Uninsured Americans are having a hard time enrolling in private health insurance coverage through HealthCare.gov. The federal website is slow, unresponsive and at times provides inaccurate information about applicants’ eligibility for federal tax credits. Insurers, meanwhile, say they’re receiving duplicate enrollments, missing data fields, and other errors in the applications that consumers complete.
State-run health care marketplaces in Kentucky, New York, and Washington state appear more adept at quickly fixing problems and enrolling people, but the bright spot of reform isn’t the often-touted health care exchange. In these early days of implementation, the real standout is the government-run Medicaid program that provides health care insurance to Americans under 133 percent of the federal poverty line.
In fact, a survey of news reports from the states that have chosen to expand their Medicaid under the Affordable Care, shows that the program is responsible for thousands and of new enrollments and appears more successful in enrolling uninsured Americans than private insurers operating in the exchanges:
CONNECTICUT: Of the 3,847 individuals who signed up for coverage, 1,857 qualified for Medicaid, 1,897 signed up for plans with one of the three private insurance carriers, and 93 qualified for the Children’s Health Insurance Plan. Of the individuals who signed up with private carriers, 772 won’t receive a subsidy and 1,125 will receive a federal subsidy to lower their monthly premium.” [CT News Junkie]
MARYLAND: “About 82,500 people had signed up for Maryland’s expanded Medicaid program as of Friday, more than 30 times the 2,300 Marylander’s who managed to enroll through the state’s insurance exchange.” [Politico]
OREGON: “Though Oregon’s health insurance exchange is not yet up and running, the number of uninsured is already dropping thanks to new fast-track enrollment for the Oregon Health Plan. The low-income, Medicaid-funded program has already signed up 56,000 new people, cutting the state’s number of uninsured by 10 percent, according to Oregon Health Authority officials.” [The Oregonian]
ILLINOIS: “The sign-up process apparently hasn’t been as difficult for Illinoisans poor enough to qualify for the health-care law’s federally funded expansion of Medicaid eligibility, which the General Assembly approved this year without a single Republican vote. Those applicants are routed to the state’s ABE website for Medicaid.” [The State-Journal Registrar]
WEST VIRGINIA: “More than 50,000 West Virginians have already enrolled in the state’s Medicaid program that was expanded under the Affordable Care Act….But most new Medicaid signups came through an auto-enrollment program DHHR began in the weeks leading up to the opening of the insurance marketplace.” [Charleston Daily Mail]
ARKANSAS: “After two weeks of enrollment, a total of 56,288 adults have told the Arkansas Department of Human Services (DHS) they want to enroll in the “private option” health insurance program, [the state's Medicaid expansion] according to data released Tuesday. From Oct. 1 through Oct. 12, DHS received 1,509 applications through its state-run web portal and 1,119 telephone and paper applications. That is in addition to the 53,660* current DHS clients who have already been determined eligible and returned letters saying they wanted coverage.” [Arkansas Department of Human Services]
Medicaid advocates attribute this success to several factors. The program, which was first signed into law in 1965, has years of experience in connecting low-income beneficiaries to health care benefits and has streamlined and simplified those processes. Medicaid also operates outside of the error-ridden federal exchange system and several states, including Arkansas, Illinois, West Virginia, and Oregon are auto-enrolling eligible individuals who are already receiving state benefits. Arkansas, for instance, sent letters to over 100,000 food stamp recipients, inviting them to apply for Medicaid coverage, along with a a stamped envelope. Almost 50,000 people responded.
Other states like Maryland have better functioning marketplaces (where an uninsured individual can be directed to Medicaid coverage) or robust consumer assistance and simplification procedures that allow for an easy sign-up process, the Center on Budget and Policy Priorities’ (CBPP) Judy Solomon explained. Consumers can also apply at the local Medicaid office.
“States that are committed to the Medicaid expansion are seeing some results,” Washington & Lee law professor Timothy Jost said. “Obviously people want health insurance and Medicaid is the cheapest way to get it …when it’s easy to sign up people do.”
Dan Diamond, of the Advisory Board, notices the same pattern: