.gov, how many received federal subsidies and how many of those enrollees were previously uninsured.

This report appeared in Crain’s Modern Healthcare magazine, a Chicago-based sister publication of Tire Business.

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