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Are State HIXs Making the Grade?

News reports have state-run health insurance marketplaces faring better than the federal portal, with some marketplaces enrolling thousands in health coverage.

It's hard to avoid news about the now 10-day-old launch of the health insurance exchanges, which persisted with varying degrees of success, in spite of the shutdown of the federal government. While technical shortcomings dominated early headlines, some online marketplaces have turned the corner, racking up health plan enrollment numbers that may soon start to make a dent in their respective state's percentage of uninsured residents.

In all, 16 states (15 states and the District of Columbia) are now running state-based health insurance marketplaces, while the rest rely solely on the federal exchange. Massachusetts led the way years before the Affordable Care Act, having established universal health care for its residents nearly seven years ago. Massachusetts Gov. Deval Patrick, for one, hopes the rest of the country sees the same benefits that have come to his state as a result.

"Accessible, affordable, quality care in all cases improves lives and in many cases saves lives. It gives peace of mind and economic security to families. It increases productivity for large and small employers as well as for students. It creates jobs and contributes to our economic strength. It's a powerful statement of who we are," Patrick blogged in The Huffington Post.

Government Technology looked at states launching their own exchanges, and how it's gone so far:


California’s online health-care marketplace -- Covered California -- received nearly 1 million unique visits during its first week of operation, according to state officials. During that time, nearly 30,000 Californians were determined to be eligible for health coverage. Average online wait time for the entire first week was slightly more than 15 minutes, although that figure had been cut to less than four minutes by Friday, Oct. 4, the state said. “We’ve started strong,” said Covered California Executive Director Peter V. Lee. “The amount of interest and number of applications we’ve received in the first week underscores the demand among Californians for quality, affordable health care.”

Unique visits: 987,440 (as of Oct. 5)
Applications: 43,616
Applications completed with household eligibility determined: 16,311


Although visitors to Colorado’s health information exchange website were met with sporadic error messages, state officials pronounced the launch of Connect for Health Colorado a success. “While there have been some challenges, we are pleased to see that Coloradans are looking at their options, shopping and signing up for health plans,” said CEO Patty Fontneau, in a statement posted Oct. 3. More than 100,000 people visited the Colorado exchange in its first several days of operation, creating more than 8,000 accounts, according to the state.

Unique visits: 107,000 (as of Oct. 3)
Accounts created: 8,400


According to Access Health CT, as of Oct. 9, business has been brisk at the online portal as well as the call center, staffed with 45 employees. On launch day, the Connecticut portal logged 167 enrollees, a figure much bigger than officials expected, according to news reports. Some reports say the state logged the first completed application for coverage, at 9:30 EST on Oct. 1.

Site visitors: 115,892 (as of Oct. 9)
Applications processed: 3,087


Hawaiians who sought coverage on the state’s health insurance exchange probably found the experience disappointing. As of today, the exchange has almost no functionality. Site visitors can only provide basic information via a form on the site, with a vague promise of follow-up in the coming weeks. The site’s rocky launch left many looking for someone to blame, given the state’s early commitment to health-care reform. The Hawaii Health Connector was established in August 2011, and Hawaii was the first state to publicly announce its intention to create a state-based exchange. State lawmakers grilled the Health Connector’s executive director, Coral Andrews, at a hearing on Oct. 9, according to news reports. Officials are working toward a relaunch on Oct. 15.

Unique visits: 19,457 (as of Oct. 1)


Idaho is running a state-based exchange, but it relies on the federal government’s site for plan shopping and enrollment until the state’s platform is ready. received 18,000 visits on Oct. 1, according to a statement from Executive Director Amy Dowd, and she told The Spokesman Review that another 14,000 people visited the site over the next two days. Dowd’s official statement also acknowledged user frustration stemming from problems with the federal health exchange platform, but added, “We have heard that Idahoans are getting through and that applications are processing.” No enrollment figures were available. The state intends to have its own health insurance exchange platform running by October 2014.

Unique visits: 32,000 (as of Oct. 3)


Kentucky’s Kynect health insurance exchange appears to be one of the stars of the Affordable Care Act rollout. On Oct. 2, the Wall Street Journal said the site was outperforming most of its state-based peers. And a week later, Bloomberg Businessweek speculated that the site’s success may translate into a political boost for Gov. Steve Beshear. As of Oct. 9, the exchange had nearly 4 million page views and users had established 24,000 accounts, the state said.

Pageviews: 3.8 million (as of Oct. 9)
Accounts created: 24,000
Unique visits: 193,729


State officials in Maryland told the Wall Street Journal that "thousands" of state residents had expressed interest in obtaining coverage through the state exchange, but technical hiccups continue to impact their ability to secure health insurance. “We have added server capacity, made technical adjustments, and improved call center employees’ ability to serve consumers,” reads a statement on the Maryland Health Connection website. U.S. Census Bureau statistics reveal that 600,000 residents of the state are currently without health coverage, so once technical fixes are in place, the exchange may be well positioned to narrow the gap.

Unique Site Visitors: 174,023 (as of Oct. 6)
Accounts created with verified identity: 13,532
Applications submitted with eligibility determination: 566


Minnesota’s health insurance exchange, MNsure, avoided major crashes, according to local news reports, but continued have nagging glitches entering its second week of operation. Minnesota Public Radio reported on Oct. 8 that users were having intermittent problems with creating accounts, perhaps tied to repair work being done on the federal data hub that supports state exchange sites. As of Wednesday the problem appeared to be resolved, with state officials tweeting that 96 percent of people attempting to create an account were completing the process successfully. More than 100,000 people visited the Minnesota exchange website on Oct. 1, according the Pioneer Press, even though the site didn’t launch until the afternoon.

Visits: More than 100,000 (as of Oct. 1)
Accounts created: More than 6,000 (as of Oct. 6)

New Mexico

Individuals and families in New Mexico will purchase health plans through the federal government’s site for the 2014 calendar year. In an Oct. 8 interview with the Albuquerque Journal, Mike Nuñez, interim CEO of the state’s health insurance exchange, said signing up for individual coverage continued to be difficult due to problems with the federal website. However, the state-run health insurance exchange for small businesses is functioning smoothly, Nuñez said, telling the paper that 524 employers has used the exchange to sign up 1,074 employees. Nearly 40,000 people had visited the state’s exchange sites as of Oct. 8, the Journal reported.

Visits: 37,000 (as of Oct. 8)
Enrollments: 1,074 (small business employees)

New York

New York’s health insurance exchange website drew an astonishing 10 million visits during its first day of operation – with 2 million of them arriving within two hours of the site's opening, according to The heavy traffic caused problems with the site during its first week, but performance improved as the state added computing capacity. The state reported that more than 40,000 people had signed up for health plans as of Oct. 8.

Site visits: 10 million (on Oct. 1)
Enrollments: 40,000 (as of Oct. 8)


Although Oregon residents won’t be able to apply for health coverage online until the end of October, more than 234,000 people had visited the state’s Cover Oregon website as of Oct. 7, according to state officials. Users can browse plans and premiums and get unverified estimates of their health insurance subsidies. The Associated Press reported Oct. 7 that Cover Oregon had received 1,300 paper applications.

Visits: More than 234,000 (as of Oct. 7)

Rhode Island

A volume-induced crash spanning a couple hours on launch day notwithstanding, HealthSourceRI reported as of October 4 that more than 26,000 Rhode Islanders visited the state's health insurance marketplace, and 3,000 created accounts. Many had their efforts derailed by snags in the federal system's ability to verify applicants, according to HealthSource RI spokeswoman Dara Chadwick. "There are still some issues with identification verification," she told USA Today.

Unique site visitors: 26,039 (as of Oct. 4)
Enrolled: 580


Site visitors to the Vermont portal, Vermont Health Connect, also report rough going in the first few days, but officials say it’s getting better. Commissioner of the Department of Vermont Health Access Mark Larson oversees the state’s marketplace. “Seven days ago, there was speculation we wouldn’t be able to go live. Today we are talking about what is the pace of applications that has to occur to be successful. Within that is a significant milestone,” Larson told the Burlington Free Press earlier this week.

Unique site visits:
30,843 (as of Oct. 4)
Number of accounts established: More than 2,300


After a rough launch on Oct.1, which included being shut down for part of the day, the Washington state health benefit exchange recovered nicely. By Oct. 8, The Washington Post was pointing to the site as an example of what Obamacare looks like when it works. More than 800,000 people had visited the Washington health insurance exchange as of Oct. 7, according to the state, and more than 9,000 people had enrolled in health plans. In addition, 10,000 others had completed applications, but hadn’t submitted payment yet, the state said.

Visits: 837,000 (as of Oct. 7)
Enrollments: 9,452

Washington, D.C.

Users created more than 1,000 accounts on Washington D.C.’s health insurance exchange site – DC Health Link – during its first day in business, according to the city. A local media outlet said the site drew more than 15,000 unique visitors on Oct. 2 and that more than 4,000 accounts had been created.

Unique visitors:
15,452 (on Oct. 2)
Accounts created: 4,121 (as of Oct. 2)

Noelle Knell is the executive editor for e.Republic, responsible for setting the overall direction for e.Republic’s editorial platforms, including Government Technology, Governing, Industry Insider, Emergency Management and the Center for Digital Education. She has been with e.Republic since 2011, and has decades of writing, editing and leadership experience. A California native, Noelle has worked in both state and local government, and is a graduate of the University of California, Davis, with majors in political science and American history.