The Hawaii Health Connector, after a distressing two weeks of delay, limped to the starting line on Tuesday with a somewhat halting launch of the state’s online health-insurance marketplace. It’s a relief to see the website open, but the private nonprofit that operates the exchange faces a heavy lift in regaining the confidence of the consumer — and the elected officials who authorized it.
The Connector and the other exchanges that went live Oct. 1 comprise a central element in the Affordable Care Act’s reform package. The sites are meant to provide a more consumer-friendly platform, not unlike an airfare shopping portal or other online marketplace. The goal is to allow individuals and small businesses to more easily purchase insurance and claim any subsidies or tax credits for which they qualify.
Unfortunately, the inaugural weeks of this "Obamacare" rollout have been rocky, especially with the federal government’s exchange unable to meet site demand and the uneven performance by state exchanges. And until its postponed debut this week, Hawaii’s was the only state exchange unable to deliver the comparative information of prices that had been promised.
The site operation remained buggy on Day 1. The Connector tech staff now has very little spare time remaining to get those knots worked out.
In public statements over the past two weeks, exchange executives blamed the initial problems on doubts that the software would supply shoppers with the correct insurance-rate figures and choices. Consumers are actually buying insurance through the exchanges, said Executive Director Coral Andrews, so the purchase is a contract that must include accurate figures.
Nobody could dispute that. Still, considering the setup costs, $205 million in federal grants for building and marketing the exchange, there should have been more beta testing done. Hawaii’s taxpayers had a right to expect better performance, and a more timely rollout, with the federal funds already invested.
In the first two weeks, the participating carriers — Hawaii Medical Service Association, Kaiser Permanente and Hawaii Dental Service — were providing rate information via the Web, phone banks and, in the case of HMSA, walk-in retail centers. That blunted some of the initial frustration, but this was no substitute for the side-by-side comparison information, as well as calculations of any subsidies or tax credits, that was promised through the exchange.
Prolonged delay also has made the job much harder for the "marketplace assisters," the nonprofits contracted to help with outreach. The process of hiring this army of aides has fallen far behind schedule, too.
Although the initial enrollment period lasts for six months, the Connector’s window of opportunity to effectively achieve its enrollment goals — signing up 300,000 residents with insurance — is much narrower. The agency has spent its marketing dollars promoting the Oct. 1 start date, and it will be difficult to regenerate that same level of interest.
The public won’t be served if they end up with too little time to use this expensive new tool before the new health policies take effect in January.
State lawmakers may need further fact-finding on the Connector, beyond the day-long briefing they hosted last week. The Connector was created in statute as a private nonprofit in 2011, but it still answers to the Legislature. Elected officials certainly should consider further changes to the law to enhance the transparency and responsiveness of the agency, as well as changes to the makeup of the governing board.
Perhaps this state has rested on its health-care laurels for too long. The employer-provided insurance mandated by its Prepaid Health Care Act has covered a relatively high proportion of Hawaii’s population.
But the information-technology shortcomings of Hawaii’s government are showing up here. Online exchanges have been touted as the next big thing, an improvement in providing understandable bottom-line information and ease of comparison shopping. The Connector now has to make up a lot of lost time to deliver this service to the state.
For decades, Hawaii’s employees and those in the social safety net have benefited from the state’s progressive health-coverage policy. They would like to see health care reform play out much more smoothly from now on.
