Workers process paper applications for Cover Oregon, the state's… (Don Ryan / Associated Press )
In Oregon, a state envied for its high tech, sign-ups under the new federal healthcare law have been anything but.
About 400 newly hired workers in Salem are processing paper applications by the thousands for health insurance under President Obama's law. They review each 19-page application, calculate eligibility for tax subsidies, and then mail back a packet of each consumer's options — which the customers must mail back to complete the sign-up process.
Meanwhile, at the headquarters of Cover Oregon, the agency set up by the state to run its transition under the Affordable Care Act, dozens of software engineers have fanned out at long tables on the first floor, trying to untangle the technical problems that have made Oregon the only state with a health insurance exchange that has yet to go online.
One floor up is the "Go Live Situation Room," where the state's tech pros strategize around a conference table. But the name hints at the irony: There is no "go live" date for Cover Oregon's exchange.
Federal officials say their own site — even with all its troubles — should work by the end of November for the vast majority of Americans in the 36 states it serves, but Oregon's leaders are making no such promises. Yet they insist that even with the state's Dec. 4 deadline looming for those seeking coverage as of Jan. 1, they will get people covered one way or another.
"Even if the website doesn't get fixed, we're confident that we can get everybody who wants to get enrolled enrolled by Jan. 1," Gov. John Kitzhaber said in an interview last week.
Kitzhaber, a Democrat and former emergency room doctor who will announce by the end of the month whether he is running for reelection, is eager to draw attention to Oregon's feat on the other side of the healthcare law's ledger. The state has already enrolled about 75,000 Oregonians in the healthcare plan's expansion of Medicaid, the state-federal program providing coverage to low-income people — and officials expect to top 100,000 by March, slashing the state's uninsured rate by about 20%.
But the pool of new Medicaid enrollees is separate from the pool of Oregonians eligible to sign up for private plans through the insurance exchange. It is estimated that Oregon has about 560,000 people who are uninsured. The state has received more than 40,000 paper applications — with many representing an entire household — but a spokesman for Cover Oregon could not estimate how many of those applicants were signing up for private plans; an initial sampling suggested many of them were headed for Medicaid.
That is potentially a major problem for Oregon, which, like every state, is aiming for high turnout among the young and healthy to offset the inclusion of older and sicker customers. The inability to directly enroll online "will probably be the greatest deterrent to people who essentially feel they are healthy and don't need insurance," said Deborah Chollet, a health insurance expert at Mathematica Policy Research, based in Princeton, N.J. The 11 insurance companies offering plans on the exchange have not received any data from the state, leaving them in the dark about the mix of enrollees.
"Younger people in particular are more inclined to do things electronically and more frustrated if they cannot; people who have health problems are going to be motivated to overcome that frustration," Chollet said. Even with a small army of state workers engaging potential applicants at fairs across the state, "they have their work cut out for them," she said.
No one would have expected Oregon, of all states, to be so far behind nearly two months into the implementation of the Affordable Care Act. Oregon has been an innovator in trying to improve health outcomes among its Medicaid population, attempting to transform the system by ensuring that the agencies caring for those low-income patients are coordinating care for varied ailments — including mental health, nutrition and chronic conditions like congestive heart failure.
Faced with a budget gap, the state made an unusual deal with the federal government last year: Oregon would get $1.9 billion over five years if it demonstrated that it could reduce Medicaid costs while improving the health of that population. If the state fails, it faces serious financial penalties.
In the state's most recent quarterly progress report, health officials found that ER visits within that population had dropped by 9%; and emergency department spending was down 18% from 2011. There were also 29% fewer hospital admissions for chronic conditions. Before the reforms, Medicaid expenditures were estimated to grow about 5.4% a year, more quickly than the 4.5% growth in state revenue. Based on current projections, Kitzhaber says, Medicaid costs are expected to grow at no more than 3.4% annually by next fiscal year.