State and federal health officials have had three and half years to erect new online insurance marketplaces for individuals and employers. However, with the launch deadline mere hours away, many are stumbling toward the finish line.
Signed in 2010, the health care reform law charged every state with launching no later than Oct. 1 two new insurance exchanges, one for individuals and one for small employers. It gave the federal government the same deadline to set up exchanges for residents of states that elected not to build their own marketplaces.
On every exchange, business owners and individuals were supposed to be able to see how much they would pay for plans from an array of insurers, apply for new tax breaks, enroll in plans and pay their premiums, all online.
In addition, to help small business owners reign in their health costs, the exchanges were supposed to allow employers to choose different plans for different employees, rather than one plan for their entire company.
In other words, this is how it is supposed to work.
On day one, though, many of those features will not be available, as both sides of the exchanges, but particularly the small business marketplaces, have been saddled with a number of delays — most of them stemming from the sheer scope of the technology and infrastructure required to operate the online portals.
Here is a full rundown of what individuals and employers can expect to see in each state when the new insurance exchanges open on Tuesday.
California, Connecticut, Hawaii, Idaho, Kentucky, Massachusetts, New Mexico, New York and Rhode Island are on track to launch new exchanges with all the intended functions on Tuesday.
As a result, in those nine states, individuals and business owners will be able compare coverage offered by various insurers and enroll in a plan online. They will also be able to see which tax breaks they are eligible for under Obamacare.
Everywhere else, the exchanges are scheduled to open with some missing parts.
Thirty-four states decided to let the federal government run all or part of their marketplaces: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Louisiana, Maine, Michigan, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin and Wyoming.
In April, Department of Health and Human Services officials announced they would delay for one year the option for employers to choose various plans to cover different workers. On the federal exchanges, therefore, small business owners must choose one plan for their entire company until 2015.
Obama administration officials announced another delay last week, explaining that, due to technical problems, small business owners would not be able to enroll in coverage online until November. That is, they will still be able to create an account and compare options, but they will not be able to select and register for a plan (this will not affect the possible start-date for new plans, which is scheduled for Jan. 1 at the earliest).
A Spanish-language version of the site will also not be ready to go on Oct. 1.
In addition, a number of reports have surfaced in the past two weeks that the federal exchange is experiencing software glitches that are preventing it from determining how much each person would pay for plans. However, the Obama administration has insisted those problems will be resolved in time for the launch on Tuesday.
Colorado officials last week announced that individuals and business owners who want to apply for the tax breaks will have to call in to the exchange and speak with a representative, rather than using the online system, as its site has shown a high error rate when determining eligibility for federal subsidies.
Initially poised for a full launch, D.C.’s exchange has hit the same snag. District officials last week explained that, due to a high error rate during final tests, the city’s new insurance exchange will not be able to determine whether individuals and small business owners qualify for federal subsidies when it first opens on Tuesday.
The Maryland Health Department this spring announced it would not be ready to roll out the small business side of the state’s new health exchange until January (the individual marketplace will still open on Oct. 1).
The setback will postpone employers’ access to tax credits created by the health law, which, starting this year, will only be available through the exchanges.
State officials insist the exchange will be ready to launch on schedule; however, internal documents obtained by MinnPost paint a very different picture.
As of Friday, most of the systems were still “at risk” of not being ready by deadline, according to the documents, including the small business portal, which still did not have a test plan or a process for detecting or fixing problems.
Nevada’s exchange will not have a Spanish-language portal until November, officials say, nor will it have a system to sort plans by costs and providers when it first opens Tuesday (visitors will have to browse through each plan and take heir own notes to compare options). State officials have said they are expecting additional bugs on day one.
In August, the state announced that its residents would have to solicit a broker or an exchange representative to help them sign up on the new site, tell them which plans are available and walk them through applicable tax subsidies. It will be at least a couple weeks before individuals and employers can sign up and enroll on their own.
Vermont’s exchange has experience only a minor glitch, as officials last week announced the state’s new insurance marketplace will not be ready to collect premiums until November. In other words, individuals and employers can still shop for and select a health plan, but they cannot submit their payment for another month.
Gov. Peter Shumlin (D) and state health officials have called the delay a non-issue, as plans will still take effect on schedule on Jan. 1.
Washington state exchange
In Washington state, the new insurance exchange is schedule to open on schedule—but most small business owners will not have access to plans. Only one insurance company, Kaiser, signed up to sell small business coverage on the exchange, and only in two counties.
In every other county, at least for the first year, employers will not have access to a small business portal, and as a result, it is not clear how—or if—those companies will be able to access the new tax credits.
One final note, for small business owners across the country: Barring a last-minute deal to the contrary, the potential government shutdown would have no effect on whether the federal or state exchanges open on schedule, as funding for the marketplaces is considered mandatory spending, which is not subject to congressional reauthorization.