Next Steps for States and The Affordable Care Act


Like other states that opted to run their own exchange, Colorado spent several years and hundreds of millions in federal dollars to create an insurance marketplace specifically tailored for Coloradans.

Complex legislation, multiple studies, numerous vendor contracts, dozens of public hearings and behind-the-scenes preparations led up to the launch of Colorado’s site in October.

As of April 1, Colorado signed up 119,000 people for commercial insurance — a little shy of its goal of 136,000.

State officials are already working on improvements for next year’s enrollment period, which starts Nov.15 and runs until Feb. 15, 2015.

“It makes me sick to think about it,” said Lindy Hinman, chief operating officer of Colorado’s exchange, Connect for Health. “But we’re already working on next year’s enrollment.”

In the days after the March 31 deadline to sign up for health insurance, advocates already were talking about how states and the federal government could improve on the process and the insurance products next round.

With a few exceptions, state and federal health insurance exchange officials are declaring the first Affordable Care Act open season a success.

State-by-state numbers are not yet available, but the Obama administration estimated more than 7 million people signed up for private insurance, exceeding initial targets, and about 9 million more signed up for Medicaid.

Under the 2010 health care law, states were given the option of creating and running their own exchanges, financed with federal money.

Nearly every state had considered the federal program’s offer to build its own customized state exchange. But with the exception of Nevada, only Democratic-led states had the political will to enact the necessary laws.

At a walk-in exchange office in downtown Denver’s pedestrian mall last week, there was an almost giddy atmosphere in some parts of the room. Ten agents were helping an office full of consumers who were at various stages of deciding on insurance coverage.

Pop-up offices, such as the one here, were one of Colorado’s most successful enrollment tactics, Hinman said. A last-minute decision based on consumer feedback led to six offices opening in late March so consumers could walk in and get help without an appointment. The state already had 55 appointment-only offices across the state and 3,000 registered brokers and navigators. At least one other state, Rhode Island, also created pop-up sites for the final enrollment push.

Another successful move, Hinman said, was allowing consumers to shop for plans anonymously. Not requiring people to register before looking at their options helped simplify the process.

In addition, she said Colorado’s creation of a new nongovernmental, nonprofit organization to run its exchange allowed maximum flexibility in contracting with vendors. Other states gave exchange authority to existing state agencies or created new quasi-governmental units.

By most measures of success, Colorado’s exchange website fell somewhere in the middle of the 15 state-run exchanges. Its website performed better than those in Hawaii, Maryland, Massachusetts, Minnesota and Oregon, where pervasive technical problems plagued exchanges from the beginning to the end.

On average, state-run exchanges signed up a higher percentage of those who were eligible than did federally run exchanges, the report said. The group plans to update the analysis when the federal government releases final numbers in the next few weeks.

Consumer advocate Families USA, which is closely aligned with the Obama administration, released a report April 1 recommending 10 ways to build on the health law’s enrollment momentum. Among them was getting more people to sign up for Medicaid through the successful practice by some states of prequalifying residents for Medicaid if they were already on the rolls of means-tested programs such as food stamps and low-income health plans.

Those who qualify for low-cost or free health care under Medicaid are considered covered under the health care law.

In the weeks ahead, the administration’s estimated enrollment numbers could go higher. In the 36 states that relied on federally run exchanges, enrollment is still possible until midnight April 15 for consumers who can show that they tried to enroll before midnight March 31.

Most state-run exchanges are offering consumers the same grace period with varying rules on how to prove that an application was started.

Oregon, which has one of the most troubled exchanges, is offering a full month’s extension and is not requiring proof that an application was started prior to March 31.