HARTFORD, Conn. ‚ÄĒ Facing tight deadlines and daunting workloads, states across the country are scaling back ambitions for implementing the Affordable Care Act.
At a monthly board meeting of Connecticut‚Äôs health insurance exchange, members of the standing-room-only crowd got a reminder that they, too, were behind schedule. The insurance marketplace they were working on nights and weekends won‚Äôt be completely ready on time.
‚ÄúIt is highly complex, it‚Äôs unprecedented and it‚Äôs not going to be smooth,‚ÄĚ Kevin Counihan, chief executive of the state‚Äôs exchange, Access Health CT, told the group.
That‚Äôs why Connecticut ‚ÄĒ like other states across the country ‚ÄĒ has lowered the bar, doing what it can in the time it has left before the health-care law‚Äôs major programs are launched Oct.¬†1.
Although the states are promising to provide new marketplaces for individuals to compare and buy health insurance plans, the Web portals will be a bare-bones version of what was initially envisioned.
And then there are the federal setbacks. The Obama administration has put off significant aspects of the health-care overhaul as it races to finish provisions that will give Americans more insurance options and provide many with financial assistance to buy coverage. On Tuesday, the White House announced a decision to delay the ‚Äúemployer mandate,‚ÄĚ a requirement that employers with 50 or more workers provide coverage.
‚ÄúIn 2011, there was this ‚Äėwe‚Äôre going to save the world‚Äô mentality,‚ÄĚ said Rebecca Pearce, executive director of the Maryland Health Benefit Exchange. ‚ÄúIn 2013, it focuses more on how do we deliver on the requirements of the law.‚ÄĚ
The District of Columbia and 15 states ‚ÄĒ including Connecticut ‚ÄĒ are building their own marketplaces. Those jurisdictions, among the Affordable Care Act‚Äôs most ardent supporters, took on the responsibility of building Web portals that are at the heart of the federal health-care overhaul. Most states, eschewing the heavy workload, left the task to the federal government.
The White House expects 7¬†million people to buy health insurance or enroll in Medicaid through these Web portals. Millions more are likely to browse these sites for health plans and explore possible options under the federal law, which imposes an ‚Äúindividual mandate‚ÄĚ requiring most people to obtain coverage or pay a penalty.
In Connecticut, Counihan and his colleagues decided in January to delay about 30¬†percent of the Web portal functions they had hoped to have ready by October.
‚ÄúWe were beginning to slip in timing,‚ÄĚ Counihan said. ‚ÄúWe were getting these messages that we weren‚Äôt going to be able to hit our timelines because of the complexity. Some things were either requiring more time or coding than we had expected.‚ÄĚ
When a consumer asks to be exempted from the individual mandate, for instance, the request will probably have to handled manually, by an exchange worker, rather than automatically, by a computer. Technology to track those points at which customers give up on the application process ‚ÄĒ turning away from the Web site rather than completing the application ‚ÄĒ will also wait until a later date.
‚ÄúThis is a two- to three-year implementation we‚Äôre doing in 10 months,‚ÄĚ Counihan said. ‚ÄúI wish we had one more year.‚ÄĚ
Across the country, other states report similar problems.
In Oregon, officials decided to delay a feature that would allow consumers to customize searches for rating the coverage provided by insurers. And a feature for insurance brokers to track the consumers they enroll will wait for two to four months.
How will brokers keep track of potentially thousands of customers in the interim? Cover Oregon‚Äôs executive director, Rocky King, suggested that they might use ‚Äúindex cards.‚ÄĚ
‚ÄúI know the agents will have all their Excel worksheets,‚ÄĚ King said. ‚ÄúWe‚Äôve gone to them and said: ‚ÄėYou‚Äôre our priority sales force, but you‚Äôre not necessarily the priority for how you access the system. The consumers are.‚Äô‚Äą‚ÄĚ
Nevada officials recently delayed plans for a chat function on the state‚Äôs Web portal.
‚ÄúThe longer the process takes, the more difficult it is,‚ÄĚ said Jon Hager, executive director of Nevada‚Äôs Silver State Health Insurance Exchange. ‚ÄúIt will affect our enrollment, so we are trying to make sure we have those items implemented as soon as possible.‚ÄĚ
Hager described the Web chat function as a ‚Äúlow-impact item‚ÄĚ because users with questions will be able to reach out to a call center, which will be ready by Oct. 1. ‚ÄúThe things we delay are those that we think will not have a significant impact,‚ÄĚ he said.
The federal government has faced multiple delays on health-care provisions affecting employers. The White House‚Äôs announcement Tuesday that it would not enforce the employer mandate until 2015 followed a setback in April, when the administration decided to delay for a year a key function of the small-business marketplace. Rather than allowing each employee to pick a health plan, as the law intends, workers will have to enroll in a plan selected by their employers.
The Government Accountability Office recently questioned the federal government‚Äôs ability to launch the federal exchange, which will serve the majority of states in 2014 next year.
‚ÄúWhether [the administration‚Äôs] contingency planning will assure the timely and smooth implementation of the exchanges by October 2013 cannot yet be determined,‚ÄĚ the GAO said.
For states that are setting up their own exchanges, the administration will make sure that they are ready in October, said Alicia Hartinger, a spokeswoman for the Center for Medicare and Medicaid Services.
‚ÄúAmericans in every state will be able to shop for quality, affordable insurance in a marketplace beginning October 1, 2013,‚ÄĚ she said in a statement. ‚ÄúWe have provided states with the flexibility they need to build a marketplace that meets their needs, and we are working closely with them to ensure that they are ready.‚ÄĚ
Even after deferring some items, Connecticut officials still say they face long nights and weekends in the office to get the new marketplace off the ground on schedule.
At Access Health CT, employees regularly turn up during nonbusiness hours. The office is closed Friday, the day after the Fourth of July holiday, as a way to force employees to take a day off.
‚ÄúAt 9 p.m., you would have no trouble finding someone to go out to dinner with,‚ÄĚ said Peter Van Loon, the exchange‚Äôs chief operations officer, about a typical day. ‚ÄúCome in at noon on Saturday and you could hold a meeting. It‚Äôs not that people are chained to their desk. I have trouble kicking people out.‚ÄĚ
Connecticut has made progress. It was the first state to complete an intensive technology test in which the state‚Äôs portal successfully connected to a federal data hub.
But officials have learned that good news can have a downside. The state agency spent weeks reprogramming its Web site after the federal government shrank the insurance application from 21 pages to three.
When the Supreme Court struck down a key element of the federal Defense of Marriage Act, Access Health CT board members cheered. Then, they remembered that it would add to the workload: The marketplace would now need to recognize same-sex marriages, a coding change unlikely to be ready for October.
‚ÄúEverything continues to change all the time,‚ÄĚ Van Loon told his staff at a meeting later that day. ‚ÄúWe‚Äôre going to have to adjust some processes around that. If DOMA requires a manual work-around, we‚Äôll do that.‚ÄĚ