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ACA Exchanges: Why Weren't States Ready?

Health insurance marketplaces got off to a rocky start this month, largely because of an aggressive timeline that rushed development for many states.

Sixteen state-run health insurance exchanges launched this month, and so far the norm has been errors, downtime and long waits. Hawaii’s portal, which had very little functionality as many as 11 days after the launch, showed what a worst-case scenario looked like, while states like Washington and New York had initial problems but recovered quickly in the first week. The state employees who manage these portals are quick to point out the huge demand for health insurance and how important these portals are, but the ongoing problems left many wondering: If health insurance marketplaces are so important, then why weren’t states ready?

One of the biggest factors contributing to the errors and long wait times was the aggressive timeline put on states that opted to run their own exchanges, said Cathy de Moll, assistant commissioner of planning, communications and marketing for Minnesota’s Office of Enterprise Technology. Considering the limited time the staff had to organize and implement the state’s exchange, Minnesota did rather well, de Moll said, especially compared to some of the other states. “We actually are very proud of the fact we were one of the states that didn’t crash on the first day,” she said.

One of the design choices they made that helped was giving users the option to browse available plans without creating an account, de Moll said. A large portion of the initial interest was from people who weren’t necessarily ready to buy insurance right away, but just wanted to see what was available, she said. And the plan worked – the site did not crash despite more than 100,000 visitors in a 12-hour period on the first day.

Another thing that helped Minnesota carry out a relatively successful launch was the way their IT organization was structured, she said. “We had recently consolidated all IT into one agency and so when this came along, we were able to pull together a team of security and infrastructure folks that could quickly be brought together to form a sort of crackerjack team,” she said.

Minnesota’s users, like those in other states, experienced some glitches, but most of them were related to users interacting with the federal hub – something states had little control over.

The state realized early on that given the short timeline, this would be a difficult project, de Moll said, so they had to make some reasonable concessions when it came to functionality. “There had to be choices made about how much of the functionality you could get done in that period of time and to focus on getting those done really well rather than trying to do everything that you would like to have a year from now,” she said. Now that the site is stable and relatively glitch-free, she said, they can focus on adding more functionality.

Just as in Minnesota, California’s exchange agency also recognized how aggressive the timeline looked early on, said Anne Gonzales, public information officer for Covered California. “This is a huge effort to put together something so complex and … it was a quick turnaround,” she said. “We just became a state agency last year and that’s an awful short time to hire everybody you need and do the logistics of starting a new agency along with getting a new health insurance exchange and the technology to go along with it. It’s a big job.”

California’s launch didn’t fare quite as well as Minnesota’s, with many users experiencing wait times of more than 15 minutes throughout the first week, but the state resolved many of the website’s issues quickly. Since the launch, California has periodically disabled access to enrollment functionality during off-peak hours to apply fixes, make increased bandwidth available and to generally speed up the website, Gonzales said.

As of Oct. 10, the Covered California portal is nowhere near where the agency would like to see it in terms of functionality and speed, but staff is working on it continuously. The good news about the portal, according to Gonzales, is that the huge response shows what kind of demand there is for affordable health care.

Covered California's service center received more than 19,000 calls in the first day of operation, and its website saw more than 5 million page views, from more than 514,000 unique site visitors. The agency received more than 16,000 applications in the first week, including both paper and Web-based enrollment applications.

Though there were some initial problems, Gonzales said, the agency is proud of the work it has done and compared to some of the other states, considers its launch a success poised for continued growth.

Colin wrote for Government Technology and Emergency Management from 2010 through most of 2016.