@ezraklein: Big deal:backroom connection between insurance companies and Feds is a disaster

How Does ACA’s First Week Compare to Medicare Part D’s?

Posted on October 6, 2013 by CHIR Faculty

By Jack Hoadley, Georgetown University Health Policy Institute

Since the official opening of health insurance marketplaces on October 1, there have been reports of broad interest and high traffic to marketplace websites, but also of various glitches and delays with those websites. Back in the fall of 2005, there was a similar launch for Medicare’s new Part D prescription drug benefit.

Does this excerpt from an article from the Washington Post of November 8, 2005, sound familiar?

The rollout of the new Medicare drug benefit has been anything but smooth. At a news briefing yesterday, Mark B. McClellan, head of the Centers for Medicare and Medicaid Services, provided a how-to demonstration of the much-awaited Medicare Prescription Drug Plan Finder, which he said would be available on www.medicare.gov by 3 p.m. It wasn’t. … Problem is, the Medicare folks have had some trouble getting the tool up and running. The original debut date was Oct. 13, but officials delayed it, citing the Jewish holiday Yom Kippur. Next it was promised on Oct. 17, but that day, too, came and went without personalized plan comparisons being available. Late in the month, McClellan told reporters that the feature definitely would be ready before Nov. 15, the date when seniors can begin signing up for the drug benefit. Yesterday (November 8), McClellan announced that the time had come. … But the tool itself appeared to be in need of fixing yesterday. Visitors to the site could not access it for most of the first two hours. When it finally did come up around 5 p.m., it operated awfully slowly.

Even though there were problems this week, marketplace websites were at least up and running on the promised day, October 1. As reported by HHS officials, there were nearly 5 million visitors to healthcare.gov on the first day, far more than have ever visited Medicare.gov. During the 2005 signup period for Medicare Part D, the number of daily visitors to the online Plan Finder peaked at about 160,000 for a program that would enroll more people than are expected to enroll under the Affordable Care Act. By this standard, the level of interest in getting online information from the marketplaces is remarkable.

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Glitches continued with the Part D website and call center throughout the open enrollment period. But the program added both phone lines and customer service representatives and implemented other upgrades over the weeks. The website – both its functionality and the accuracy of its information – was the source of ongoing frustration for its users, but it did get better over time.

By the end of open enrollment in May 2006, over 16 million successfully enrolled for drug benefits in Part D (not counting another 6 million automatically enrolled as a result of participation in both Medicare and Medicaid). Initial glitches did not deter their enrollment. And today, Part D enjoys widespread popularity.

http://chirblog.org/how-does-the-aca-first-week-compare-to-medicare-part-d/

Why It Doesn't Matter If People Aren't Signing Up for Obamacare Yet

—By Stephanie Mencimer

Republicans have been insisting for a week now that Obamacare is a failure because immediately following its official debut on October 1, few people actually signed up for subsidized insurance plans through its new health exchanges. "Error message after error message. Failed security standards and 60 hours on website hold for just this one Kansan. It is clear, Obamacare is failing — an embarrassment, particularly for the former Kansas governor who is now in charge of Obamacare," Rep. Tim Huelskamp (R-Kan.) complained on the House floor last week.

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What happened in Massachusetts is pretty much exactly what's happening right now with Obamacare. After the law went into effect in Massachusetts, state offices were totally overwhelmed by the number of people clamoring to sign up for insurance, or what the state's Medicaid director dubbed the "stress of success." Lost paperwork, computer glitches, confusion over who was eligible for what, and not enough staff to handle the workload meant that in those early days, consumers could wait several months after submitting an application to finally get coverage. So many people were trying to enroll in the expanded Medicaid program that the Medicaid agency ended up with a months-long backlog of applications. In the first two months, only 18,000 of more than 200,000 potentially eligible people had successfully signed up through the connector, according to Jonathan Gruber, an MIT professor who helped design the Massachusetts system and served on the Connector board. And all of that happened in a state with only 300,000 or so eligible applicants and without a well-funded opposition trying to derail the law at every turn.

But guess what? Eventually the kinks got worked out and people got covered. Enrollment opened in October 2006, and by the deadline for getting mandatory coverage, July 1, 2007, the Boston Globe reported, 20,000 more people had signed up for insurance on the exchange than the state had expected—12,000 of them in just the two weeks before the deadline. Total enrollment went from 18,000 in December 2006 to 158,000 a year later, says Gruber. Today, Massachusetts has the lowest rate of uninsured residents in the entire country—less than 4 percent—and polls show that people are generally happy with how everything worked out. The conservative Massachusetts Taxpayers Foundation has called the state's health care reform law “a well thought-out piece of legislation.”

The federal exchange is fielding vastly more work than the Massachusetts Health Connector, and if it's having trouble with the workload, that's largely thanks to Republican opponents. The drafters of the ACA never envisioned the federal government running health care marketplaces for most of the country. The ACA was specifically designed to respect the state's rights that Republicans claim to care so much about. It empowered states, which already regulate the sale of insurance, to run the exchanges. Healthcare.gov was supposed to be a backstop for states either too small to run their own or that dropped the ball on setting up their own exchanges. Instead, Republican governors across the country, and mostly in the South, abdicated the job completely. So instead of running a marketplace for a couple of states as planned, Healthcare.gov is having to do the work of 70 percent of them, including big states like Florida, Texas and Virginia (and also, ahem, Kansas). Of course the site was going to have some problems!

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http://www.motherjones.com/mojo/2013/10/it-doesnt-matter-if-no-one-signs-obamacare-week

Based upon my survey of a large number of health plans accounting for substantial market share in the 36 states the federal insurance exchange is operating in, not more than about 5,000 individuals and families signed-up for health insurance in the 36 states run by the Obama administration through Monday.

"One carrier exec told me that yesterday"

After 10 days of operation, Kentucky's online health insurance marketplace, kynect, is getting close to enrolling 10,000 enrolled in new health insurance plans. So far, 9,453 individuals are enrolled. Individuals who sign up for health insurance by Dec. 15 will start coverage on January 1, 2014.

More than 200,000 unique visitors have clicked on 4.1 million kynect web pages since the website launched on Oct. 1.