As the nation approached Open Enrollment for the new Affordable Care Act, the California exchange was held out as a model of preparation that would make applying for the subsidized health insurance a breeze for residents. While a significant number of California residents have successfully applied, the Covered California website and enrollment systems presented significant challenges and failures not only for those applying but also insurance agents, enrollment Counselors and the health plans themselves. The management at Covered California has consistently ignored the failure of their design and process and sought only to promote their perceived successes.
Website no better than Healthcare.gov
Did anyone test these health plan enrollment websites before they went live? The Covered California CalHEERS enrollment website seemed to have just as many problems, issues, bugs or glitches as the national Healthcare.gov site. The truly persistent and technology savvy computer users could complete their application after navigating the mine field of issues presented by Covered California. Agents had to wait until late November before we could even start an enrollment online through our accounts because that side of Covered California website was not built out.
- Covered California website frustrations
- Tips and Trick to getting Covered California website to work
Paper applications ignored
Thousands of agents and consumers hoped to avoid the technical problems of the Covered California website and submitted paper applications instead. The managers at Covered California, insulated in a bubble of software technology, assumed that virtually everyone would apply online. Consequently, it sounds like there was very little contingency planning for the wave of paper applications that showed up in their mail room. By December Covered California was telling agents they had to re-submit applications online that they had previously mailed. Apparently, all the agent applications were sitting in room and there wasn’t enough staff time to deal with them.
Multiple answers to same question
Not only was Covered California overwhelmed with paper applications, they couldn’t keep up phone inquiries as well. A series of poorly worded online and paper application questions, confusion over what constituted household income, and lack of basic electronic communication from Covered California combined with lack of detailed information on their website led to clogged call center phone lines with two-hour wait times as standard. This was further exacerbated by call center staff that was adroit at providing two different answers to the same question.
Where’s the invoice?
Of course, a family’s odyssey for health insurance isn’t over until they receive an invoice. Before a bill can be generated, the insurance company or health plan has to receive the information from Covered California. Several carriers were saying they had received very little enrollment information from Covered California through mid-November. I called on numerous enrollments only to find no record of enrollment or corrupted data on the carrier side. Why weren’t the data transfer systems between Covered California and the carriers fully tested for the proper transmission of enrollment applications?
Bottleneck created by cancelled plans
A good portion of the grief was created by Covered California insistence that all non-ACA compliant health plans be closed by December 31 by participating insurance carriers. There was an unnecessary tsunami of individuals and families that had to rush in December to get coverage because their plans were being closed by Covered California. They could have allowed the health plans to extend coverage for three months and ease the online bottleneck. This crush of online applications literally locked up the CalHEERS enrollment website on the last day of enrollment on December 23rd. The real insult from Covered California was the Executive Director Peter Lee telling reporters at a press conference on December 23rd that the website was experiencing only mild delays and pages loading slowly.
Website failure admitted
So total was the failure of individuals, families and agent like me from actually completing applications on December 23rd that Covered California extended the deadline to December 28th. An email to agents outlined the “work around” solutions to finishing an earlier application or starting an enrollment for a January 1st effective date. The looming question is whether the health plans can actually generate and mail the invoice to these late enrollments by the January 6th payment deadline for coverage.
- Deadline extended to December 28th
- Internet security issues at Covered California
- Covered California loses data and applications
Hidden pediatric dental
The Board of Covered California made a stupendous error by pulling the pediatric dental out of the health plans and making them “stand alone” plans. In other words, after a family enrolled in the health plan they were suppose to enroll their dependent children 18 years old and younger in a pediatric dental plan. This portion of the the website eluded many families and agents a like. Consequently, there are scores of families who have enrolled in plans that are technically out of compliance with the ACA because they never enrolled their children in a dental plan. How will this issue be resolved?
The best laid plans fell apart
The grand plan for enrollment was to have ten or fifteen thousand Certified Enrollment Counselors on the ground taking applications in-person. For a variety of reasons, less than a couple thousand counselors were actually certified and able to perform enrollments in the first couple of months. Covered California then turned to the health insurance agents that they had been persistently ignoring to pick up the slack. While certified agents enrolled thousands of individuals and families, many ignored the Medi-Cal eligible population.
- Covered California In-Person Assister Program
- Agents asked to work for free
- Discrimination practiced at Covered California enrollment events
At least the carriers are ready
I still believe with all its numerous flaws the Affordable Care Act is worth pursuing and implementing. The importance of extending affordable health insurance coverage to all Americans is not diminished by the failings of an inept and arrogant government bureaucracy. The bright spot is that most of the insurance companies and health plans are actually ready to service the new members who have enrolled. Not everyone may get their current doctor in-network, but the health insurance will be ready to roll in 2014.
Listed above were some of the many blog posts I wrote on Covered California in 2013. I also wrote positive reviews of the agency. For a complete list see my Navigator page.