ACA Embarks on Three-Month Enrollment Race With Few Snags

Health Insurance Report™ helps you track and analyze legal, legislative, and regulatory developments affecting the health-insurance industry throughout implementation of the Affordable Care Act...

By Alex Wayne and Dalton Barker

Nov. 17 — The Affordable Care Act’s second year of enrollment began with only scattered glitches, buoying Obama administration officials who seek to further reduce the portion of Americans without health insurance.

The federal enrollment system was working well enough that 100,000 people submitted applications on the first day, Nov. 15, Secretary of Health and Human Services Sylvia Mathews Burwell said Nov. 16 on NBC’s “Meet the Press.” It’s a dramatic turnabout from 2013, when collapsed on its first day of business.

HHS officials have reported no technical problems thus far, though some state-run insurance exchanges, including Washington and California, had difficulties. The Obama administration aims to add at least 2 million people to the 7.1 million already enrolled in plans established by the ACA. The enrollment period ends Feb. 15.

“When we encountered glitches, they were small and easily remedied.”

—Ken Fasola, HealthMarkets Inc.

“When we encountered glitches, they were small and easily remedied,” Ken Fasola, president and chief executive officer of HealthMarkets Inc., said. HealthMarkets is a network of about 3,000 insurance agents based in North Richland Hills, Texas.

Washington state’s website was operating again Nov. 16 after being pulled down the day before because it was providing incorrect data on tax credits, the local exchange said in a statement. Covered California, the insurance marketplace run by the nation’s largest state, said on Twitter Nov. 7 it was working to fix unspecified “website issues.”

While consumers should have an improved enrollment experience, insurers are preparing to address technical issues on the back end of the federal health insurance marketplace (see related article).

Confused, Frustrated

The biggest hurdle for the ACA may be finding and winning over confused and frustrated consumers, many of them with bad memories of last year.

At the Greater Prince William Community Health Center in Manassas, Va., last weekend, officials expected at least 500 people to show up for assistance signing up for insurance. Frank Principi, the executive director, said he ran ads for two weeks on cable television, Hispanic radio and in newspapers to draw the uninsured to the event.

Diego Osorio, an enrollment counselor, said it had taken him about an hour and a half to sign up his first clients of the day, a couple who had emigrated from Peru. They enrolled in a silver-level plan from Kaiser Permanente that would cost them $214 per month after a subsidy, he said.

“It’s not quick,” he said. “But it’s quicker than last year.”

‘Pretty Specialized’

Some of those waiting needed assistance with difficult family situations. Leonilda Diaz of Manassas asked Burwell for help directly during a news conference at the enrollment center; her ex-husband, she said, had refused to provide her a document to prove she and her children qualify for ACA coverage, she told the secretary.

“I need to have insurance no matter what,” Diaz said later in an interview. “I just need to take care of myself and my kids.”

Health clinic officials and Burwell’s aides quickly ushered Diaz to the front desk of the center. Diaz said she had tried and failed to obtain coverage last year.

“This is a case that’s a pretty specialized one,” Burwell said. “We’ll follow up. Let’s see if we can help.”

Americans buying ACA plans for 2015 can expect to pay about 3 percent more on average for the cheapest coverage—a small increase by historical standards—though premium changes vary widely by state.

Bronze-level insurance, the least expensive full-coverage plans available, will cost at least $307 a month on average for a 50-year-old nonsmoker next year, according to data released Nov. 14 by the Centers for Medicare &Medicaid Services and analyzed by Avalere Health, a Washington consulting firm (see related article). The cheapest silver plans, the category most popular with consumers, would cost the same person $381 on average, a 4 percent increase from a year before.

Recalculate Eligibility

It won’t just be new enrollees using the website in coming weeks: The Obama administration has encouraged those who enrolled in 2014 to return to the site to recalculate their eligibility. Those who don’t will find their 2014 insurance automatically renewed on Dec. 15, and in some cases the premiums may be sharply higher. Enrollees will also be given the same subsidy as 2014, even if their income has changed.

Enrollment events similar to the one in Virginia are being held around the country. At one in Chicago, William Carothers, an insurance broker for The Insurance Exchange Ltd., said many consumers have “preconceived notions” and little knowledge about ACA programs.

“It’s like putting pieces of a puzzle together,” Carothers said.

Minorities, Millennials

Get Covered Illinois, the state agency working to implement the health-care law, hosted 75 events two days ago aimed at reaching uninsured people, Brian Gorman, its director of outreach and consumer education, said in an interview.

“This year we are really focusing on African-Americans, Latinos and millennials,” Gorman said. “These are the most likely to be uncovered.”

About nine of 10 uninsured people told the Kaiser Family Foundation in an October survey that they didn’t know when enrollment opened for 2015. Miranda Adams, 19, a sophomore at the University of Illinois-Champaign, said her mother had reminded her to sign up.

“I had no idea until she told me,” Adams said in an interview at the Chicago event. “I have no idea what the plans are or what’s being offered.”

In California, Peter Lee, the head of the state’s health-care exchange, has been on a 21-city bus tour to promote the open enrollment period. Between stops in East Los Angeles and Santa Ana, he said he didn’t expect “huge numbers” to enroll on the first day. Still, Covered California has said it expects 1.7 million residents to sign up this enrollment period. That would be an increase of about 500,000, or 43 percent, from 2014.

“It’s going to be tough,” Lee said in a telephone interview. “We’d rather shoot for the stars and hit the moon than not try.”

To contact the reporter on this story: Alex Wayne in Washington at

To contact the editors responsible for this story: Crayton Harrison at; Maura Reynolds, Stephen West

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