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October 19, 2013
Editorial: Health exchanges must work to overcome rough rollout


(Oct. 19 -- By the Editorial Board)

Known as "Mr. Social Security" and "The Man Who Built Medicare," Wilbur J. Cohen defined good policy as "1 percent inspiration and 99 percent implementation."

That will be true of Obamacare as well.

Overshadowed by the ignominious government shutdown, the health exchange marketplaces, where uninsured people can shop for coverage that begins on Jan. 1, opened up for business on Oct. 1. Sixteen states, including California, run their own exchanges. Thirty-four states, who have leaders that oppose Obamacare, are relying on a federal exchange.

The online rollout was less than smooth, with numerous technical problems.

That is not totally unexpected. The Center on Health Insurance Reforms, based at Georgetown University, has a new report that provides perspective on the launch of the prescription drug benefit for the elderly in 2005 and lessons for the Obamacare exchanges. As the report notes, although the Medicare Part D program in 2005 "encountered significant technical, educational, and coordination difficulties at first, eight years later, many of the initial difficulties have been forgotten. The public generally views the program as a success."

The websites for Covered California and the federal exchange work well as places to find out options and to window shop before the Dec. 15 deadline for Jan. 1 coverage.

And for uninsured people who have no idea what might be best for them, the websites do a good job of pointing people to help. Type in your city or ZIP code and you can get a list of "certified enrollment counselors," insurance agents and county offices that can help you understand the different options, assess eligibility for subsidies and help you with an application.

As Covered California's executive director Peter Lee told The Bee's editorial board, people do not need to rush into this. They should take their time in looking at their options. They shouldn't just go by monthly premium cost, but use the cost calculator that asks you how much you use the health care system and calculates out-of-pocket costs as well. He urges Californians to "pause and think about stuff" before enrolling.

Two weeks in, Lee says he is "thrilled about how things are going." He is the first to acknowledge any number of glitches - long waits on the phone, not enough server capacity on Day 1, putting up the provider directory too quickly. But two weeks in, call waits are now less than two minutes, the website has enough server capacity, and a revamped provider directory is expected to go up this week.

Between Oct. 1 and Oct. 12, Californians launched more than 94,500 applications for health insurance.

Lee expects not much actual enrollment in October, but a "two-humped camel" - the first enrollments starting in mid-November leading up to the Dec. 15 deadline and then a big second round in February leading up to the March 31 deadline for those who didn't enroll.

Outreach will ramp up in mid-November. For example, Sacramento Mayor Kevin Johnson announced that the city on Nov. 16 will host a day of public outreach to the 300,000 people in the Sacramento region who do not have health insurance.

The Kaiser Family Foundation sees California, which has 15 percent of the nation's uninsured, as a laboratory of how Obamacare will work. The foundation did a baseline survey of the nearly 6 million uninsured Californians on this "once-in-a-lifetime policy shift that will put health insurance within many of their grasps." California's uninsured here are more positive about Obamacare than nationally but feel they don't have enough information yet about how it will work for them. They do, however, expect their ability to get and keep health insurance will improve.

Now that we're in Cohen's "99 percent implementation" phase, perseverance and a commitment to working out glitches - as Americans did with the ultimately successful Social Security and Medicare programs - will be essential.

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November 2013

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