When officials from the three states above, plus Minnesota, testified before Congress, they received a sharp rebuke from Rep. Darrell Issa (R-Calif.), according to The Globe:"To use a common platform would be common sense ... It makes no sense to ask vendors to duplicate the software but bill us twice, three times, four times for simply reinventing it."
Kentucky opted to build its own exchange, Kynect. As its technical leader, Chris Clark, said in an interview with FierceHealthIT, "No one understands the local health of the state better than Kentuckians."
Kynect's keys to success, Clark says, include making the office of the health insurance exchange a state agency, engaging with stakeholders, focusing on usability and spending the summer "head-down in testing." The site experienced some high volume on Oct. 1, 2013, but adding virtual machines addressed that, and the site experienced no technical issues thereafter, Clark says.
In the end, about 321,000 Kentuckians - more than 7 percent of the state's population - enrolled using Kynect. Seventy-five percent hadn't previously had health insurance. Given healthcare reform's goal of insuring the uninsured, Kentucky serves as a model for other states to follow.
Winners: Deloitte, Optum
Deloitte was behind the health insurance exchange websites in Connecticut and Kentucky - and, if Maryland's do-over is any indication, the consultancy will be building more sites.
Meanwhile, Maryland, Massachusetts and Minnesota are turning to Optum, the technology unit of the insurer UnitedHealth Group, to fix their exchanges. Makes sense, since Optum was instrumental in turning around Healthcare.gov, which the government declared "fixed" on Dec. 1.
(Minnesota, for its part, launched a buggy health insurance exchange on Oct. 1, and the MNsure site will be thoroughly audited - but the state beat its signup goal by 34 percent, and Minnesotans pay the lowest health insurance premiums in the country. Let's call the Land of 10,000 Lakes a draw.)
Despite hiccups, the Covered California exchange wins on sheer volume alone: More than 1.2 million enrollees, including 412,000 in March alone, plus another 1.9 million who signed up for the state's Medicaid program. (With 500,000 incomplete applications as of March 31, many a victim of poor site performance, California extended the enrollment deadline to April 15.)
At the other end of the volume spectrum: Hawaii, where fewer than 8,000 had officially enrolled by the March 31 deadline - so few, in fact, that state officials say the health insurance exchange website may not be financially viable, according to the WSJ.
Explaining why that number is so low gets to the technical problem: A backlog of 11,000 applicants who, for whatever reason, weren't able to complete registration by March 31. They're still eligible for coverage this year but obviously have to complete the process. If other states' failures are any example, these customers will do so over the phone or in person - which defeats the purpose of using the health insurance exchange website in the first place.
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