Healthcare officials from states running their own ObamaCare exchanges say they’re better-equipped to deal with the challenges surrounding the implementation of the Affordable Care Act.
Speaking at the National Press Club on Friday, officials from Rhode Island, Kentucky, California and Washington, D.C. — four of the exchanges where ObamaCare has been most successful — said they’re nimbler than the federal government and more in tune with their constituent’s needs.
Rhode Island reached its 2014 enrollment goal in early January, about three months before open enrollment ends.
And in early October, while ObamaCare sputtered nationally, Kentuckians poured into the state’s exchange. The state’s governor, Steve Beshear (D), was a guest of the Obamas at the State of the Union. The president called him a “man possessed” when it came to implementing the healthcare law.
“[Beshear] made the decision to do this at the state level even though it wasn’t politically popular,” said Audrey Haynes, the secretary of the Kentucky Cabinet for Health and Family Services. “He felt we knew our insurance market best, and we have the personal relationships with carriers ... we better understand our market and our state’s demographics.”
Kentucky has one of the highest percentages of uninsured in the country, with 640,000 of the state’s 4 million people lacking coverage.
It’s also one of the sickest states in the country, according to data. Kentucky ranks 50th in percentage of smokers, 50th in cancer deaths, 48th in heart attacks, 41st in diabetes and 40th in obesity. Those numbers are likely to get worse before they get better, as people using their health insurance for the first time discover previously unknown conditions.
As of Jan. 27, Kentucky had enrolled more than 180,000 through its exchange, nearing its goal of 220,000 by the end of March.
Haynes said Kentucky’s enrollment success is due to the state’s centralized structure. The agency that handles Medicaid, the health and family services department and other key advisory boards all fall under one roof.
“We don’t have as many structural barriers,” she said. “Sometimes organizational structures get in the way, they become barriers.”
Haynes said when consumers in her state have been stumped by a computer glitch, the insurers and exchange workers have settled the matters individually, sometimes processing the paper work by hand, to help the person through the process.
“We’re looking out for people in a much more intimate way,” Haynes said. “That’s not something you get in a much larger system.”
Of course, many of these exchanges had the advantage of a functioning website. The federal website, HealthCare.gov, was barely functional for the first two months of open enrollment, and the federal small-business exchange is still offline.
Companies with fewer than 50 employees were slated to begin buying coverage through the Small Business Health Options Program (SHOP), an online ObamaCare exchange, in December. But in late November, the White House pushed back the launch date for the exchange by one year, so it could focus on getting the online exchange for individuals up and running.
Contrast that with the Washington, D.C., exchange, where the fully operational SHOP portal is responsible for more than half of the district’s total ObamaCare enrollees. As of mid-January, 20,000 had signed up for coverage through the D.C. exchange, with nearly 12,000 of those coming through SHOP.
These states are buoyed in their efforts by a wealth of funding for marketing and public relations.
The states running their own exchanges have an almost four-to-one advantage in money to spend on promoting the exchanges, according to data cited by Heather Howard, the director of the State Health Reform Assistance Network. She said the state-run exchanges have $200 million for outreach and enrollment assistance, compared to only $50 million for the states in the federal exchanges.
In addition to their own marketing budgets, the states can apply to the federal government for grant money. In Washington, D.C., the exchange has used some of that money to launch a youth enrollment leadership council and is reaching out to young people at dance clubs and bars, to people waiting in line at stores to buy the latest Nike Air Jordans and to Denny’s patrons in the middle of the night.
Meanwhile, the Obama administration, insurers and outside advocacy groups are just now ramping up a public relations blitz aimed at getting consumers to sign up for ObamaCare before open enrollment for 2014 ends on March 31.
Many campaigns were put on hold in the fall, while the administration worked to fix the problem-plagued HealthCare.gov website.
“The problems at the federal level scared away a lot of early adopters,” Ferguson said. “They’re recovering and are moving ahead, but the damage has been done to their marketing and outreach. That piece has to be addressed, and they’ll have to redouble their efforts in that area.”
Of course, not every state-run exchange has been a success.
Oregon was initially spotlighted by liberals for having implemented one of the country’s more ambitious healthcare overhauls, but the state’s exchange has suffered technical issues similar to those affecting the federal system, and has only reach a fraction of those it hopes to enroll.
Maryland has a similar story, and is considering ditching its exchange and joining the federal marketplace.
Howard said those exchanges suffering through rocky rollouts would ultimately turn it around.
“They’re doing audits to see what went wrong, and whether and how to salvage what they’ve built so far, or to start over,” she said. “But they’ll be successful over time.”