Cover Oregon has given up on having a fully functional website by the end of open enrollment on March 31.
“We do not intend to launch the portal this month,” said Aaron Karjala, the Cover Oregon chief information officer. “The runway to getting the enrollments is too short. We can’t be assured it will improve our performance to get us to maximum enrollment.”
Oregon will remain the only state insurance exchange to not deliver the one-stop online shop as promised, and instead must continue its current, improvised manual-online hybrid sign-up system.
Karjala said his team was still finding an unacceptably high number of IT errors with the Oracle software, and Cover Oregon does not have enough tech support to handle the inundation of phone calls if the start-to-finish portal went public. The full system is working internally for Cover Oregon as well as insurance agents, but it’s easier for the exchange’s technical experts to manage the bugs with a limited number of people, particularly insurance professionals who are more familiar with the system than consumers.
Cover Oregon’s backup system has enabled the state to sign up people for insurance at about the same rate as the national average. As of Thursday, the state had 45,000 people in private plans as well as 101,000 people who have gained access to Medicaid through Cover Oregon.
The exchange has relied primarily upon a manual process to get those numbers. One option allows consumers to submit a PDF application online, wait to receive an eligibility packet in the mail from Cover Oregon, and then sign up for a plan of their choice online.
Cover Oregon opened the start-to-finish portal to social service agencies and insurance agents in mid-February. About 5,000 people have signed up that way.
Insurance agent Andrew Eachon of Century Benefits in downtown Portland said he could get customers signed up and covered in as little as 15 minutes with this process, particularly for couples or single people. He said applications for families of three or more have resulted in software errors, requiring them to reboot the application or call Cover Oregon for help.
Applications for families are more complicated and may involve getting free Oregon Health Plan coverage for the kids and subsidized private insurance for their parents. But even if the portal produces an error, Eachon said, Century can get people enrolled on the same day they apply, rather than wait as long as 10 days for the process by mail.
He told The Lund Report that consumers can come to his office, but 95 percent of the sign-ups for his business have taken place over the phone. Consumers have often scouted out plans on the website, but otherwise they tell him or his partner what they want, and Century will then guide them to the right plan -- much as insurance agents have long done. “We narrow down the options for them,” he said.
Federal Extensions
Acting Cover Oregon director Bruce Goldberg told reporters that he has two big requests from the federal government pending. One request will make March 31 the deadline to apply rather than enroll in coverage. As long as potential applicants fill out an application by the end of the month, they would get insurance, even if they don’t select their plan until April. People eligible for Medicaid already will be able to sign up after the open enrollment closes.
His second request would bring home the waiver that Rep. Shemia Fagan, D-Clackamas, outlined in House Bill 4154 -- extending open enrollment to April 30.
Goldberg was careful to frame this request not as an extension but as a “special enrollment period” -- U.S. Health Secretary Kathleen Sebelius has made it very clear that open enrollment will not be extended. But, Goldberg believes the feds will give Oregon a special enrollment period because Cover Oregon has had more problems than other states.
“Not having an online enrollment system,” he told reporters, “we’re in a different place than other states.”
Cover Oregon has been particularly bad at getting young people to buy subsidized insurance. When the exchange finally coughed up demographic data earlier this week -- Oregon took a month longer to release such data than anyone else -- the numbers showed Cover Oregon was dead last with only 18 percent of applicants younger than 35. The national average is 25 percent, behind the Obama administration’s rosy goal of 40 percent.
Oregon’s concentration of adults 55 and older is at 41 percent -- much higher than a national average of 30 percent. Goldberg downplayed the figures -- noting that age doesn’t always equate to health outcomes, but the data seemed to validate critics like insurance agent Rick Skayhan, who in November said the state had crafted an adverse selection group, letting in only those determined people desperate for coverage.
The paltry figures for young adults have come despite a well-publicized advertising campaign featuring jingles from Portland indie rock musicians.
“There is a sense among young people that the system is broken and you can’t enroll,” Goldberg lamented. “But the issue is you can enroll. There’s 150,000 people who can attest to that.”
Cover Oregon has few plans to bring back those catchy ads and let young adults know that they’ve got less than three weeks to sign up. Marketing director Amy Fauver said they would instead rely on word-of-mouth, earned media and some ad buys on social media sites like Facebook.
“We have a limited budget for advertising,” admitted Goldberg, who added that Cover Oregon was saving resources in case it gets approval to keep the exchange open through April. If that occurs, expect Cover Oregon ads to return to radio and television.
Goldberg also made it clear that consumers who want to receive credits retroactively for plans bought outside the exchange had to buy a plan equivalent to one sold on Cover Oregon. The recent federal policy change does not apply to plans sold by insurance companies like Regence BlueCross BlueShield, which opted not to participate, even if such plans offer the Affordable Care Act’s essential health benefits.
Consumers who want the tax credits will need to contact Cover Oregon and get them authorized through the exchange. Cover Oregon will then be able to get the surcharge from insurers needed to make it sustainable.
Oregon’s Numbers
After putting relatively solid numbers up in December and January, Cover Oregon started treading more water in February, sitting at 39,000 policies sold as of March 1. Oregon dropped behind Louisiana, Utah and Idaho, falling back in line in 27th place.
Oregon’s eastern neighbor sold 44,000 plans as of March 1 -- 5,000 more than Oregon. Idaho’s high numbers are partly explained by Republican Gov. Butch Otter’s refusal to expand Medicaid, pushing some residents onto the exchange who would qualify for the Oregon Health Plan across the state line.
But those numbers are still embarrassing. With 1.6 million people, Idaho is less than half the size of Oregon. Karjala and Goldberg reported Thursday that enrollment had picked up in March and Cover Oregon was now up to 45,000 private enrollments, but without comparable data from other states, it was hard to put those figures in perspective.
One table that’s been tossed around, putting the state in 49th place, is based on projections that are both unfair and misleading and appear to rely on make-believe numbers.
A table on the front of Wednesday’s Oregonian rated the best and worst states based on the percentage of their projected enrollment. For Cover Oregon to have met its sky-high expectations, it would have needed to be in sixth place -- ahead of New York, Pennsylvania and Illinois. Oregon is the 27th-largest state.
How those projections were determined is unclear, but they are so unrealistic that they seem to be little more than boosterism and faith that a state governed by a medical doctor would outpace a state like New York that is five times its size.
Goldberg was unable to immediately answer where or how those early projections were derived, and Cover Oregon spokeswoman Ariane Holm did not respond to an information request by email.
Christopher David Gray can be reached at [email protected].
Oregon will continue using the current technology for Medicaid enrollments, but it will have to improve on the system. Officials estimated the cost of the improvements at about $35 million. They said the federal government would pay 90 percent of those costs and of the costs of switching to the federal exchange. In total, Oregon has spent nearly $250 million of the $305 million it received from the federal government under the Affordable Care Act.
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