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5 PPACA open enrollment nightmares

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By this point in the second annual Patient Protection and Affordable Care Act (PPACA) open enrollment period, many Americans who signed up at last year just to see how it worked may regret ever giving the exchange system their correct e-mail addresses. is bombarding people who filled out applications and never actually bought coverage with e-mails pleading with them to return and get covered.

A look at one e-mail inbox shows one e-mail sent Feb. 5 with the subject line “Time is running out;” a second, sent Feb. 7, with the subject line “Your application reminder;” and a third, from Kevin Counihan, the chief executive officer of the PPACA exchange system, sent Sunday. That one, like the one sent three days earlier, has the subject line “Time is running out.”

“I urge you to submit your application before it’s too late to get health coverage for 2015,” Counihan wrote. “There are only 7 days left until open enrollment closes on Sunday, February 15.”

The first PPACA exchange open enrollment period started Oct. 1, 2013, and straggled to an end in mid-April 2014 in most of the country. In most of the country, the current open enrollment period started Nov. 15 and is supposed to end, as Counihan said, Sunday. State and federal regulators could make special arrangements and exceptions, but, in theory, consumers who apply for individual coverage for 2015 after Feb. 15 will have to show they qualify for a special enrollment period (SEP).

Technical glitches crippled exchange promoters during the first open enrollment period, but the glitches, and Republican efforts to block exchange enrollment efforts in some states, helped get the exchange program and its qualified health plans (QHPs) a fortune in free publicity.

This year, most exchange systems seemed to work reasonably well, and the exchanges that report on call center performance said their call centers have been answering calls reasonably quickly. In Minnesota, for example, the average wait time for MNsure exchange contact center callers has been under 15 minutes from the start of the open enrollment period up until Jan. 25. The average wait time has been under 5 minutes for most of that time.

The exchanges could be getting a surge of QHP applications now, as the open enrollment deadline nears, but, up till now, business has not been that great, given how much more smoothly enrollment systems have worked.

See also: 3 off-exchange health market changes.

Charles Gaba, the editor of, is estimating that the exchange system may have received QHP selection information for about 10.3 million people as of Feb. 6. That’s more than the total paid enrollment of 8.4 million that the exchange QHPs attracted in 2014, but only 23 percent more.

MNsure, a state-based exchange, says it enrolled or re-enrolled 44,331 people in exchange QHPs between Nov. 15 and Jan. 25. That’s up just 9 percent from the QHP enrollment figure MNsure reported for March 24, 2014.

In Connecticut, the home of Access Health CT, a state-based exchange with enrollment systems that worked well last year and are working well this year, QHP enrollment has increased about 10 percent, to 89,869, as of the end of January.

At Connect for Health Colorado, another state-based exchange that has had functional enrollment systems for two years in a row, exchange QHP enrollment increased to 125,006 as of Dec. 31, 2014. That was up just 4.4 percent from QHP enrollment at the end of the first open enrollment period.

The exchange system seems to be designed to generate big spikes in activity near critical deadlines. In Colorado, for example, application volume increased to about four to six times the typical weekly total during the week of Dec. 15, the application deadline for consumers who wanted to have exchange QHP coverage in place by Jan. 1, 2015.

But, even if a Feb. 15-related surge materializes, the PPACA exchange system marketers seem to have found themselves trudging through a nightmarish fog this time around.

One obvious barrier was the success the PPACA exchange system and PPACA Medicaid expansion had at decreasing the number of uninsured Americans during the first open enrollment period. The remaining uninsured consumers may be harder to reach, or more skeptical about the value of health insurance.

See also: 3 PPACA exchange enrollment shadows.

For ideas about other nightmares that may have kept access to functional enrollment systems from causing enrollment activity to soar, read on.


1. Bad memories of 2014

Some consumers had a terrible time applying for coverage in 2014, and some agents, brokers and nonprofit enrollers have complained that they are still having trouble getting paid for work they did in 2014.

Some exchanges seem to depend heavily on good relationships with brokers. Connect for Health Colorado, for example, says brokers have helped more than one-third of its 2015 enrollees.

See also: 3 benefits sellers size up the market.


2. Ebola

About a month before the open enrollment period started, when CMS and its parent, the U.S. Department of Health and Human Services (HHS), wanted to be busy marketing the exchange system, CMS Administrator Marilyn Tavenner and HHS Secretary Sylvia Burwell suddenly had another priority: Potential outbreaks of a terrible disease in Dallas and New York.

See also: Ebola vs. PPACA: 3 effects


3. Money problems

The exchanges still have some federal marketing money, but less than they did in 2014, and they are supposed to be working toward making themselves self-sufficient.

Insurers that might have pitched in may have been afraid to invest much in promotional efforts, for fear that the exchange enrollment systems would once again be crippled by glitches. 

See also: 10 ZIP codes that love PPACA exchange plans.

Iced-covered window.

4. Snow

Blizzards have repeatedly disrupted business of all kinds since the beginning of January.

In Iowa, officials anticipated that problem in September, when they were seeking an exchange marketing contractor. Officials said the winning bidder should schedule any in-person meetings with consumers “as early as possible,” to reduce the need for state employees to have to drive around Iowa during blizzards.

See also: Economy in U.S. expanded less than forecast last quarter

Disappointment in PPACA World.

5. Dream-reality collisions

Volunteer exchange helpers, and paid employees at nonprofit agencies, were filled with visions of helping uninsured consumers finally get access to health care through the exchange system.

This year, the volunteers have heard stories about consumers who got covered and got care, and also complaints about narrow networks, lack of out-of-area benefits, high out-of-pocket costs, and plans that suddenly shut down. 

See also: View from PPACA World: Ken Fasola.


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