Successfully transitioning to HealthCare.gov
Following months of efforts to fix the troubled website, Cover Oregon’s board voted on April 25 to switch to using Healthcare.gov rather than continue to try to repair the existing site. The Cover Oregon website will still exist, but will redirect visitors to Healthcare.gov.
The supported state based marketplace (SSBM) model means that Cover Oregon will be working together with HHS, with the state retaining some functions and HealthCare.gov being utilized to enroll people in private plans and Medicaid through the exchange. Tina Edlund, Director of the Oregon Health Agency, was selected in early May to lead the transition.
At a board meeting on October 9, Cover Oregon provided a detailed update on the exchange’s transition to HealthCare.gov – which appeared to be going very well more than a month ahead of open enrollment. All 15 carriers offering plans in the exchange have been added to the HealthCare.gov system, and testing between the carriers and HealthCare.gov began on October 9 and has continued ever since – far longer than last year’s 10 day testing period.
As of early November, the transition to HealthCare.gov – being overseen by Deloitte Consulting – was still “on track, … going well,” indicating that open enrollment will likely get off to a much better start in Oregon this year. In early November, a quality assurance report from consultant Maximus found that on eight out of ten metrics, the new system scored “green”, meaning low risk of failure.
The exchange expects open enrollment to launch smoothly this year, although they have said that significant volume could still result in website slow-downs. And they’ve been working with federal officials to develop a solid contingency plan – which will not rely on paper applications like last year.
Improved access to help online and over the phone
Cover Oregon is working together with CMS to create “learning pages” that will be hosted on HealthCare.gov and will help prepare Oregon residents for the upcoming open enrollment period.
The exchange will be utilizing three separate websites during open enrollment, but they will be interoperable. HealthCare.gov will be the main enrollment platform for people applying for private plans and for income-based Medicaid. CoverOregon.com will be available to help people find local in-person assistance with enrollment. In addition, OregonHealthcare.gov will help applicants who are eligible for Medicaid for reasons other than income (disability, pregnancy, etc.), and will redirect visitors to HealthCare.gov for enrollment.
There will also be two call centers available for residents seeking help over the phone. The HealthCare.gov call center will assist people with enrollment, and the state-run call center (which was all they had in 2014) will be able to provide answers to general questions and help people find local in-person assistance.
Enrolling and re-enrolling for 2015
All 2014 policies that were purchased through Cover Oregon will terminate on December 31, 2014. Open enrollment begins on November 15 and ends on February 15. But in order to have seamless coverage, with a new plan taking effect January 1, current enrollees must re-enroll through HealthCare.gov between November 15 and December 15.
In addition to the existing policy-holders who will need to re-enroll, new applicants will also be able to obtain coverage during open enrollment. To have a policy in place on January 1, the enrollment must be completed by December 15.
Oregon has completed the rate review process for 2015. So although enrollment and 2015 rates will not be available on Healthcare.gov until November 15, Oregon residents can visit oregonhealthrates.org to see detailed information about the rate review process and the average rates for 2015.
Although Healthcare.gov will be handling Oregon’s private plan enrollments for 2015, Cover Oregon will still be involved in Oregon Health Plan Medicaid enrollment. The exchange confirmed in mid-August that the online application for Oregon Health Plan will be more streamlined and the eligibility determination process will be completely automated by 2015. But there are still some doubts as to whether the entire process for seamless Medicaid enrollment will be up and running by mid-November.
2014 progress despite challenges
Although the Cover Oregon website has been largely regarded as a technological disaster, things should be much better during the 2015 open enrollment period, when enrollments will be processed through Healthcare.gov. Despite myriad technological problems, Cover Oregon had enrolled 105,661 people in private plans by November 3 (not all of those policies are still active; some enrollees never paid their premiums, and others have cancelled their coverage at some point during the year; significant attrition is always expected in the individual insurance market). Of the private plan enrollees, roughly 53 percent were uninsured prior to obtaining a policy through Cover Oregon.
Oregon expanded Medicaid under the ACA, and 314,798 people had enrolled in Medicaid (Oregon Health Plan) by November, the majority of them completing their Medicaid enrollment via Cover Oregon. From fall 2013 to July 2014, Medicaid enrollment in Oregon increased by nearly 57 percent – from 626,356 people to 983,025.
Despite the tremendous technological difficulties experienced by the exchange, Oregon had the seventh highest drop in uninsured rate during the first half of 2014 according to a recent Gallup poll. The state’s uninsured rate was 19.4 percent in 2013, and had fallen to 14 percent by mid-2014.
Turning around a failed exchange
Cover Oregon will be switching to a SSBM by the start of the 2015 open enrollment period, but the exchange is still working to repair itself. In mid-June, Cover Oregon announced that they had selected a new executive director, Aaron Patnode. The hiring of Patnode, who was previously a Kaiser Permanente manager, indicates that the exchange is still thinking long-term, and Patnode’s reputation as a problem solver and “turn-around artist” bodes well for the long-term success of the exchange in a partnership with HHS, or possibly as a fully state-run marketplace in 2016 or beyond.
In addition to Patnode, the state also hired “corporate turnaround expert” Clyde Hamstreet earlier this year in an effort to right the failed exchange. Hamstreet and two assistants worked throughout the summer and the exchange spent upwards of $600,000 on their services. In a scathing report written in late August, Hamstreet noted that Cover Oregon was “in serious disarray” and had numerous organizational and leadership problems. But Hamstreet also said that if Cover Oregon continues to exist, “its strengths will flourish.”
For now, Oregon has a supported state-based marketplace, which means that even if the Supreme Court rules against the availability of premium tax credits in states with federally-run exchanges, tax credits will still be available in Oregon despite the fact that enrollment will be completed via HealthCare.gov. The future of Cover Oregon and its governing organization is uncertain, although one of the possibilities suggested by Hamstreet is for the state to partner with a neighboring state to split the cost and administration of state-run exchange technology.
Uncovering what went wrong
The FBI and federal prosecutors have launched investigations into the failed exchange – which cost $248 million in tax dollars and was never able to enroll applicants entirely online. In early June, Governor John Kitzhaber asked Oregon Attorney General Ellen Rosenblum to take legal action against Oracle – the creator of the Cover Oregon website – in order to recover funds spent on the site.
But Oracle is fighting back, saying that officials at Cover Oregon and Oregon Health Authority are to blame for the debacle. Both sides have sued each other, and the issue is highly contentious. Following Clyde Hamstreet’s less-than-glowing report about the myriad problems at Cover Oregon, Oracle’s CEO Safra Catz has pointed to the report as evidence that Oracle is not to blame for the exchange’s catastrophic failure in 2014. Catz is asking Oregon’s lawmakers to assist with ending the lawsuit against Oracle, noting in late October that litigation is “not in the best interest of the state or its citizens.”
On February 18, four and a half months after open enrollment began, Cover Oregon’s website was finally functional enough for insurance agents and navigators to be able to process enrollments start to finish online. Although the site was never fully functional for the general public to complete the entire enrollment process online, the availability of some electronic enrollment was a huge improvement after months of relying solely on paper applications.
Despite the fact that Cover Oregon was the only exchange relying solely on paper applications for the first four months of open enrollment, its total enrollment numbers are around the middle of the road when compared with enrollment in other states – all of which were using much more efficient online applications for months.
Grandmothered plans can be renewed
Virtually all of the existing 2013 individual policies in Oregon were eligible for renewal into 2014. Moda Health Plan Inc. and PacificSource Health Plans allowed existing policies to extend until the end of March. And seven carriers allowed 2013 policies to be renewed until the end of 2014: Regence BlueCross BlueShield of Oregon, Kaiser Foundation Health Plan of the Northwest, Providence Health Plan, LifeWise Health Plan of Oregon, Health Net Health Plan of Oregon Inc., Time Insurance Co. and John Alden Life Insurance Co.
The renewal of 2013 plans into 2014 gave many Oregon residents in the individual market some breathing room as they waited for Cover Oregon’s website to improve.
Oregon is also permitting those pre-2014 plans to be renewed again this fall and remain in force throughout 2015, at each carrier’s discretion.
Exchange worked to cover risk pool members
The Oregon Medical Insurance Pool – a state run high risk pool – closed at the end of December, but the state implemented a temporary medical insurance program that automatically covered risk pool members who were not able to enroll in an exchange plan with a January 1 effective date.
The temporary plan remained in force until March 31, but ceased operation at that point. Insureds who were still covered under the temporary program lost their coverage at the end of March, but the risk pool had been working closely with members to get them transitioned to new policies, so there were very few people still on the temporary program at that point.
Cover Oregon’s history
The Oregon legislature authorized a state-run health insurance exchange in 2011, and the exchange developed a formal business plan, which the Legislature approved in February 2012 as a final go-ahead for the exchange. The U.S. Department of Health and Human Services (HHS) gave conditional approval to Cover Oregon in December 2012. The exchange has a 2014 budget of $105.7 million, which will be covered with federal grant money, and $62.4 million budget in 2015 according to a Cover Oregon spokesperson.
Cover Oregon is overseen by a nine-member board of directors, two of which are non-voting members. The board receives input from the Individual and Employer Consumer Advisory Committee. The 19-member committee holds monthly meetings, which are open to the public. The Consumer Advisory Committee was mandated by the legislation that established the state’s exchange.
Committee members are selected by the board and must include individuals or employers who will use the exchange, individuals who will enroll in state medical assistance through the exchange, minority groups, and representatives of organizations that will people purchase insurance through the exchange. All geographic areas of the state must be represented.
Cover Oregon is acting as “active purchaser,” meaning it limits the number of health insurers that can participate in the exchange. Participating insurers are required to offer a bronze, silver and gold plan and have the option to offer additional plans.
Contact the Oregon exchange
More Oregon health insurance exchange links
State Exchange Profile: Oregon
The Henry J. Kaiser Family Foundation overview of Oregon’s progress toward creating a state health insurance exchange.