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.”