No, not that smiling woman. Not the one whose face was featured on the law’s federal website until administrators realized the site wasn’t delivering smiles to customers.
Connecticut runs its own Affordable Care Act (ACA) insurance marketplace, and its online exchange has been working.
In fact, of 11 states that are running their own online sign-ups and have delivered progress reports, all are doing better than the federal website HealthCare.gov, which 36 states are relying on.
The performance gap is a sign of how the federal website has been, by the admission of its own creators, marred by management failures including inadequate testing. It also reflects the fact that it’s easier to create a website for residents and insurance firms in a single state than for dozens of them.
Important, too, to this comparison is the politics of Obamacare. It’s no secret that the law – with its “individual mandate” for Americans to buy insurance and its imposition of new federal standards for acceptable coverage – is more popular in Democratic-leaning states than in conservative ones.
The ACA gave states the option of setting up their own exchanges, and those that did so tend to be those in which both officials and the public generally welcome the law.
“We made this work, and it's worked actually pretty well,” Sen. Sheldon Whitehouse (D) of Rhode Island said at a recent hearing on Obamacare in the US Senate.
But even in the states where the law’s launch has been relatively smooth – which include Connecticut and several other New England states – the early “success” doesn’t mean that the road ahead in implementing Obamacare looks easy.
All across the nation, states face similar hurdles ahead: a likely surge of demand near the end of the calendar year and, in many cases, questions about how to adapt on the fly to a new presidential directive allowing canceled insurance policies to be reinstated.
More on those challenges in a moment. First, here’s a look at the stark contrast between states that set up their own websites and those that are relying on HealthCare.gov.
• The 11 states that run their own websites and have given progress reports account for about 30 percent of America’s population, but 75 percent of total enrollments during the first month of Obamacare exchanges.
• When states are ranked by the share of potential enrollees who have already signed up, these 11 states capture the top 11 spots. In other words, no state relying on the Obama administration to manage its exchange did better than Maryland, which had the poorest-performing state-run website. The numbers for potential enrollment, by state, come from analysis by the Kaiser Family Foundation, a nonprofit research group.
• All 11 state-run exchanges had at least 1,000 enrollees, led by California at 35,364. By contrast, of the 36 states using HealthCare.gov, 27 had fewer than 1,000 enrollees.
• Within the 11 states running their own exchange websites, results vary widely. Vermont and Connecticut have done a lot better than Minnesota or Nevada, in the share of potential enrollees signed up. Maryland, where website users have run into significant technical challenges, is signing up people at a pace only slightly faster than Delaware, a neighboring state that’s relying on HealthCare.gov.
Even in the states where enrollment is going fastest, the sign-ups are just getting started.
The Kaiser Family Foundation estimates the potential pool of shoppers on Obamacare exchanges at nearly 29 million Americans in all 50 states. Those are people who, for instance, don’t have employer-based insurance or Medicare, and whose income is too high to qualify for Medicaid. Of these, more than half (17 million) would qualify for subsidies when buying insurance under the law.
During the first month of Obamacare enrollment, only 106,000 people signed up for a health plan nationwide, with three-fourths of those being people in the 11 states running their own exchanges.
The enrollment period still has several months to go – through the end of March. Purchases were expected to be slowest at the very beginning. And not all the potential enrollees are expected to sign up in the first year. The Congressional Budget Office has projected about 7 million signups for 2014.
Yet the numbers suggest that, even within the group of 11 states reporting numbers from their own exchanges, about 95 percent of enrollments for 2014 are still to come.
That tally assumes that, since these states account for one-fourth of the “potential market” in the Kaiser analysis, they’ll also account for about one-fourth of some 7 million actual signups for next year.
President Obama has emphasized that the sign-up period runs for six months, allowing time to fix website problems and ramp up enrollment.
By that measure, some of the states running their own exchanges appear to be doing pretty well.
But the reality may be tougher. Many Americans are rushing to get insurance policies in place by Jan. 1, not March 31. And to achieve that target, sign-ups need to happen by Dec. 15 – which means the next few weeks could be ones of heavy demand.
The rush promises to be especially big in the nation’s most populous state, California. That’s because California’s state-run exchange called on insurers to cancel by Dec. 31 those policies that don’t comply with the federal law.
Where cancellations in most states will be spread out over the course of 2014, in California the affected households all need to go shopping for new plans now.
More broadly, this question of policy cancellations has become another factor complicating Obamacare’s implementation across the whole nation.
States now have to scramble because of a move Mr. Obama made last week. Responding to criticism that he’d broken a promise that people can keep their current insurance, he said insurance providers should be allowed to reinstate canceled policies, even if those policies don’t meet minimum coverage standards imposed by the law.
Obama’s executive order makes any change voluntary. That creates uncertainty nationwide. State insurance commissioners – and then insurance firms themselves – need to decide whether to OK the renewal of now-canceled policies.
States that try to honor the president’s “you can keep it” could face turmoil in the enrollment process. The ACA is designed to draw a balanced mix of people into the ranks of newly insured, including younger and healthier people as well as people who are older or who use more medical services.
Reviving old insurance policies could thwart the balanced “risk pool” that insurance companies have been expecting.
“Changing the rules after health plans have already met the requirements of the law could destabilize the market and result in higher premiums for consumers,” Karen Ignagni of the industry group America's Health Insurance Plans said in a news release Friday.
For that reason, states including Washington and Rhode Island have said they won’t be allowing canceled plans to be offered anew.
Some states are still deciding. In California, Insurance Commissioner Dave Jones said Friday that the state’s exchange, called Covered California, should “release health insurers selling in the Exchange from the contract provision that requires them to cancel policies on December 31.”