Obamacare Enrollment Falling Short In Washington State

With less than two weeks remaining for people to buy health coverage for 2015, it’s going to be a scramble for the state insurance exchange to hit its goals.

The good news is that since the Affordable Care Act kicked in, hundreds of thousands of formerly uninsured people have coverage in Washington through the expansion of Medicaid and sale of individual health-insurance plans.

The trouble for the Washington Health Benefit Exchange, which runs the state insurance marketplace, is that too few people are buying their coverage through the Washington Healthplanfinder website, which needs to reach the enrollment targets to help pay for its operating costs.

By Jan. 25, the state was only 60 percent of the way toward its goal of selling 213,000 insurance plans in the current enrollment period, which began in November. The window for this second round of enrollments closes Feb. 15.

There are numerous reasons for the underwhelming sales. Some officials think the nationally set enrollment window was badly timed, spanning Thanksgiving and Christmas holidays, when distractions abound and pocketbooks are strained. Then there’s the challenge of enrollment closing before most people fill out their tax returns, which means many uninsured people will realize too late how much they’re being penalized for going without coverage.

In addition, enrollment projections in Washington underestimated how many residents would be eligible for Medicaid, pulling them out of the pool of potential exchange customers. In the past 16 months, the number of Medicaid enrollees has grown by nearly half a million, to 1.7 million.

Finally, many exchange customers from the first enrollment received confusing or insufficient notices about what they needed to do to renew their plans, sometimes leaving them uninsured when they meant for their coverage to continue.

That’s what happened to James Bach, of Orcas Island. Bach and his wife, Lenore, bought insurance through the exchange last year and planned to keep it. A flier from their insurance company, Group Health, assured them they would be renewed automatically. Buried in a second notice was a sentence advising that they might need to take action to renew, but it wasn’t explicit.

It wasn’t until Bach tried to use his insurance in January that he learned it had been canceled at the end of 2014.

“It’s like turning someone’s power off,” Bach said, noting that if a company is going to shut off your power, water or cable, you get repeated notices with big red letters warning you there’s a problem. “Why wouldn’t they do it with health insurance?”

Bach, who runs a software-testing business, should have received a notice from the exchange telling him to renew, but he said he never got one.

Melinda Hews, executive director of health-insurance exchanges at Group Health, said her organization was told a batch of 20,000 reminders mistakenly was not sent by the exchange before the end of the year.

Exchange officials say they are certain everyone was provided renewal information.

“There has been many fingers pointing in all directions,” Hews said. “We’re sorry for the confusion that this new process caused people.”

Everyone with exchange insurance needs to go back to his or her Healthplanfinder account and give permission to pay for the coverage, said Michael Marchand, spokesman for the exchange. It’s like a magazine subscription, he said: “It doesn’t automatically renew unless you give the system the OK to bill their card.”

If exchange customers find that their coverage was inadvertently canceled or if they had technical problems causing them to miss an enrollment deadline, they can fill out a petition to request that their plan be made retroactive to prevent any gaps in coverage.

Bach opted to take his business elsewhere.

“We decided to abandon the exchange because of this crazy thing,” he said. He also changed insurers.

“Someone’s life could actually be at stake, and people are trying to cover their butt,” Bach said.

Working with a broker in Friday Harbor, the couple found a new plan that started Feb. 1 and say they’ve have had a positive experience overall.

Nationwide, exchange enrollments seem to be going better than in Washington.

By the end of January, 9.5 million people signed up for insurance or were automatically re-enrolled in plans sold through the federally run exchange or from one of the 13 states with their own exchange site.

While the number includes people who haven’t yet paid for their coverage, it seems likely the Obama administration will meet this year’s enrollment goal of 9.1 million customers.

The Washington exchange and its partner organizations are hustling to promote coverage, and they’re shifting tactics to include messages highlighting the penalties faced by those who remain uninsured.

Most Americans must have 2015 coverage or face a penalty of $325 per adult or 2 percent of their adjusted income — whichever is higher.

The campaign is particularly targeting younger residents, who often need more convincing of the benefits of health insurance. Tuesday night, the exchange sponsored the launch party for the Sasquatch! Music Festival, a popular concert at the Columbia Gorge over Memorial Day weekend. The exchange is running ads on music websites, social media channels and by radio DJs. Public Health — Seattle & King County is doing outreach events at community colleges.

And a pro-insurance public-service announcement starring Seahawks Russell Wilson and Richard Sherman has racked up 1.8 million views since it was released in early January.

Marchand said enrollments look like they’re ticking up this first week of February — and he hopes the trend continues.

That’s because funding for Healthplanfinder comes from three sources: the exchange’s share of a 2 percent tax on all insurance premiums, a fee charged on insurance companies selling through the exchange, and from cost sharing with the state agency that manages Medicaid.

People eligible for Medicaid, which is locally called Apple Health, sign up for the program through the Healthplanfinder website.

The board overseeing the exchange is asking state lawmakers to approve a budget request of $147 million over two years, which is already higher than what the Legislature initially allocated.

Through new sales or renewals, the exchange needs to sell 86,000 plans in the last three weeks of open enrollment to reach its target and provide funding to operate within that request.

Marchand said the exchange knows lawmakers will be looking everywhere to make cuts, not grow budgets.

That could mean paring back services, he said. “We’ve got to figure out how to live within our means.”

Categories: Insurance, The Health Law