March 30--Monday marks the end of a six-month enrollment push for Maryland's troubled health exchange, and despite a surge in the past week, it is unclear whether the state can overcome technical problems that have persisted since the Oct. 1 debut and meet its goals.
As a flurry of consumers signed up for health insurance Saturday during an enrollment fair, Gov. Martin O'Malley said that he expected the next enrollment period to run more smoothly on a new platform built by Deloitte Consulting LLC, replacing the troubled existing website.
The exchange board has not made a final decision, but O'Malley said the "Deloitte platform" used in Connecticut, Kentucky and elsewhere has been among the best performers in states that are running their own exchanges. He said he regrets that Maryland did not go with Deloitte from the start, though the company did not bid on the work.
In recent days, those who had trouble signing up online and those who procrastinated have packed the offices of advocacy groups charged with helping people through the enrollment process and have flooded the state's call center lines to meet a March 31 deadline under the Affordable Care Act. Those who do not sign up face penalties that begin at $95 or 1 percent of their income in the first year and will have to go without insurance.
O'Malley said extensive work-arounds have enabled the state to surpass its "ambitious goal" to sign up 260,000 people. Total enrollment reached 269,336 as of Tuesday.
But a key segment of that overall goal -- signing up Marylanders for private plans -- might remain out of reach. As of March 22, Maryland had enrolled 49,293 in private plans, well short of the stated goal of 70,000.
Experts say that most states with glitch-free websites have better enrollment numbers than Maryland, whose online marketplace crashed the first day.
"It's been highly detrimental," said Bill Melville, senior analyst with Decision Resources Group, a health care research group. "The states that have done well have very user-friendly sites. I have been on Maryland's site and I would not describe it as that."
Maryland might have lost potential applicants who got tired of trying to navigate the system, particularly younger people who may not think they need insurance coverage, analysts say.
"When you go and you get stuck or you have a long wait, you get pretty tired of that," said Janet Weiner, associate director for health policy at the Leonard David Institute of Health Economics at the University of Pennsylvania. "Plus, I think the publicity around how bad the experience was can also turn people off. It is kind of a snowball effect."
In an analysis for the Robert Wood Johnson Foundation, Weiner found that through March 1, states that operated their own insurance marketplaces did better than those with a federally run site. About 20.3 percent of those eligible enrolled in state-run sites, compared with 12.4 percent in states where the federal government is facilitating the marketplace -- a difference attributed mostly to technical problems with the federal website.
But Maryland did even worse, signing up just 9.1 percent of those eligible, according to the report.
The Obama administration said last week that more than 6 million people had bought health insurance on federal and state exchanges, meeting a goal for the system to be sustainable. The federal government had revised its initial goal of 7 million down to 6 million.
Before the launch of its health exchange, Maryland had set itself up as a model of the Affordable Care Act. But it became better known for one of the most disastrous launches in the country and was cited by critics as an example of why Obamacare does not work. In the aftermath, the head of the Maryland exchange resigned under pressure and the state cut ties with the contractor that developed the website.
Now, the end of the open enrollment period raises questions about the future of the Maryland exchange. The exchange board is expected to debate during a meeting Tuesday whether to fix the website, use the federal site or use another state's system. And Lt. Gov. Anthony G. Brown, the O'Malley administration's point man on the health exchange, said an announcement would be made this week.
O'Malley said Saturday that a decision is necessary soon because there is little time before the next open enrollment, which begins in November for private plans. Those interested in Medicaid -- the bulk of enrollees so far -- can sign up at any time.
In contrast with Maryland's troubled exchange, Connecticut's site, developed largely by Deloitte, has been running smoothly from the start and is considered among the most successful in enrolling consumers in private health insurance plans. Connecticut, a smaller state with fewer uninsured, had enrolled 170,021 in such plans as of March 21 and raised its goal from 100,000 to 185,000. Sources told The Baltimore Sun weeks ago that Maryland plans to use that system.
"There have been a couple of models that have worked," O'Malley said. "Our biggest mistake was going with IBM and not Deloitte, which appears to have worked the best. We'll be looking at that now. Some people suggested we switch midstream, but I said no because that would have been disruptive and our goal is enrollment, so we made it work."
O'Malley said the constant triage on the website and extra staff in the call centers has helped in Maryland -- and the pressure of a deadline has motivated consumers. He said early results show that 1,700 people enrolled in private plans Friday alone. And officials at the enrollment fair hosted by HealthCare Access Maryland that he attended in Baltimore on Saturday said it drew more than 500, so many that some couldn't be served and had to leave a contact number.
And while O'Malley blamed the contractors and said he expects that the state and federal governments would seek redress, some said there are still unanswered questions.
Kathy Szeliga, the minority whip in the House of Delegates, called for further investigation into the exchange's problems and questioned whether the 2014 election cycle is slowing the push for accountability. She supports shifting the exchange to the federal system rather than spending more money to fix the website.
"We owe it to the taxpayers to see what went right and what went wrong," said Szeliga, a Republican whose district includes parts of Baltimore and Harford counties.
Meanwhile, Marylanders who attempted to buy insurance and faced glitches on the state health exchange will get a reprieve until mid-April if they call a hot line before the deadline. Everyone else will have to wait for the fall enrollment period.
Brown said Maryland was able to enroll an adequate number of people, particularly given the problems with the website.
"Those numbers exceeded the goal," he said, "and when open enrollment closes we will continue our work in stabilizing our system, our platform, so we are in the very best position come Nov. 1 for open enrollment."
It could be several weeks before Maryland's final enrollment numbers for the October to March period are released.
Maryland met its Medicaid goal long ago, and as of Tuesday had enrolled 220,043 under that program.
The spotlight remains on the goal for private insurance plans. For months, the state had touted a goal of enrolling close to 150,000 in private plans but changed that to 70,000 in February, saying the initial goal was inaccurate. It blamed a mistake by the Hilltop Institute at the University of Maryland, Baltimore County, a nonpartisan heath research organization that used complex analysis to come up with the goals.
Some Marylanders have also chosen to enroll directly through private insurers instead of dealing with the troubled exchange. CareFirst BlueCross BlueShield said that enrollment increased significantly in March and that the number of individuals who had enrolled for coverage effective April 1 had surpassed that of the previous two months. It expected a surge in the final weeks, but said it would have to wait until after the deadline to get a count.
Maryland Health Secretary Joshua M. Sharfstein said he expected a surge of young people in the final days. Young, healthy people are crucial to making Obamacare work, but some experts have questioned whether they would enroll.
"Even in the face of these great technical challenges the numbers have really surged," Sharfstein said. "I think it is really important to note that the exchange is a lot more than an IT system. We have been able to do a tremendous amount of manual work. We have applied a lot of elbow grease to get many thousands of Marylanders insurance in the face of a very frustrating IT system."
Medicaid expansion is just as important as getting people into private insurance, Sharfstein said. People enrolled in the state's Primary Adult Care program for low-income people had $164 million in uncompensated hospital care in fiscal year 2013. Now that those people have Medicaid, such expenses will be covered and everyone will save money, Sharfstein said.
The state had always expected to see a surge in the final weeks, partly because some people naturally wait until a deadline nears.
At Healthy Howard, which has a contract with the state to enroll Marylanders, about 100 people were coming in each day last week, compared with 70 a day in prior weeks. The advocacy group said the website is still slow, but that its navigators have become more adept at getting around the problems.
"It really continues to be an ebb and flow," said Eric Masten, director of advocacy, health policy and communication for the group. "Some days it performs well; other days it doesn't."
Rakesh Puri, a 39-year-old pizza restaurant owner from Glenelg, visited one day last week to get insurance for his family. The father of two said he came to avoid the tax penalty for missing the enrollment deadline but was also glad to get health coverage for his daughters. The family has been paying out of pocket when they go to the doctor.
"It is better to have insurance," he said.
Sandy Zheng, 26, was there to get insurance for her elderly parents. Having insurance was never a priority for the couple, who spend most of their time running their Chinese restaurant. Zheng said her parents probably still would not buy insurance if not for the mandate, but as a daughter she is glad it is now a requirement. Both of her parents have health problems they ignore, she said.
"Health insurance is not their No. 1 priority, but this now forces them to have it and hopefully they will go to the doctor," Zheng said.
Even with the glitches in the state's health exchange and the uncertainty it faces, some feel the state is still achieving the goal of getting people insured.
"It's not just avoiding a penalty," said Christine Hall, executive director of Healthy Howard. "It's about getting people health care."
Baltimore Sun reporters Meredith Cohn and Erin Cox contributed to this article.
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