Federal health care mishaps taint state exchanges

Against a backdrop of mishaps on the federal health insurance exchange, Minnesota and other states that built their own websites are trying to separate themselves from the crush of bad publicity.

The state-built sites, while not flawless, have gotten off to a much better start, analysts say. Now, some are worried that the confusion between the two could keep healthy consumers away.

"In calls with reporters, in public presentations and in social media, we're consistently trying to make a distinction between the federal government and our website," MNsure spokesman John Reich said. "It's really important to us that we don't get caught up in something not related to us."

Minnesota is one of 15 states and the District of Columbia building their own insurance marketplaces. The launch of these exchanges has been far from trouble-free — Oregon's still isn't working — but new federal figures released this week show that enrollment has almost doubled for states running their own marketplaces. About 200,000 people nationwide have used state exchanges, with strong enrollment in California, Connecticut, Kentucky, Washington and Minnesota.

Minnesota's MNsure exchange saw enrollment triple in its second week and the pace continues to gain steam each week, officials said, though it remains below early projections. As of mid-November, more than 500 community-based navigators have been certified to help sign people up for coverage.

"State-based models are working better for any number of reasons, including the fact that they've done better outreach," said Matt Eyles, of Avalere Health, a research and advisory services firm.

A recent analysis by Avalere of state exchanges found that enrollment is ahead of the pace of Medicare Part D, which rolled out in 2006 under the Bush Administration. About two-thirds of seniors who voluntarily enrolled in a Part D plan did so after coverage began.

It may get down to the wire. The White House promised to have the federal website running smoothly by the end of November. But last week, President Obama said he couldn't guarantee that the site will be bug-free by then.

On Friday, with millions having trouble signing up for coverage, the federal government extended the deadline a week, to Dec. 23, for consumers to enroll in a health plan for coverage that starts Jan. 1.

Peter Lee, executive director of California's health insurance exchange, known as Covered California, said it's "quite clear" his state's enrollment through the exchange has been reduced by a "steady drumbeat" of bad publicity over the poor performance of the federal healthcare.gov site.

The state recently changed its marketing message to directly address problems with the federal website, boasting that residents could get through Covered California in 15 minutes.

"Many don't understand there are separate websites," Lee said. "Instead of running ads about affordability, we've had to shift ads to address directly confusion consumers have had about the federal website."

What's not being talked about, he said, is the successful interface between the states and the federal hub, which checks enrollment information against such databases as the Internal Revenue Services and Homeland Security.

"The vast majority of time, that hub has been working great," Counihan said. "There's a working, live, real-time interaction with 16 state-based exchanges … and it takes about 3 seconds."

Meanwhile, MNsure has its hands full with its own issues. Consumers are waiting an average of 20 minutes to get through to the call center, and the agency is in the process of doubling its 30-person call center staff. The first wave of new hires may be in place as early as next week.

Anticipating another ramp-up in volume as the sign-up deadline approaches, officials are discussing whether to open the MNsure website on Sundays. Consumers can research plan options around the clock, but they currently are only able to buy a policy between 6 a.m. and 10 p.m. Monday through Saturday.

Kirby Erickson, executive director of the state's high-risk insurance pool, the Minnesota Comprehensive Health Association, said he had hoped that 22 percent of current enrollees would move out of the program by January, as it prepares to shut down next year. But he's dialing back expectations because consumers, who rely on this safety net insurance program, are afraid to shop on the open market.

Connecticut's Counihan said the consumer confusion is to be expected, and that implementation of exchanges will take three or four years.

"We have to be careful of drawing too many inferences," he said. "It's early in the game."

MNsure's Reich said the next couple of weeks are critical to both MNsure and the federal government. "We'd all like to have the federal exchange fixed," he said.