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 Despite grand ambitions, an early start, millions of dollars from
the federal government and a tech-savvy population, Oregon's online
enrollment system still isn't ready more than a month after it was
supposed to go live. The state has resorted to hiring or reassigning
400 people to process insurance applications by hand.
"We're all surprised and frustrated that we're in the position that
we're in now," said Jesse O'Brien, a health care advocate at the
Oregon State Public Interest Research Group, which lobbied for the
exchange.
The state has received about 18,000 paper applications, at 19 pages
each, and is scrambling to manually file and clear them. State
officials have not been able to say when they expect the online
system to launch, nor have they established a deadline to submit
paper applications in order for coverage to begin Jan. 1. Meanwhile,
the exchange's board is demanding answers from the executive
director about when the website will work and how his team will get
people enrolled on time.
For consumers, the application process can be long and frustrating.
"I've been trying since the very first day of October just to try to
find out the coverage I could get," said Donna George, 43, a
bookkeeper from Bend, Ore., who's been uninsured for three years.
When the online system wouldn't work, George submitted a paper
application Oct. 7 for herself and her husband. Finally, on Nov. 12,
she received an enrollment packet that tells her how much of a tax
credit she'll receive and lays out her coverage options. She's now
waiting to meet with her insurance agent to pick a plan and return
the forms.
Oregon has long prided itself on being a leader in health policy.
Its Medicaid system has been a testing ground for new innovations
since the early 1990s. The state started laying the groundwork for
an insurance exchange a year before Congress passed the health care
law that called for one in every state. Gov. John Kitzhaber, a
former emergency room physician, is a respected voice on health
reform.
The state also has a large population of young, underemployed
progressives who might provide a burgeoning market for affordable
coverage. Its ultra-competitive health care market led to
lower-than-expected premiums. Lawmakers from both parties have
embraced the law. And the Portland area is a thriving hub of
technology companies known as the Silicon Forest.
In other words, Oregon had everything going for it.
But its exchange, known as Cover Oregon, became a victim of its own
lofty ambitions and the state's stubborn refusal to dial them back
until it was too late.
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While exchanges in many states are telling applicants who appear to
qualify for Medicaid to contact a separate agency, Oregon insists
its exchange must be a "one-stop shop" for both Medicaid and private
insurance. The state also wants its exchange to eventually be able
to help enroll people in a wide array of public-assistance programs,
not just health care.
Exchange leaders stuck with their plan even as risk consultants
warned repeatedly that they were in danger of missing the Oct. 1
deadline to launch.
"We won't know whether we made the right decisions until our system
is up and running," said Amy Fauver, chief communications officer
for Cover Oregon. "But we're going forward in the way we feel we can
best serve Oregonians."
Exchange officials say they haven't fully launched their website
because their software still can't accurately determine whether
applicants are eligible for Medicaid or the Children's Health
Insurance Program, particularly for people with complex family
arrangements.
Kitzhaber, a Democrat, has pledged that the problems won't
"interfere with our objective of making sure that every Oregonian
that wants to be enrolled" by the start of the new year "is, in
fact, enrolled."
Oregon does have one big success to brag about. The state has
enrolled 70,000 people in Medicaid, reducing the ranks of the
uninsured by more than 10 percent. The large number of Medicaid
enrollments came in large part thanks to a "fast-track" enrollment
process approved by the Obama administration. Using income data
already on file, the state mailed a simple seven-question Medicaid
enrollment form to people in the Supplemental Nutritional Assistance
Program who qualify for health coverage under the federal health
law's expansion of Medicaid.
Pressure is growing on exchange officials to fix their problems.
U.S. Rep. Kurt Schrader, a moderate Democrat who took heat after
voting for the health care law, released a sharply worded statement
on Friday demanding that the exchange and its main contractor,
Oracle, make it work. "The implementation of Oregon's health insurance marketplace has
been abysmal," Schrader said. "The current situation is completely
unacceptable, and I expect much more from a state with a reputation
for being an innovator in the field of health care."
[Associated
Press; JONATHAN J. COOPER]
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