Health Insurance Exchanges: Week 1

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October 9th, 2013

Health Insurance Marketplace

Despite being over-shadowed by the government shutdown, the online ACA Health Insurance Exchanges launched last week. The opening was received with just as much delight as the shutdown and came under heavy criticism from users experiencing delays and glitches.

The online health insurance exchanges are a principle feature of the ACA and are designed to accomplish two primary tasks:

  • Create an accessible marketplace where consumers can shop a variety of choices at competitive prices.
  • Explain coverage options – how to purchase, benefits, how subsidies work, and which plan meets their requirements.

While the exchanges are still in their infancy and bugs are to be expected, the first week of operation has yielded a number of issues that have concerned millions across the nation. We’ve broken down the health insurance exchange’s first week of operation to reveal it’s day-by-day progress and the experiences of patients, payers, and providers.

Day One

  • Healthcare.gov received nearly 5 million visits in the first 24 hours.
  • By 10am the following message was posted on the site – “The system is down at the moment. We’re working to resolve the issue as soon as possible. Please try again later.”
  • The New York State of Health online exchange claimed to receive 10 million visits by Tuesday afternoon.
  • Further reports clarified that only 9,000 people were actually able to enroll.
  • Traffic to exchanges elsewhere was just as unclear with large amounts of visits crashing multiple exchanges - many being due to rapid refreshing from users experiencing difficulties.
  • Covered California was getting 10,000 hits per second Tuesday morning. Claims a total of 5 million hits on day one. KUSI-TV San Diego reported that number was closer to 645,00.
  • Minnesota’s exchange had yet to go live by mid-day.

Day Two

  • By Wednesday afternoon, only seven state-based exchanges were fully functional.
  • DC’s exchange, seven other state exchanges, and all 36 exchanges run by the HHS were still not working at maximum operating speed.

Day Three

  • Pennsylvania exchanges reported that by Thursday morning, individuals were finally able to begin enrollment in the online exchange.
  • Healthcare.gov reached 7 million visits.
  • A growing backlog of individuals waiting to enroll continued across multiple states.
  • Clinics and other in-person assistance groups announce a high number of walk-ins and phone calls.

Day Four

  • HealthCare.gov reaches 8.6 million visitors.
  • Cigna Corp, Molina Healthcare Inc., and WellPoint Inc. begin to report enrollment.
  • A bottleneck application process is blamed for system overload and glitches.

Day Five & Six

  • The application process for new enrollees was disabled to allow maintenance work.
  • Still reports of delays. “We have lots of visitors on the sight right now. Please stay on this page.”
  • Insurance issuer competition remains high, with an average of 53 health plans available in each state and at least two different insurance companies present on the exchange.
  • Blue Cross and Blue Shield report a total of 794 different Blue plans available nationwide.

Many of the issues experienced by users trying to enroll in the online health insurance exchanges have come down to poor website design and server capacity. These are direct results of pressuring tech teams to build the exchanges within a short period of time (caused by the numerous mandate delays and rescheduling) and coordinate a number of components.

The following graphic highlights the vast number of entities that must communicate efficiently in order for the exchanges to operate at full functionality. Learn more about the software behind the exchanges here.

Health Insurance Exchanges

While technical difficulties remained the focus of the criticism directed at the exchanges, the numbers also failed to impress. Many exchanges reported page visits to be above expectations but didn’t necessarily translate into enrollment or purchases.

J. Mario Molina, CEO of Molina Healthcare Inc., described the situation. “What we are seeing is a lot of shopping right now and very few decisions being made.”

The disproportion between exchange visitors and actual enrollees or coverage purchases could stem from a number of reasons – most likely due to visitors either ‘window shopping’ insurance options, or rapid refreshing of pages whilst on the exchange after experiencing technical difficulties.

Despite a controversial first week, the exchanges are still expected to reach its projected targets within 6 months, according to gov’t officials. Though the present numbers don’t reflect much progress, criticizing the health insurance exchanges would be premature until data that truly measures their success is released, such as number of enrollees, number and types of plans purchased, purchaser demographics, and most importantly – actual premium prices. One thing for sure, if they are to be a success, ease of access will definitely have to be a key component.


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