Health Insurance Exchanges Suffer Ills Of Geography

Oct 12, 2013
Originally published on October 12, 2013 8:05 am

These first two weeks have been rocky for the state health insurance exchanges. The online marketplaces opened across the country Oct. 1, with computer glitches and staffing shortages.

Even the states that have agreed to run their own exchanges are having a hard time. In states that have not embraced the Affordable Care Act, the federal government is struggling to fill in the gap.

As Alexandra Dixon threads her way among the people waiting to see a doctor at the Community Clinic, Inc., in Silver Spring, Md., she introduces herself with a bright smile and an outstretched hand.

"I'm one of the new health care navigators. Have you heard of the Affordable Care Act?" she asks.

While some folks mumble, "Um, no, I don't think so," Dixon is nonetheless booked up with appointments. She's one of 350 people in Maryland who have been hired and certified to help people enroll in the federal health care law's insurance options.

"Sure, I've had a couple of people go, 'Ooooh, Obamacare, I don't want that,' " Dixon says. "But for the most part, people have been really excited and really happy and know what this is."

Dixon sits down with Maria Hernandez, a construction worker who's been uninsured for the past five years. Hernandez says sometimes she gets sick, but without insurance, it's better just to take some medicine and stay home. With Dixon's help, she's started an application for insurance.

Despite Dixon's assistance, no one at the clinic where she works has actually enrolled on the exchange: The Maryland website freezes almost every time.

But whenever Dixon hits a roadblock, she sets up an appointment for the patient to come back, "because the portal is a lot better this week than it was last week," she says. "I have every expectation that next week it will be working better than this week."

And she has her state behind her: Maryland has embraced the health law. It's one of the 16 states, plus the District of Columbia, that are running their own exchanges. The rest are being run by the federal government, which has been stretched thin, according to Caroline Pearson of Avalere Health, a consulting company that's been tracking the insurance marketplaces.

"The states that are operating their own exchanges just have a lot more funding available to do outreach and enrollment," Pearson says. "The federal government just had limited funding left to do that, and it was spread across a large number of states."

The entire state of Ohio, for example, received just $3 million in grants to reach out to those who might need the insurance — compared to $24 million in Maryland, which has half as many uninsured residents.

That frustrates Lisa Hamler-Fugitt, who runs the Ohio Association of Foodbanks, the state's main consumer-outreach group for the exchange.

"We have too few boots on the ground," she says. "We need hundreds if not thousands of individuals to assist us."

Instead, she'll have about 40. Ohio has laws putting additional restrictions on navigators, such as requiring them to go through a longer certification process. Hamler-Fugitt believes that's caused a three-week delay in getting her navigators to work.

These early differences between states could hamper the goal of the Affordable Care Act, which is to get as many people insured as possible, according to Pearson of Avalere Health.

"Recent polling shows that only about 12 percent of the uninsured population who could benefit from exchanges understand that they are launching and began on Oct. 1," she says.

The effort that's needed to ramp up awareness won't be there in states that aren't proactive, Pearson says.

But, she adds, this is only the beginning of the enrollment process; launching an initiative of this size is always a huge lift, she says.

Consumers have until the end of March to sign up for coverage in 2014.

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SCOTT SIMON, HOST:

This is WEEKEND EDITION from NPR News. I'm Scott Simon. The new health insurance exchanges are now in their second week and it has been a rocky start almost everywhere. Just how rocky may depend on what state that you live in. Jenny Gold tells us about people called the navigators, people hired to help consumers enroll in coverage.

JENNY GOLD, BYLINE: The waiting room at a community clinic in Silver Spring, Maryland is filled with people waiting to see a doctor. Alexandra Dixon walks among the rows of chairs with a bright smile and an outstretched hand.

ALEXANDRA DIXON: My name's Alex and I'm one of the new health care navigators. Have you heard about this new Affordable Care Act?

UNIDENTIFIED MAN: No, I don't think so.

GOLD: Dixon is one of 350 people in Maryland who've been hired uncertified to help consumers enroll in the new health insurance options that are offered as part of the Affordable Care Act. So far, she's been pretty booked up with appointments.

DIXON: Sure, I've had a couple of people go: ew, Obamacare, I don't want that, but for the most part people have been really excited and really happy and, you know, know what this is, you know.

(SOUNDBITE OF PEOPLE SPEAKING FOREIGN LANGUAGE)

GOLD: Today she's helping Maria Hernandez, a construction worker who's a legal immigrant and has been uninsured for the past five years.

MARIA HERNANDEZ: (Foreign language spoken)

GOLD: She says sometimes she gets sick but without insurance it's better just to take some medicine and stay home. She's gotten her application started with Dixon's help, but pretty much every time Dixon tried to enroll someone, the Maryland exchange website freezes up.

So far, no one at the clinic has actually been able to enroll in an exchange plan. But whenever Dixon hits a roadblock, she just sets up an appointment for the patient to come back.

DIXON: Because the portal is much better this week than it was last week, so you know, I have every expectation that even next week it's going to be better than this week.

GOLD: And she has her state behind her. Maryland has been on the forefront of implementing the health law. It's one of only 16 states running its own insurance exchange. The rest are being run by the federal government, which has been stretched thin. Caroline Pearson works at Avalere Health, a consulting company that's been tracking exchanges.

CAROLINE PEARSON: The states that are operating their own exchanges just have a lot more funding available to do outreach and enrollment. The federal government really had limited funding left to do that and it was spread across a large number of states.

GOLD: One of those states is Ohio which got just $3 million in grants to do consumer outreach. That's compared to $24 million in Maryland, which has half as many people without insurance.

LISA HAMLER-FUGITT: It has been challenging, to say the least.

GOLD: That's Lisa Hamler-Fugitt, who runs the Ohio Association of Food Banks, the state's main consumer outreach group for the exchange.

HAMLER-FUGITT: We have too few boots on the ground. We need hundreds, if not thousands of individuals to assist us.

GOLD: Right now, she'll have about 40. On top of that, Ohio placed extra restrictions on navigators, including requiring them to go through a much longer certification process with the insurance department. Hamler-Fugitt says that's stalled the process of getting her navigators on the ground by three weeks. She says looking at states like Maryland is just frustrating.

These early differences between states could hamper the goal of the health law, which is to get as many people covered as possible, according to Caroline Pearson at Avalere.

PEARSON: Recent polling shows that only about 12 percent of the uninsured population who could benefit from exchanges understand that they are launching and began on October 1st. So doing a big push out in the community, you know, can potentially bring a lot of people into the market that you're not going to see in a state that isn't as proactive.

GOLD: But, she adds, this is only the beginning of the enrollment process and launching a program of this size is always a huge lift. Consumers have until the end of March to sign up for coverage in 2014 and as the kinks get worked out, it's possible that this year's enrollment will still be a success. For NPR News, I'm Jenny Gold.

SIMON: And that story comes to us from the nonprofit news service Kaiser Health News.

(SOUNDBITE OF MUSIC) Transcript provided by NPR, Copyright NPR.