Maryland struggling with technological problems with online insurance exchange

Wonkblog's Sarah Kliff explains three proposals that would make good on President Obama's promise that everyone can keep their health care plan. (The Washington Post)
November 19, 2013

Maryland is wrestling with stubborn technological problems with its online insurance exchange, posting weak enrollment even as other states have signed up thousands of consumers for plans under President Obama’s new health-care law.

In October, the exchange’s first full month of operation, 1,278 people signed up for the private plans, and 465 signed up in the first week of November. Those low numbers raise questions about whether Maryland will achieve its enrollment target of 150,000 by the end of March. The state has about 800,000 uninsured residents.

Backup options, such as paper applications, are proving time-consuming and cumbersome. Front-line helpers must manually enter information from paper applications into electronic ones, using an internal state Web page available from only some government buildings. That puts access out of reach for many helpers working at community organizations.

The Maryland exchange’s rocky start is in marked contrast to some other states running their own marketplaces, including California, Connecticut and Kentucky. The District’s exchange, after struggling with initial problems, is working well, officials say. But other states are struggling. In Oregon, exchange officials say they haven’t enrolled anyone in a private plan because of technological trouble. In Virginia, 1,023 people signed up in October, a low number that reflects the state’s reliance on the federal exchange, which has faced an array of problems.

Health-policy experts say states that have had success have several factors in common. For example, more bare-bones Web sites have turned out to be more reliable than the more complex ones. Maryland has scaled back some of its features to focus on the core functions needed for sign-ups.

See how many people have been able to enroll so far

Other states with healthy enrollment numbers are pursuing outreach efforts that go well beyond the Web sites, including aggressive campaigning by public officials. For example, in California, officials in various cities are competing with one another to sign up residents, said Peter Lee, director of that state’s exchange.

Maryland’s stumbles were unexpected, given that the state was one of the earliest and most enthusiastic supporters of the Affordable Care Act.

“What is surprising to me is that the state has been so supportive of the ACA, has messaged positively about it and invested in it early, that it’s a bit of a puzzle to me why the numbers are so low,” said Dan Mendelson, president of Avalere Health, a consulting firm.

The problems have become fodder in the race to succeed Gov. Martin O’Malley (D). State Attorney General Douglas F. Gansler (D) is blaming the missteps on his chief Democratic rival, Lt. Gov. Anthony G. Brown, who played a leading role in implementing the law.

“Our focus is on improving the performance of the system,” said Joshua Sharfstein, Maryland’s health secretary. He acknowledged that there are too many error messages and delays involving the Maryland Health Connection. The exchange has not sent any enrollment data to health insurers because officials are still testing the data for accuracy. Over the coming weeks, Sharfstein said, “I think we’re expecting to see a lot more improvement.”

The District’s marketplace, DC Health Link, is “fully functional,” said Richard Sorian, a spokesman for the exchange.

Officials in Maryland and the District say momentum is growing. “We’re making strong progress,” Sorian said Tuesday. “But there’s plenty more to do, and we will continue to do aggressive outreach.”

Sign-ups in Maryland increased by more than a third in the first week of November, to 1,743 as of Nov. 9.

In the District, in the three weeks between Oct. 21 and Nov. 13, the number of households choosing a health plan more than tripled, from 321 to 1,115.

On Oct. 29, Rebecca Pearce, Maryland’s exchange director, said that she was “not satisfied” with the performance of its main contractor, Noridian Healthcare Solutions, and that Noridian would be adding resources. Days earlier, Noridian terminated its contract with EngagePoint, a subcontractor that had been responsible for a key part of the Web site work. The two companies filed competing lawsuits, court documents show. The dispute is being resolved through a formal resolution process, the companies said.

Paper applications are supposed to serve as a main backup to Maryland Health Connection Web site. But navigators and other personnel trained to help consumers enroll are running into a host of logistical problems. Often, for example, the information required for the paper application does not match the information needed for the electronic application. The electronic application asks for the numbers on the front and the back of someone’s “green card,” but the paper version asks only for the number on the front. When information doesn’t match up, navigators must call consumers to get that information, a time-consuming process.

“October was such a bust,” said Wendy Korrick, outreach and enrollment director for Community Clinic, a nonprofit group that serves about 50,000 low-income residents in Montgomery and Prince George’s counties. The group, which has enrolled fewer than 10 people, was originally supposed to enroll 6,000 in private plans and Medicaid by the end of March.

Laurel resident Cassandra Perry, 32, said she has tried to log onto the Maryland Web site more than two dozen times since Nov. 1. At first, the Montgomery College student received one error message after another. More recently, she has occasionally been able to view plans, but hasn’t seen enough to sign up, she said.

For nearly a week, Perry was locked out of the system because she lost her password and there was no automated way on Maryland’s site to recover it. She waited for days for a call back from a customer service representative, but then found the slip of paper with the password.

“But it doesn’t matter,” she said Tuesday. “I’m still stuck . . . and I’m one of the ones pretty excited to go into the exchange.”

If the numbers that Perry has seen online are correct, she could save $70 a month on her current state-subsidized plan of $267 a month.

Katrina Greer, 52, of Oxford has given up on Maryland’s exchange after she was repeatedly unable to log in. An identity-theft problem kept her from passing the security questions to set up an account. Frustrated and out of patience late last month, she contacted her insurer, CareFirst, and renewed her $454-a-month plan for a year.

“I’m not really a sorry case; I’m not really a victim,” said Greer, a consultant who specializes in fundraising for nonprofit organizations. She said she just didn’t want to be a guinea pig as the state works out the bugs with its system. “I swear, it’s all so complicated you need your own consultant.”

Some states that have not enrolled large numbers of people in private plans have signed up tens of thousands of individuals for Medicaid, the state-federal program for the poor and disabled. In Maryland, more than 80,000 people in a special health plan for low-income residents will automatically be enrolled in Medicaid coverage starting Jan. 1. Oregon, for example, has 70,000 people in Medicaid, reducing the ranks of the uninsured by more than 10 percent, a spokesman said.

Alice Crites, Aaron C. Davis and John Wagner contributed to this report.

Lena H. Sun is a national reporter for The Washington Post, focusing on health.
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