Blog PostNovember 25, 2013

Board strife as Colorado exchange far behind projected enrollment

Author: Michael Booth

Publication: The Denver Post


Enrollment in the Affordable Care Act through Colorado‘s health insurance exchange is barely half the state’s worst-case projection, prompting demands from exchange board members for better stewardship of public money.

The shortfall could compromise the exchange’s “ability to deliver on promises made to Colorado citizens” and threatens the funding stream for the exchange itself, according to board e-mails obtained by The Denver Post in an open records request.

The exchange, meant for individuals and small groups buying insurance, had projected a lowest-level mid-November enrollment of 11,108, in a presentation to a board finance committee. The exchange announced Nov. 18 that it had signed up 6,001 Coloradans so far.

The midlevel scenario for November was 20,186 members, and the highest projection 30,944 members.

As federal startup grants taper off under Obamacare funding, the exchange is meant to pay for itself with per-member charges on the private insurance companies offering policies. It needs 136,300 enrollees in 2014 to raise $6.5 million of its $51.4 million expenses.

Significant operational issues are not being addressed in the wake of bumpy local and national startups for Obamacare, said board member Ellen Daehnick, whose e-mails and comments are sharply critical of board leadership.

“The enrollment numbers are not meeting the projections,” Daehnick said in an interview. “They are behind even the low projections. This board has moved from looking at a plan to looking at actual performance that has not met expectations, at least from my perspective.”

Colorado is one of 14 states running its own exchange, while the troubled federal site handles the exchanges for 36 other states.

The exchange has not hit either internal projections or those made earlier by consultants supportive of the Affordable Care Act, said board member Dr. Mike Fallon, a conservative voice on the board who calls the act overly complex and expensive.

“None of this surprises me,” Fallon said of the shortfall. “I don’t know what we as a board could have done. Health insurance is a difficult product to sell.”

Other board members said hitting enrollment marks now is not as important as making sure exchange websites and call centers work smoothly when people are ready to sign up.

Surveys show many potential exchange customers have had no insurance for years, said board chair Gretchen Hammer, who is director of the Colorado Coalition for the Medically Underserved. Those consumers have different decisions to make than someone with private insurance who needs new coverage on Jan. 1, Hammer said.

Other board members have expressed concerns that the slow enrollments portend a logjam at the Dec. 15 deadline for buying coverage that would start at the beginning of next year. They have asked the Connect for Health Colorado executives and staff for assessments of what would happen if tens of thousands of Coloradans try to buy policies at the last minute.

Daehnick said the exchange staff’s responses to those questions are lagging.

“In the midst of this situation, the communication from the (executive director) to the board has been that the launch is successful, even ‘fabulous,’ with a few glitches,” Daehnick wrote fellow board members on Oct. 24. “Available information does not support this assertion.”

Daehnick said Friday her concerns are largely the same.

The exchange is now issuing joint updates on enrollment with Medicaid, managed by a different department of state government, which is reporting much faster sign-ups for the expansion of free Medicaid insurance under the Affordable Care Act.

Medicaid said on Nov. 18 it had signed up 47,309 Coloradans newly eligible under expanded Medicaid income rules, well on its way to reaching the 160,000 it expects to be eligible overall.

One of the exchange’s frustrations since the Oct. 1 launch is that federal rules require private insurance consumers seeking a subsidy on the exchange to first find out if they qualify for Medicaid. In practice in Colorado, that has required a tedious 12-page application; if any information is missing or wrong, consumers might wait up to 45 days to get their “denial” and then move on to buy a private policy.

Gov. John Hickenlooper has asked staff and state agencies whether the Medicaid steps are necessary and why other states like Kentucky appear to be more streamlined, according to internal e-mails.

“Gov is worried that we are asking more than needed on medicaid side and it is slowing folks down,” wrote his chief of staff, Roxane White, to Medicaid officials.

Officials at the state Health Care Policy and Finance department, overseeing Medicaid, have told the exchange they are working with federal officials to slim down the process for those certain they want private insurance instead of Medicaid.

The exchange and Medicaid have made some good progress, said board member Steve ErkenBrack, who is head of Rocky Mountain Health Plans in Grand Junction. But, he said, he knows there are many who desperately need to get through to a new policy by Dec. 15.

“This is not a theory for people, this is about real people with real problems, and we need to make sure that transition is as smooth as possible,” he said.

Michael Booth: 303-954-1686, [email protected] or