For the state that pioneered the public insurance exchange only to see dysfunction during the first ACA open enrollment, there are still many miles to go.
The Massachusetts Health Connector is finally working on some level for many consumers, after a disastrous relaunch for the first Affordable Care Act open enrollment that led to some 300,000 residents being temporarily insured through Medicaid.
"One year ago, a broken website, a backlog of paper applications and severe consumer anxiety and frustration created uncertainty about the Affordable Care Act's viability in Massachusetts, the birthplace of health care reform," said Connector senior policy analyst Marissa Woltmann and deputy director of strategy Ashley Hague, at the exchange's recent board meeting.
"Mistakes by the Commonwealth, an underperforming systems integrator and a lack of transparency failed Massachusetts consumers and our health care community," they said.
Fast forward to mid-February, and the Connector has enrolled more than 338,000 residents in ACA plans.
While there are still some issues with call centers that are being addressed, Woltmann and Hague said, the enrollment numbers "make it clear that the website is working."
And yet there are steep challenges to overcome if the exchange is going to work in the long-term--starting with the need for $20 million.
"There's a really long road ahead," Louis Gutierrez, the exchange's new executive director, told the Boston Globe. "There's a substantial amount of missing functionality and a substantial range of defects that we're going to need to remediate."
The $20 million needed--on top $254 million of mostly federal monies spent so far--should not be hard to access, Gutierrez told the Globe. It is being sourced from unspent federal and state funding.
The hard part will be achieving the kind digital retail experience that Massachusetts residents are used to in so many every other part of their economic lives. Despite the talent of greater Boston's health and technology companies, ther states and Healthcare.gov may end up eclipsing Massachusetts, with more navigable websites, quality ratings and provider search features.
"I do not expect a fully functional website with all bells and whistles for this fall," Gutierrez told the Globe.
Among the priorities for the 2016 open enrollment is the online payment system, which was "a common source of frustration for consumers and project leadership during" the recent open enrollment, said Woltmann and Hague in the board presentation.
"As originally designed, the payment system was not user-friendly, leading to payment processing errors for some consumers, and anxiety about whether premiums were being appropriately applied to guarantee coverage," Woltmann and Hague said.
The Connector is also working on troubleshooting risk adjustment questions with state regulators and health insurers. A number of small and mid-size insurers represented by the Massachusetts Association of Health Plans believe they are being charged too much in the state's home-grown risk adjustment formula, based on "significant inaccuracies in the data being extracted from the all payer claims database."