Strong HIX Open Enrollment Run Ends with Stumble at Finish

In the second year of open enrollment, signups in the public health insurance exceeded 10 million—an increase of 40%—despite a last-minute rush and computer glitch. But a health insurer leader gives the exchange performance mixed marks.

For the operators of the fledgling public health insurance exchanges, no news was good news—until a computer glitch and call center anguish struck over the Valentine's Day weekend.

Compared to the chaotic inaugural open enrollment season for the Patient Protection and Affordable Care Act–spawned exchanges, the second open enrollment period that was set to close Feb. 15 had been relatively serene.

As of Feb. 11, at least 10.1 million Americans had either renewed a health plan or purchased a new one on the exchanges, federal officials said last week during a conference call with reporters. If all of those health plans are effectuated, including payment of the first month's premium, year-over-year enrollment in the exchanges would spike more than 40%.

Unlike the first open enrollment that nearly collapsed in the fall of 2013, the past three months slipped by with few dire headlines about the functionality of HealthCare.gov, the federally operated website that drives exchanges in three dozen states. New features on the website such as a window-shopping tool and a more adequately staffed call center had eased the enrollment process, federal exchange CEO Kevin Counihan said during last week's call.

"You talk to folks and the difference in the enrollment experience between this year and last year is pretty dramatic," the HIX czar said. "When it's easier for people to enroll, they also tell their friends that it's easier to enroll. It's the second year. It's getting just a bit more established."

This weekend, though, the HIXes hit Heartbreak Hill.

In a sprint-to-the-finish call center crush that started Friday, would-be HIX health plan beneficiaries faced long wait times that were experienced through Sunday's midnight enrollment deadline. On Valentine's Day, a data-verification feature failure on HealthCare.gov prompted a special enrollment extension through Feb. 22. The data verification glitch reportedly stopped about 500,000 people from enrolling.

Barring more last-minute shopper woes this week, the "front-end" of the federally operated exchanges appears to be moving in the right direction, however.

"Our call center reps have taken more than 12.1 million calls, and more than 8.2 million users have accessed the window-shopping tool on HealthCare.gov," Andy Slavitt, principal deputy administrator of the Centers for Medicare & Medicaid Services, said during last week's conference call. Call center traffic had increased 37% from Feb. 4 to Feb. 11 and callers were experiencing "minimal wait times," he said.

"That data tells me that our approach of making things more accessible, simpler, and easier for consumers was the right approach, and these are lessons we will take into the coming year."

Slavitt also reported an enrollment spike in the South, where several states such as Texas have high numbers of uninsured and underinsured residents. After cautioning reporters about the "apples to oranges comparison" of pre-effectuated health plan applications during open enrollment to the effectuated number of health plans at the end of last year, he said several Southern states had experience explosive HIX growth. "Texas has 85% more sign-ups. Louisiana 88%. South Carolina 94%. Mississippi has 97% more folks signing up for coverage," he said.

Chris Johnston, associate vice president for new business at Detroit-based Health Alliance Plan, which is part of Henry Ford Health System, says the federally operated exchanges have improved but are still a work in progress.

"It was evident from the first open enrollment that CMS grossly underestimated what they were getting into and how to manage the entire process. The technology was inadequate, many of the rules and guidance from CMS were changing throughout the open enrollment period, and general public confusion was very evident," he told me. "For 2015, their change in technical expertise certainly helped, with fewer instances of the website going down. Many of the rules also had greater clarity. I would certainly have to credit the National Association of Health Underwriters (NAHU) for playing a huge part in educating the government on how this industry works, which helped CMS fix many of the issues."

Johnston says federal officials face several HIX market maturation challenges, particularly development of the Small Business Health Options Program (SHOP) exchanges. "There is still a great deal of room for improvement for not only how CMS corresponds with insurance carriers through technology, but also how their call center disseminates information to the general public. Also, the SHOP exchange has yet to prove its viability due to technology issues and for its complex and unrealistic regulations surrounding tax credits."

Uncertainty clearly remains an X factor on the exchanges.

From my perspective, the most important number in the HIX equation is 10 million, which is the rough estimate of individuals who will have healthcare coverage through the exchanges this year. Before the launch of the public exchanges in 2013, the ranks of uninsured and underinsured individuals swelled into the tens of millions. Many of these Americans relied on the emergency room, where they received episodic care in the most costly of settings.

For the sake of these millions and the ability of this country to improve healthcare in communities from coast to coast, I'm hoping the next HIX open enrollment is smoother from start to finish.