The new health insurance marketplaces, or exchanges, opened a week ago. Even though we are only a few days into a six-month enrollment period, pundits on all sides have used the rollout to forecast the success or failure of the new health care law.
When reading the instant-analysis accounts, it's best keep in mind that there is a great deal more to the health care reform law than the new marketplaces. And the success of these marketplaces will be clear only after they have been in business a whole lot longer than a week. The current open-enrollment period continues until the end of March 2014, and that gives the federal and state exchange websites time to correct problems that are inevitable with such large and complex IT systems.
Even though the first week had many rough spots, it is clear that there is great demand for affordable insurance coverage. We have to be careful to separate the start-up problems from the tremendous interest that created them. By the end of business on Friday, the federal exchange website had received 8.6 million unique visitors.(1) That's one-and-a-half times the population of Colorado. And that does not include the visitors to the state-based marketplaces in California, New York and 14 other states, including Colorado.
That demand has not been limited to websites alone. According to the U.S. Department of Health and Human Services, more than 406,000 people contacted its call center, and 225,000 requests have been made for online chats.(2) There are multiple points of entry into the marketplaces, so not all insurance will be purchased from websites.
Most of the problems reported last week affected the federal exchange and some of the larger state-based exchanges. They were the result of high user volume and software and hardware failures. In the federal exchanges, according to Todd Park, the top technology adviser to the Obama administration, high volume caused a failure in software designed to create user accounts.(3) The federal website did not always recognize user accounts that were created before the opening day, other users were unable to establish new accounts, and for some, the website failed when accounts were linked to an email address.(4)
Some of these problems probably were not caused by high volume alone and may be the result of software code and design problems, as well as issues with the website's data hub.(5) Nevertheless, such problems, even serious ones, are not uncommon in the start-up of such a large and complex computer system. The real issue is not so much that they occurred, but rather the length of time it takes to correct them. If these problems are not addressed reasonably soon, it may well have a negative impact on early enrollment.
However, not everyone was going to enroll on Day One or even Week One. Making decisions about something as important as health insurance will take time. Many people who now have access to affordable coverage may have been uninsured or are unfamiliar with the health insurance market. This is new to them, and there is a great deal to learn. Many new customers may require assistance from marketplace navigators and insurance experts.
As for Colorado's exchange, in its first week of operation, Connect for Health Colorado had more than 185,000 website visits, or roughly 50,000 per day. In its first three days of operation, more than 10,000 accounts were opened for individuals, families and small businesses.(6) Even though some website issues occurred on opening day, most of those problems were corrected by early afternoon.(7) Software upgrades for a provider directory and quality measures will be introduced soon.
Here's how some other state exchanges fared in the first week:
California: More than half-a-million unique visitors accessed the website on the first day, and 7,700 applications were started.
Washington: Even though the website was offline for much of the first day, more than 28,000 accounts were created by the end of the week.(8) By Tuesday, Oct. 8, almost 9,500 people had signed up for coverage in Medicaid or through private insurance, and another 10,497 people had submitted applications for coverage.
Kentucky: 10,000 users had completed applications.
Massachusetts: Nearly 7,000 accounts were created.
New York: The state's exchange doubled its server capacity in order to meet heavy user demand. By the end of last week, almost 65,500 people had actively shopped for health insurance coverage.
Nevada: Almost 19,000 Nevadans had created a website account.(9)
Clearly, not all of the stories from last week herald some inevitable disaster. The truth is that we won't be able to gauge the success of these marketplaces for some time, and ultimately they will be considered a success only if enough people find affordable coverage that meets their health care needs.
There are two deadlines that are important. The first is Jan. 1, when coverage takes effect. Administration officials predicted enrollment would start slowly and then increase to meet the mid-December deadline for full-year coverage.(10) The second deadline is March 31, when the open-enrollment period ends.
If we are still encountering system problems or if enrollment is substantially lower than expected by the end of the open-enrollment period, there may be be cause for concern. Even then, the conclusion will not be final, but it may indicate that a re-evaluation of some parts of the system may be necessary.
Or the marketplaces may well be working better than expected by the end of March. Only time will tell.
This is more of a marathon than a sprint. Even strong supporters of the Affordable Care Act and the insurance exchanges predicted problems in the early stages. But in this time of political division we should expect that problems will be both overstated and understated in the moment. So, pay less attention to today's sound bites and instead take the longer view.
– Bob Semro
1. Jackie Calmes, The New York Times, Urging Patience, Obama Says Problems With Health Care Sites Reflect Demand, Oct. 5, 2013.
2. Elise Viebeck, The Hill, ObamaCare site under scrutiny, Oct. 5, 2013.
3. Michael D. Shear, The New York Times, Health Exchange Delays Tied to Software Crash in Early Rush, Oct. 7, 2013.
4. Michael D. Shear, The New York Times, Health Exchange Delays Tied to Software Crash in Early Rush, Oct. 7, 2013.
5. By Jay Hancock and Phil Galewitz, Kaiser Health News, Experts Suggest Software Problems, Not Just Demand, May Be Behind Marketplace Glitches, Oct. 4, 2013.
6. Patty Fonteneau, emailed communication from Connect for Health Colorado, Oct. 4, 2013.
7. Eli Stokols, KDVR-Channel 31, Colorado health care exchange stalled on first day, now running, Oct. 1, 2013.
8. The New York Times, Tracking the Progress of the Health Exchanges, Oct. 8, 2013.
9. The New York Times, Tracking the Progress of the Health Exchanges, Oct. 8, 2013.
10. The New York Times Editorial Board, Pent-Up Demand for Health Insurance, Oct. 4, 2013.