On the Public Health Insurance Marketplaces: December 2013

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As 2013 came to a close, Americans flooded public exchanges by phone, in person and overwhelmingly online to secure health plans for themselves and their families prior to the end-of-year deadlines. While some states saw record numbers of applicants — as many as 1,000 a day in some cases — others experienced the resignations of their exchange directors and continued efforts to overcome technical issues plaguing their exchanges.

UPDATE: This will be the last “On the Public Health Insurance Marketplaces” post – we hope you have enjoyed regular updates on the exchanges across the United States. Check back throughout 2014 for blog posts on a wide variety of topics related to exchanges, both on the federal and state level.

Latest Developments:

State Run Exchanges and Partnerships -

California: As of December 23rd, 400,000 Californians had enrolled in plans on the state exchange.

Approximately 53,510 people enrolled in plans on the exchange over a three day period the week before the December 23rd enrollment deadline. To accommodate the rush, Covered California enlisted the help of extra staff to man the phones and aid with in-person enrollment as Californians flocked to enroll in plans in the last days before the deadline.

Of the 11 insurers that provided plans on the state-run exchange, 96 percent of enrollees selected offerings from just four providers, raising the question of whether smaller providers could compete against giants Anthem, Kaiser, Blue Shield, and HealthNet. As of December 13th, Anthem Blue Cross dominated, with 30 percent of enrollees choosing a plan offered by that insurer.

While demographic information for enrollment were not yet available through the end of the month, it has been reported that just 1,000 Spanish-speakers have enrolled in health insurance. In previous months, less than 5 percent of the 109,296 people who enrolled in plans identified as Spanish-speakers.

As enrollment deadlines approached, Covered California has opened enrollment “storefronts” across the state to sign up individuals and families on plans. While online enrollment has been steady, an estimated 80 percent of residents interested in enrolling prefer in-person support, hence the decision to open more physical locations, often located in malls.

California’s small business exchange opened for business, with the target of enrolling 7,000 businesses next year. This successful launch comes in contrast to the federal small business exchange, which has been postponed until further notice.

Covered California sent out 114,000 eligibility letters to plan applicants that contained blank spaces or missing information due to a computer error. Missing information included federal subsidy amount and eligibility for insurance. New letters have since been sent out to correct the error.

Colorado: Colorado did not require insurers to extend cancelled health plans, joining a handful of other states — California, Washington, New York, and Vermont — that have opted out of the extensions.

As of December 23rd, Connect For Health Colorado had a total of 35,356 enrollments. While the 23rd was initially the deadline for enrollment to begin on January 1st, exchange officials extended it to December 27th, clarifying that offices would be closed over Christmas but the website would still be taking enrollments.

Boomers dominated enrollment in the first two months, with 43 percent of all enrollees being 55 to 64 years old. By contrast, only 17 percent of enrollees fell into the target demographic — the “young invincibles,” aged 18 to 34.

Connecticut: Connecticut saw a surge in enrollment, with close to 1,000 people enrolling per day in the first week of December on the state-run exchange, Access Health CT. Enrollment on the exchange more than doubledin the subsequent two weeks, with 37,000 enrolled as of December 17th.

District of Columbia: President Obama signed up for health insurance on the D.C. Health Link exchange, selecting a bronze tier plan. His enrollment was symbolic, as his health care will continue to be provided through the military.

D.C. opted not to extend the enrollment deadline for residents, meaning December 23rd was the last chance for people to enroll and receive coverage starting January 1st.

Idaho: Idaho governor C.L. Otter opted to let insurers decide whether or not to extend cancelled plans in 2014. Effectively approving the extensions for the state, Otter recommended Idaho residents with cancelled plans contact their individual insurer to check the status of their plans.

Roughly 20,000 people had enrolled in plans by the end of 2013, according to a recent announcement by Your Health Idaho spokesperson Jody Olson.

Maryland: State officials announced that insurers decided to extend the enrollment deadline from December 23rd to 27th in response to continued technical glitches on the exchange website. Despite continued site issues, Governor Martin O’Malley reported that as of December 21st, 42,589 people had enrolled on the exchange.

Rebecca Pearce, Maryland’s exchange executive director, resigned on December 6th, as technical glitches continued to plague the site and enrollment continued to lag. Pearce was the third state exchange director to resign nationwide.

Michigan: The state legislature passed a bill that banned plans on the exchange from covering abortion services, making Michigan the 24th state to do so.

Minnesota: Enrollment on the state’s exchange, MNsure, more than doubled in December. More than 71,000 people had applied as of November 30th according to some reports, despite continued technical issues with the exchange website.

Minnesota exchange officials announced on December 20th that the enrollment deadline would be extended and people would have until the end of the year to sign up. The extension came in response to continued technical glitches with the exchange website.

Exchange officials scrambled to fix a problem with the MNsure exchange website after it was revealed that the flaw left consumer data unencrypted, leaving it vulnerable to hackers. Forensic analyst Mark Lanterman confirmed on December 17th that the flaw had been fixed.

MNsure exchange chief April Todd-Malmlov resigned, making Minnesota the fourth state to lose its exchange chief amidst mounting criticism of exchange operations. Todd-Malmlov has since been replaced by Scott Leitz.

Wait times on MNsure helplines exceeded one hour as trouble with the exchange website drove more consumers to try enrolling over the phone. Navigators helping walk people through plan options described the wait times as unusual, though they reported it varied throughout the week.

Exchange officials revealed that some Minnesotans who completed applications may not actually be enrolled, citing a number of issues including duplicate applications and unclear communication by MNsure about when premium payments are due.

Nevada: Nevada’s exchange, Silver State Health Insurance Exchange, saw an uptick in activity on the site after slow enrollment in October and November. As of December 11th, Nevadans had selected 6,629 plans on the exchange.

New Mexico: New Mexico fell far short of its enrollment goals, with just 8,539 completed applications according to a federal report released December 12th.

New Mexico launched a much-delayed $6 to $7 million marketing campaign following updates to its small business exchange. The campaign included TV, radio, print ads, and social media and will run through the end of 2014.

New York: New York exchange officials reported 257,413 completed applications as of December 1st and by the end of December over 100,000 people had successfully enrolled in plans.

New York opted to extend the enrollment deadline to December 24th, in part to allow those with cancelled plans to enroll in time to have coverage start on January 1st. Visitors to the exchange experienced “volume-based” glitches the Friday before the December 24th deadline. The errors, due to the high number of visitors to the site, occurred in the morning and were resolved by mid-afternoon.

Oregon: Individuals and families who signed up for plans on the private exchange now have until January 15thto pay premiums for coverage starting January 1st, thanks to a recent extension. Plan holders may have to pay costs out of pocket until the insurer receives payment, but once it has been processed they may apply for reimbursements.

12,000 Oregon residents with “portability plans” — plans the recently unemployed could purchase from their former employer-sponsored insurer — did not have their cancelled plans extended in 2014. Portability plans were primarily for recently laid off employees with preexisting conditions, who would have had difficulty getting individual coverage due to their condition. Insurance Division spokesperson Cheryl Martinis explained that because individuals with preexisting conditions can no longer be denied coverage on the public exchange, extending the portability plans was unnecessary.

Applicants on the state-run exchange, Cover Oregon, received a troubling robocall from the exchange on December 20th, warning them “if you haven’t heard from us by December 23rd, it is unlikely your application will be processed for Jan. 1 insurance coverage.” The call also suggested that applicants may not receive tax credits they were eligible for, due to problems with the exchange.

As of December 21st, Oregon was the last remaining state that had still not launched its exchange website, due to ongoing technical issues. The state has been relying exclusively on paper applications in the interim.

Oregon exchange officials announced they hired staff with programming skills to help check code for bugs that have continued to plague the online exchange, which was developed and built primarily by Oracle. This announcement was perhaps the most direct expression of state officials’ frustration with Oracle’s work on the site. As of December 14th, the state had withheld $18 million in payment to Oracle as they explore who was responsible for the ongoing site issues.

Two high ranking state exchange employees involved with the exchange resigned this month. Carolyn Lawson, chief information officer at the Oregon Health Authority, and Rocky King, director of Cover Oregon, both left their posts citing personal and medical reasons, respectively. Both came under fire following the failed launch of the exchange website.

Rhode Island: Rhode Island residents saw their enrollment deadline extended. Uninsured Rhode Islanders were given until December 31st to enroll and until January 6th to pay for a plan in order for coverage to begin January 1st.

Washington: An estimated 65,000 people had signed up for private insurance on the state exchange as of December 24th and an additional 69,000 had selected plans but needed to complete enrollment by paying premiums.

The Washington state exchange website experienced multiple outages, including a lengthy 4-day outage at the beginning of December. Site visitors expressed frustration and concern that they would be unable to enroll in time for the December 23rd deadline that would guarantee coverage starting on January 1st. As a result, customer service call centers received as many as 10,000 to 20,000 per day during the month of December.

Many insurers offering plans on the exchange have excluded top hospitals from their provider options as a means to curb costs. For example, four of the seven insurers providing plans on the exchange do not include University of Washington Medical Center or the UW’s Harborview Medical Center, the state’s only Level 1 trauma center and burn unit, in their provider networks.

Federally Facilitated Exchange-

Arizona: Enrollment assisters saw a steady flow of Arizonans signing up for plans on the exchange as the end of the year approached. 3,600 Arizona residents had enrolled as of November 30th and the remaining uninsured residents had December 23rd to enroll to receive coverage on January 1st.

Georgia: Enrollment numbers in Georgia rose to 6,859 by the end of last month, falling short of government projections for the month but marking a significant increase from the first month of enrollment in the state.

Indiana: 3,500 people had enrolled in plans on the federally run exchange as of December 11th. State enrollment numbers quadrupled in November, with 2,800 new enrollments following a dismal 701 enrollments in October.

Iowa: Of the approximately 12,755 applications submitted on behalf of 25,007 Iowa residents, just 757 people successfully signed up for plans on the exchange as of December 11th.

Kansas: Aetna decided not to extend cancelled plans, despite state officials’ decision to approve the extensions. BlueCross BlueShield of Kansas, by contrast, decided to approve the extensions, which allowed nearly 9,000 Kansans to keep their plans in 2014.

Maine: Just 1,480 Maine residents selected plans on the state exchange, despite nearly 250,000 who could benefit from enrolling on a plan through the exchange. Individuals and families may still enroll up to the March 31st deadline, but will not receive coverage beginning on January 1st.

Mississippi: Mississippi had the lowest enrollment in the country, with just 148 people enrolled in plans, according to recently released numbers. State residents continued to struggle to get accurate information about their eligibility and with just two insurers, Humana Health Insurance Co. and Magnolia Health Plan, their options remained limited.

Humana, one of Mississippi’s two insurance providers, equipped buses with WiFi and filled them with insurance agents ready to enroll residents in plans. By taking their outreach efforts on the road, their hope was to reach a greater percentage of uninsured Mississippians.

Missouri: Representatives from several Missouri non-profits that received federal grant money to train navigators sued the state, saying the provisions of Missouri state law that restricted them publicizing the exchange obstructed them doing their jobs. The laws reflect ongoing Republican opposition to ACA implementation in the state.

Montana: Blue Cross and Blue Shield of Montana, PacificSource and Assurant, the state’s largest insurers, opted not to extend cancelled plans for Montana residents. Plans that did not meet the minimum coverage requirements were not made available to consumers for 2014.

New Jersey: AmeriHealth became the third insurer in New Jersey to decline to extend cancelled plans, following Aetna and BlueCross BlueShield. AmeriHealth covered approximately 9,200 people on individual plans.

North Dakota: BlueCross BlueShield of North Dakota announced in early December that it would not be extending cancelled plans. This affected approximately 31,000 individuals in the state.

South Carolina: 15 insurance providers agreed to offer extensions on cancelled health plans, according to South Carolina’s insurance agency. An estimated 144,000 people on the cancelled plans will had those plans extended.

South Dakota: South Dakota insurers extended the application deadline from December 15th to December 31st for individuals who wish to receive coverage starting January 1st. This decision followed the federal government’s announcement that it would allow such extensions.

Tennessee: BlueCross BlueShield of Tennessee opted not to extend cancelled health plans for small businesses (50 employees or fewer), despite allowing the extension for individuals and families. This means small employers with cancelled plans had to find new plans in the new year.

Texas: Texas state insurance chief called for heightened security around navigators, recommending background checks and 40 additional hours of training to protect health insurance consumers from privacy concerns like identity theft.

Just over 14,000 Texans selected plans on the exchange over the first two months of enrollment. Texas had one of the highest enrollment numbers of the 36 states operating on the federally-run exchange, second only to Florida, which enrolled 18,000 over the same period.

Immigrant rights groups reported that fear of deportation was a strong deterrent for relatives of illegal immigrants. While legal residents could still participate in the exchange, there was concern that enrollment may draw unwanted attention to the residency status of their relatives.

Utah: Enrollment picked up in Utah as the federal website functionality improved, but continuing trouble with interface between the Utah and federal sites caused issues with Medicaid enrollment in the state.

Wisconsin: Nearly 7,200 people have registered on the exchange through the federal site as of December 10th. Enrollment picked up despite dismal numbers in the first month of the open enrollment period due to technical issues with the website.

[Photo Credit: Kevin Hutchinson on Flickr via Creative Commons 2.0]

This post appeared on the OneExchange Blog on January 17th, 2014 and can be viewed there by clicking here.
Towers Watson is a leading global professional services company and operator of the nation's largest private Medicare exchange. Towers Watson OneExchange is the industry’s only holistic private exchange solution, offering exchange options for U.S. employers and their active, part-time and retired workers.