Linda Sheppard

Linda Sheppard, special counsel and director of health policy and analysis at Kansas Insurance Department, discussed the state’s experience during the first open-enrollment period of the Health Insurance Marketplace. Photo by Alliance for Health Reform

The first open-enrollment period for the Health Insurance Marketplace brought triumphs and challenges. In a Washington, D.C., briefing last week, Alliance for Health Reform and The Commonwealth Fund discussed outcomes from the six-month period and what it means for the nation’s health care system.

Through the federal and state marketplaces, or exchanges, set forth by the Affordable Care Act, Americans gained the opportunity to select a private health care plan within their budget, or realize their eligibility for Medicare, Medicaid and the Children’s Health Insurance Program. An estimated 8 million Americans were insured through the marketplace between Oct. 1, 2013, and March 31, 2014.

“One of the essential goals of the ACA was to create a functioning marketplace,” said Arnold Epstein, an official from the Department of Health and Human Services’ Office of Health Policy. “We haven’t really had one in health care, a place where consumers could come and compare apples to apples and oranges to oranges and get really clear information about price and eventually, increasingly, about performance.”

More than 70 percent of applicants chose the lowest, second-lowest and third-lowest premium plans, according to Epstein. He also noted that of those who received a plan, 85 percent also received financial aid.

While millions managed to get insurance, timeliness proved to be an issue. Nearly half of all applicants waited until the end of the enrollment period to apply, according to Epstein. Richard Onizuka, CEO of Washington Health Benefit Exchange, said that Washington got 5 percent of our total enrollment on March 31.

“So people didn’t just wait to the last month, they waited to the last minute,” Onizuka said. “They literally waited to the last minute. We had 6,000 concurrent users on the system at 11 p.m.”

Onikuza and Linda Sheppard, special counsel and director of health policy and analysis at Kansas Insurance Department, noted website functionality issues for their states’ users.

“The difficulty of getting the marketplace up and running, and then even after the website went live, did create a lot of confusion (and) a lot of frustration in our state, and certainly on the part of us as the insurance regulator,” Sheppard said.

Despite difficulties, the amount of uninsured young adults and Latinos significantly decreased, and public health officials plan to target more key groups of uninsured for 2015. Experts on the panel spoke optimistically at the second enrollment period, which begins Nov. 15, but said changes to the system need to be made.

Timothy Jost, law professor at Washington and Lee University, said that 13 million people are estimated to enroll in the exchanges and 12 million more in Medicaid in 2015, with the marketplace enrollment jumping to 22 million in 2016. He noted that successful enrollment depends on the ability of insurance markets to expand competition and offer more attractive products.

“Continued aggressive outreach is also essential,” Jost said. “Many Americans who are eligible for tax credit assistance still don’t know it and still assume that coverage and care is unaffordable. Outreach is especially essential to non-English speaking communities.”

Watch this briefing at Alliance For Health Reform’s YouTube channel.