It is a slow and labor-intensive substitute for what was supposed to be a snappy online application, similar to Amazon or Travelocity. But faced with a flood of people eager to get health benefits for the first time, what had been considered Plan B has become the plan — at least until the sites are operating more reliably, according to consumer guides and community groups.
It is one way the frustrating, persistent glitches on some state Web sites as well as the main federal portal serving 36 states have had a ripple effect around the country. Community groups, insurers and consumers have been forced to adjust their strategy on the health-care law, which entered a critical period Oct. 1 with the opening of the health insurance “marketplaces,” also known as exchanges.
Insurance companies are steering people to their own Web sites, promising a smoother experience than healthcare.gov. Advocacy groups that planned to encourage people to enroll this month are also holding back, treating this period as an educational time instead.
In the case of the paper applications, the work-around could have significant consequences. Processing paper is likely to create more delays and will further complicate a process that was supposed to be one-stop shopping.
“We have gotten a few [applications] in — by persevering,” Carol Jameson, associate chief executive officer for HealthWorks of Northern Virginia, said in an e-mail Friday. The nonprofit group operates health centers in Herndon, Sterling and Leesburg serving nearly 10,000 low-income patients. On Wednesday, a counselor was able to submit an application, “but it took four hours because the system kept shutting down,” Jameson wrote. Virginia is one of the states relying on the federal exchange.
The Affordable Care Act, also known as Obamacare, requires most Americans to have health insurance starting Jan. 1 or face a fine. Initial open enrollment extends through March 31; the earliest coverage can begin is Jan. 1, as long as consumers sign up by mid-December.
But community groups and others working on enrollment have been dismayed at the severity of the problems on the federal exchange and on some exchanges run by states themselves.
Officials have declined to release enrollment data for the federal exchange. They have said they can handle applications that come in through their call center, online and by mail. Online bottlenecks are greatly reduced, and call center wait times are down from minutes to seconds, they said. In the first 10 days of operation, the federal Web site has received 14.6 million unique visits, officials said.
But getting online has been hard, even for special consumer guides known as “navigators” whose job is to sign people up for coverage. When navigators can’t enroll consumers online, they offer a choice: Come back another day or apply on paper. Many people choose paper.
“These are low- to moderate-income people, stopping by on their lunch break, between picking up their kids. They don’t have time to mess with a Web site that doesn’t work,” said Marie Hurt, director of Southern United Neighborhoods, a New Orleans-based charity that is helping people enroll in coverage in three states. She is encouraging people who stop by her center, inside a church, to avoid the federal Web site for now and use the paper enrollment form. “You don’t want people to get frustrated and give up.”
Timothy S. Jost, a law professor at Washington and Lee University who specializes in health policy, said filling out paper applications does give people the sense that the “process is underway,” he said. But, he added: “It will add to delay. It will add to errors.”
Hawaii, which is running its own exchange, announced last week that it was using paper applications and referring people to insurer Web sites to check prices. Vermont and Maryland have also been struggling with their Web sites, and consumer guides are relying on paper.
In Montgomery and Prince George’s counties, which have the largest numbers of uninsured in Maryland, 500 paper applications have been completed, according to Dourakine Rosarion, a Montgomery County health department official who is overseeing outreach and enrollment in both counties. State officials have asked community groups to hold on to paper applications and manually enter data into the Maryland site, marylandhealthconnection.gov, when site performance is more consistent, she said.
It’s unclear when. “We don’t have a firm date when everything will be resolved,” she said.
Paper may give people the impression that something is happening when an online system isn’t functioning properly. In fact, that’s not the case, said Kevin Counihan, executive director of the Connecticut exchange, Access Health CT.
Personnel reviewing paper applications need to manually type data from paper into the same Web-based marketplaces that consumers are using. Reviewers are entering through a different “portal” than one consumers use. But it’s the same online system.
“If you don’t have a working [online] system, paper doesn’t do you any good. It’s almost worse because there’s this illusion that you’ve finished something,” he said. “When in fact, it’s just getting stacked up waiting for the system to work.”
The paper process is clunky and prone to errors. And it provides “a substandard user experience,” he said. In the Connecticut marketplace, a completed paper application takes at least a week and a half to process, he said. “We get online in less than a second.”
The Connecticut marketplace has performed well. So officials there are discouraging the use of paper (and faxes) and launching an advertising campaign in a few weeks to emphasize online enrollment, he said.
In the 36 states that make up the federal exchange, paper applications will be reviewed by Reston-based Serco, which received a $1.2 billion contract to hire 1,500 workers to do the work. Once a paper application is reviewed, the consumer will receive an eligibility determination in the mail, federal officials said. At that point, the consumer can log onto healthcare.gov, or contact the call center or a consumer guide to shop and enroll in a plan.
If consumers choose to log in online, they will need to start an application from scratch.
At the HealthWorks office in Herndon, counselor Maggie Garcia has initiated paper applications for about 20 people since she started her job Tuesday.
One of them, Najah Selman of Reston, arrived for a mid-morning appointment Friday. Selman, 50, works four days a week at a day-care center but receives no health insurance. Her private plan expires in December, and she is eager to see what options there are for herself and her husband, a calligrapher who does not have insurance. The couple’s annual income of about $19,000 would most likely make them eligible for generous subsidies.
Garcia was unable to access healthcare.gov and asked Selman if she wanted to make another appointment. She did not. “I don’t want to wait,” she said. She took the paper application to fill out some additional information. “When I finish, I will mail it.”