In the grand scheme of the ACA, the first day of open enrollment today is pure symbolism and nothing else, however the early signs are not good.
Healthcare.gov has crashed, and users are receiving error messages as seen below.
The Washington Post has just put up a story highlighting the crash of the Maryland exchange, which is full of irony given that often quoted consultant Bob Laszewski wrote in April that Maryland will be, “A Health Insurance Exchange That Won’t be a ‘Train Wreck‘”
There have been reports on social media about the California exchange crashing as well, and Sarah Kliff has a sad story of a man that stayed up late in West Virginia, yet failed after two separate attempts that lasted an hour and half to enroll.
Layer these early problems on top of the other delays by the Administration, and add other previous state exchange delays such as DC pushing back enrollment, and those highlighted in a recent The Wall Street Journal story:
Colorado became the second state, after Oregon, to limit the ability of residents to enroll online in its state-run exchange in the first weeks, saying some people will have to enroll by phone or in person for about a month until glitches are ironed out.
One wonders if even the lowest projections for enrollment will remain on target.
Massachusetts Had A Running Start
After months of bumps in ACA enrollment, some clever reporter will revisit the enrollment story in Massachusetts to figure out why the process seems to have been so much smoother in the Commonwealth.
First, what will become clear is that the uninsured population was much smaller to begin with. The state had data on most of them, as they were utilizing services in the “uncompensated care pool” now called the Health Safety Net.
As enrollment began, the state just flipped a switch and started to auto enroll those individuals into the new program. This is a fundamentally different process when compared to those being undertaken in states like California, or Texas.
Thirdly, the state granted presumptive eligibility. In other words, the state took what an applicant put on an enrollment form as truth, at least for three to six months as they verified some of the information provided.
By contrast, the federal government is trying to verify, in real-time, information about each individual as they enroll.
Finally, enrollment for the unsubsidized side of the Massachusetts exchange, was first delayed, and then proceeded to fail in achieving its goals. Even today enrollment is extremely low for this population. The exchange has failed to offer innovative products and small businesses have voted with their feet.
For more information on this rarely reported element of Massachusetts reform, check out this paper I wrote on the topic for the Heritage Foundation in 2010.
As a result of this lack of understanding of how it worked in Massachusetts, we are left with misleading reports like this story on NPR today by Richard Knox on the Massachusetts experience.