- The Washington Times - Monday, December 9, 2013

Some of the states that most enthusiastically embraced President Obama’s health care law are now encountering some of the biggest glitches and organizational failures as the health insurance exchanges roll out.

Glitches that hindered HealthCare.gov, shorthand for the federal exchange system that serves 36 states, have grabbed the biggest headlines since the exchanges went live in October and were supposed to let consumers shop for private health plans and apply for government subsidies.

But as the Obama administration patches up its balky website and states like California, New York and Kentucky win praise for their in-house efforts, a handful of states that embraced the president’s reforms from the start may be faring the worst of all.

Cover Oregon started off with a bang — a fancy website, ads with customized folk songs — but at last count it had failed to enroll anyone through the Internet. In Hawaii, its director apologized for implementation delays in October before stepping down this month. And in Maryland, state lawmakers and officials are starting to point fingers over a health exchange that one insurance co-op executive termed “inexcusable.”

“Honestly, we are more than frustrated,” Peter Beilenson, president and CEO of the Evergreen Health Co-op that is offering plans on the Maryland exchange alongside much larger insurers.

Mr. Beilenson said he has seen a spectrum of online errors in trying to help Web applicants, from the site freezing up to the exchange offering “negative subsidies,” which isn’t possible.

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Adding to states’ problems, a Minnesota affiliate of ABC News reported Monday that its state exchange and other exchanges are vulnerable to a type of Wi-Fi attack that could expose usernames and passwords.

The affiliate said 58 percent of state-run exchanges failed a simulated hacking attempt, although the Minnesota exchange, MNSure, disputed the report.

Combined with the much more notorious difficulties with the main Obamacare website, HealthCare.gov, these woes are making it tougher for Americans to sign up for health insurance they must have under law. They also counter Obama administration claims that problems with its health care law are the result of foot-dragging by politicians who oppose the law.

Obamacare’s framers expected many of the states to manage their own marketplaces, but about two-thirds of the states chose to let the federal government take on the task and any of its political fallout.

Mixed outcomes among state-run exchanges are both supporting and undercutting the notion that state officials relying on HealthCare.gov would have done their constituents a favor by building their own markets.

“On balance, the states that took the responsibility on have had a bit more success, but it’s certainly not uniform,” said Matt Eyles, executive vice president at Avalere Health, a Washington-based consultancy.

The administration will shed light on each state’s progress by the middle of the month, when it releases a second round of enrollment data.

Its first report, released Nov. 13, said state-run exchanges had outperformed the federal website during the first month of open enrollment, which began Oct. 1 and lasts until March 31. The 15 state-run exchanges accounted for 75 percent of roughly 106,000 enrollees.

Early adopters of Obamacare such as Washington and Connecticut tallied 7,091 and 4,418 enrollees, respectively. But data for Hawaii was not available at the time — it reported 579 enrollments as of Dec. 2 — and Maryland came in at just 1,284.

Frustration with the Maryland Health Connection has boiled over in recent days. Its director resigned Friday amid criticism she had been unreachable during a weeklong vacation to the Cayman Islands at a critical time for the exchange website’s rehabilitation, according to a report in the Baltimore Sun.

Hoping to reverse its fortunes, the exchange is preaching patience and encouraging consumers who have problems with the website to contact its consumers support center.

“Our IT team is working around the clock to resolve the remaining technological issues affecting the website so that Marylanders will be able to enroll in qualified health plans by Dec. 23 in order to receive coverage beginning on Jan. 1,” exchange spokeswoman Dori Henry said Monday. “While we have made significant progress, we know that challenges remain.”

Mr. Beilenson’s co-op is much smaller than other insurers on the Maryland exchange, such as CareFirst or Kaiser Permanente, with only 33 full-time employees.

“We were completely ready,” he said, bemoaning the erratic exchange portal. “It’s just inexcusable.”

Oregon’s exchange reported 3,470 enrollments in its Dec. 2 enrollment report. All of them were by paper applications, instead of through its website, according to a spokeswoman.

“We are starting to see enrollments and are gaining momentum. I am confident we are on the right track to get people the health coverage they need,” Cover Oregon Executive Director Rocky King, who is taking a three-month leave of absence because of a medical condition, said at the time of the update.

Acting Executive Director Bruce Goldberg is scheduled to host a teleconference Tuesday to provide update enrollment figures and a progress report on Cover Oregon.

Analysts say that in retrospect, multiple things could have been done differently to make sure certain states and the federal system did not struggle so mightily.

Timothy Jost, a health policy scholar at Washington and Lee University School of Law, said a House version of Obamacare legislation, which called for a blanket federal exchange for all the states, might have been the better option. The Obama administration did not know the extent of its task until after the 2012 election, when states declared whether they wanted to run their exchange, resulting in a compressed time frame for preparation and testing, he said.

Website testing prior to launch — or the lack thereof — appeared to play a key role in success or failure among the state and federal exchanges, and some states may have put style ahead of functionality on their websites, analysts said.

“Complexity” with aesthetic appearances, Mr. Eyles said, “was definitely the enemy of efforts” to sign people up.

Kentucky’s exchange, kynect, tested its no-frills website for three months before launch, according to spokeswoman Gwenda Bond.

“We worked hard to make sure the content was at a sixth grade or lower reading level throughout, and to make it easy for people to check their potential eligibility and browse anonymously or to get started on the application process,” she said. “Simplicity is smart Web design.”

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