Insurance Enrollments Still Down 50,000 Heading into Open Enrollment

Cover Oregon chairwoman Liz Baxter blasted the way the Oregon Health Authority chose Kentucky for its Medicaid site, noting that the move came without transparency or any input from her board or the public, much like earlier decisions.

The Insurance Division released some new numbers Friday showing marked improvement in the number of enrollees who have transferred over to healthcare.gov, but as many as 50,000 people currently served by Cover Oregon may see a lapse in coverage if they didn't pick an insurance plan by Dec. 15.

The Oregon Insurance Division reported that as of Dec. 7, there were 26,900 people who had used the federal marketplace to sign up for 2015 coverage and an additional 17,900 people who bought individual health insurance plans outside the exchange. That’s up from just 7,200 people who had used healthcare.gov by Nov. 30, and 12,000 people who’d bought coverage on the open market.

But the net enrollment on Cover Oregon as of Dec. 1 for 2014 plans was at 76,600, which includes people who have enrolled and paid for their premiums. The 2015 numbers are those who have enrolled, but haven’t necessarily paid. They do not include people who purchased 2014 plans outside Cover Oregon.

Consumers have through the end of Dec. 15 to sign up at healthcare.gov to ensure continuous coverage on the individual market. After Monday, people can still enroll in health coverage through Feb. 15, but their policies will not take effect until February or March, leaving a gap in coverage for January.

The Cover Oregon board on Thursday heard a more detailed explanation for how the Oregon Health Authority decided to punt Medicaid enrollment to Kentucky’s website, but members of the board, which is likely to be dissolved later this winter, slammed the authority’s handling of the switch, which came about in a highly top-down, secretive and often contradictory process with zero input from the public or the Cover Oregon board.

“This board was updated on this but never asked about it. We’ve been accused of not being transparent or accountable. It’s this endless cycle of things,” said chairwoman Liz Baxter, who runs the Oregon Public Health Institute. “This process of getting to Kentucky doesn’t seem to have been transparent or very public. How has it again bypassed any kind of public process?”

Baxter noted that in the spring the Cover Oregon board had considered adopting Kentucky’s platform, but opted against it when acting director Clyde Hamstreet advised the board that it would cost them $45 million -- more than Cover Oregon could afford -- versus switching to the federal option, which could be done for $5 million.

Now the Oregon Health Authority reportedly has $43 million to make the switch to Kentucky just for Medicaid, according to administrator Julie Bozzi.

Suzanne Hoffmann, who in her role as the interim director of the Oregon Health Authority also sits on the Cover Oregon board, defended her agency’s actions to adopt Kentucky’s platform after earlier claiming it could salvage the existing Oracle software for the state Medicaid website.

“We came to a point that we could not continue with the Oracle technology,” Hoffmann said. Cover Oregon Director Aaron Patnode added that the spring decision not to go with another state’s technology was focused primarily on the insurance marketplace, not the state medical assistance program.

But Dr. George Brown, the president of Legacy Health, agreed with Baxter, saying that if the ultimate decision of the health authority may have been the right one, the process and the path that it took to reach that conclusion was poor.

Tina Edlund, a former acting director of the health authority who was in charge of the Medicaid website transition, resigned from state employment quietly last month before the Kentucky decision was announced.

Bozzi said the state would retain the services of Deloitte, which was hired to make the Oracle technology usable, and have that company do a "fit-gap" assessment of the Kentucky system to see how much Oregon’s will differ. “This will tell us the minimal requirements that need to be changed,” she said.

Once that’s done, the contract to make the change will need to be negotiated, and a quality assurance vendor such as Maximus will be hired to oversee the work, Bozzi said.

Patnode said that in the future Oregon could debate whether to use Kentucky’s technology for the individual marketplace but that wasn’t on the table for now. “We’re successfully using healthcare.gov right now, my inclination is to keep using that.”

For the small business market, the state is having employers buy insurance for the employees from a broker and then apply for tax credits rather than operate a SHOP program. But by the end of 2015, the state will either have to adopt the federal SHOP or launch its own program.

Mike Sasko, a business director at hCentive, a healthcare software company, plugged his own company for the job during the public testimony, noting it had successfully developed Kentucky’s SHOP program, along with New York, Colorado and Massachusetts. “We have a SHOP that’s operational with a call center,” Sasko said.

He said hCentive wanted to compete for the open bid of an Oregon SHOP and that Oregon could still operate on its own without relying on the federal government.

Chris can be reached at [email protected].