Of the states that built their own health insurance exchanges that are now operational, Washington, Kentucky and Minnesota enjoyed some successes that might be replicated.
The directors of the HIX in each state spoke in Seattle Wednesday, on a panel at an AHIP Institute 2014 pre-conference forum, and offered insights into the open enrollment experience.
“The sheer volume of enrollees was a big challenge,” said Richard Onizuka, executive director of the Washington State Exchange. His state’s HIX call centers experienced approximately 10,000 calls per day after the enrollment period began; they had projected only 1,500 per day. On March 31, 2014, the last day of enrollment, the Washington State Exchange received 90,000 calls, and the HIX website experienced a peak of approximately 10,000 concurrent users.
[See also: Health insurance exchanges initially frustrate payers, customers.]
“A few things helped us survive,” Onizuka said. “Managing scope and managing governance, as well as good vendor relationships, were critical. We now get about 5,000 calls per day, and are in a transition to meet needs of a 24-hour organization.”
Carrie Banahan, executive director of the Office of the Kentucky Health Benefit Exchange, confirmed that her state’s HIX also had difficulty dealing with consumer demand. “We didn’t have enough phone lines or customer service reps. We’ll be adding lines and reps in advance of this fall’s open enrollment period.” She also lauded the role played by insurance brokers and connectors in managing volume. Agents were responsible for 44 percent of Qualified Health Plan (QHP) enrollments, and 6 percent of Medicaid enrollments, while connectors enrolled 15 percent of QHP consumers and 27 percent of Medicaid enrollees.
“A great challenge for us was trying to get our system stable,” Onizuka added. “We spent the first part of October and November 2013 getting the system stable and functioning well. We finally hit our stride around mid-December.”
Onizuka also said system stability remained a challenge. “The front end of the system is stable, but the ability to get code fixes takes time,” he said.
The HIX system build was also a challenge in Minnesota, according to Scott Leitz, CEO of MNSure. “We have a complex eligibility system and that led to a complex system build. It took a long time.”
Nonetheless, the Minnesota HIX enrolled 165,000 eligible residents by the end of the open enrollment period, and reduced the state’s rate of uninsured by more than half. “That’s something we’re really proud of,” Leitz said.
Enrollment numbers of underserved residents were equally robust in Washington and Kentucky. Washington enrolled approximately 300,000 new Medicaid-eligible residents. Kentucky, the only southern state to expand Medicaid and create a state-based exchange, also enrolled over 300,000 people who did not have healthcare coverage when they applied. The state’s overall mix of applicants was 80 percent Medicaid and 20 percent in QHPs. Fifty-two percent of Medicaid enrollees were under the age of 35 for Medicaid.