Washington state making insurance exchange work

KENT, Wash. – Mindy Mansfield had health insurance when she worked at a factory that made air flow vents in Cle Elum, a small town on the eastern side of the Cascades. It covered the pills she took for her Type 2 diabetes and the ones she needed to ease her arthritis.

But as she edged toward retirement age after nearly two decades as a machine operator, Mansfield was laid off. She moved in with her older sister in Kent, lost her medical coverage and jettisoned her arthritis medication because “it was just too expensive.”

Two years of worry about whether she could stay healthy without a safety net were erased in just 20 minutes Saturday: the time it took the 62-year-old to navigate Washington’s online insurance exchange with a little help from “in-person assister” Pearl Rodriguez.

Mansfield was one of 100 uninsured women and men who flocked to an aging community center here on a drizzly Saturday afternoon and signed up for insurance coverage under the Affordable Care Act, as Obamacare is formally known. They were part of the Washington Healthplanfinder’s “mobile enrollment tour.”

Between Oct. 1 and Nov. 7, more than 9,000 people selected a private health insurance plan through the marketplace in Washington state. Another 68,532 found out they were eligible for free insurance under Medicaid. And another 81,166 have completed applications for insurance but have not finished the sign up process.

That makes the Evergreen State one of the brightest success stories in the rocky national rollout of the federal health law. Here in the home of online shopping giant Amazon.com, officials credit the exchange’s success in part to the Pacific Northwest’s high-tech bent.

In addition to the enrollment tour, which brought a long, white trailer filled with workstations, laptops and enrollment assisters to cities throughout the state, Washington Healthplanfinder has wooed young and healthy residents with android and iPhone apps and an appearance Tuesday at the University of Washington by Seattle’s own Chris Walla, guitarist with Death Cab for Cutie.

Early analysis puts “Washington at the top of the pack, with Kentucky doing similarly well,” said Sabrina Corlette, senior research fellow at the Georgetown University Center on Health Insurance Reforms. The 14 states “that went forward with their own exchanges are head and shoulders better than the states with the federal exchanges.”

The goal of Washington Healthplanfinder was to give insurance seekers a smooth online shopping experience, and many on the site’s leadership team are veterans of tech startups.

The Washington healthcare exchange itself “is a startup,” said Richard Onizuka, its chief executive. “And the people that really thought that was exciting and interesting – ‘Ooh, that sounds like a great thing to do’ – those are the people that are here. The people that were, ‘Oh what does that mean? Maybe I won’t have a computer the first day I’m here’ – those are not the people that are here.”

Another important decision Washington insurance exchange officials made early on was to allow insurance seekers to shop for plans without having to go through the lengthy application process first. Not all state exchanges initially had the same anonymous browsing capability.

HealthCare.gov, the federal exchange used by more than half of the country, lets people see what plans are available, but “to find out the actual costs for your personal situation,” the site says, “you need to apply.”

“An open browsing function in hindsight is a very good idea,” said Anne Gauthier, senior program director for the National Academy for State Health Policy. “They all have the same goal. Those (states) that went in the direction of the shopper … in October came out ahead.”

Guitarist Walla, who promoted the insurance exchange at the Seattle campus, is one beneficiary of the comparison-shopping capability. Yes, his indie band fills halls these days, but he is still self-employed, recently married and planning to start a family.

“There is no reasonable way without the Affordable Care Act to be able to comparison shop for the plan,” he said. He told students – also known as “young invincibles” and the financial heart of the federal insurance program – “about being uninsured and how terrifying that is, and how for the first time it’s a little bit better than it’s ever been.”

For all its success, the Washington exchange has not been without glitches. On its first day of operation, the website was shut down for five hours and then again overnight for maintenance. Pages were slow to load, or screens would freeze, spokesman Michael Marchand said.

“We had a choice,” he said. “Keeping the site up and troubleshooting with everyone in it, or going into maintenance mode and taking the site off-line to find out what the issues were. … We did that in the first 48 hours. We’ve been stable since then.”

In addition, an estimated 8,000 early applicants were notified that the price they were expecting to pay for their coverage was incorrect because the site miscalculated the size of the tax credit they were due. The exchange has fixed the error.

And the call center, which received nearly 100,000 inquiries in its first month, was often swamped. That’s why Mansfield came out Saturday to the Kent enrollment event for in-person assistance.

“I started calling on Oct. 1, and ooh, yeah,” she said, “I kept getting, ‘Please call back when the system is working.’ At first, they took my number and said they’d call back and never did. And they were going to send me information and never did.”

But on Saturday, she found all the information she needed.