For six weeks, trained experts at the Shepherd’s Center of Kansas City have waited to help thousands of uninsured residents obtain subsidized health coverage in the Affordable Care Act marketplace.
By the end of the first week of November, those experts had finished signing up eight people for insurance.
“We figured we’d have eight people on the first day. In the first hours,” said Pamela Seymour, the center’s executive director. “We continue to struggle” with the HealthCare.gov website.
Seymour’s experience played out across Missouri, Kansas and much of the country in the first month of the federal health exchange, according to figures released Wednesday by the federal government.
Just 751 Missourians were able to fully subscribe to health coverage through the exchange, the government said, while 371 Kansans completed the task.
By some estimates, between 400,000 and 500,000 residents in the two states could ultimately qualify for subsidies in the exchange.
The dismal numbers appear to reflect the national experience. Just 26,794 people across the nation completed the sign-up process in the federal exchange through Nov. 2, the government said.
State-run exchanges had better luck. In states with their own exchanges, 79,391 clients finished the enrollment process in the first month.
About one in four people nationwide who’ve enrolled in health coverage on the new insurance marketplaces have done so through the troubled HealthCare.gov website — even though the site serves 36 states.
New figures from the Department of Health and Human Services made public Wednesday showed that 106,185 Americans selected health plans through the exchanges from Oct. 1 to Nov. 2. The bulk of those signed up through state-run websites that serve 14 states and the District of Columbia.
Wayne Powell of Blue Cross and Blue Shield of Kansas City, which offers insurance through the exchange in Kansas and Missouri counties, said the poor enrollment was unsurprising “given the well-publicized problems with the federal marketplace.”
Politicians were quick to criticize the initial sign-up results confirmed by the numbers released Wednesday.
“The health care law is not ready for prime time,” U.S. Rep. Kevin Yoder, a Kansas Republican, said in a statement. “Mandated penalties on individuals who can’t sign up to replace their canceled health care plans should be delayed.”
Sen. Claire McCaskill, a Missouri Democrat, didn’t call for Obamacare changes. But she did criticize the botched rollout.
“The problems with the online marketplace are unacceptable and embarrassing,” she said in a statement. “This free market system has opened for business, but the front door remains locked. We need to get it fixed.”
While the numbers of the fully enrolled are low, there was evidence that Kansans and Missourians have interest in the health care offerings.
More than 14,000 applications were completed in Missouri, the government said, while roughly 6,000 Kansans filled out the form but did not buy coverage.
Seymour of the Shepherd’s Center said the sign-up process has improved in recent days, and traffic is increasing. Still, she said, only about 100 people have taken advantage of the center’s federally subsidized navigation services so far.
“Most people know that, when they come in to counsel with us, that the chances of actually getting signed up are slim to none,” she said. “If they do, it’s just a bonus. They do a happy dance.”
Wednesday’s report found California leading the nation with more than 35,364 enrollees. Word from the state suggested the pace of sign-ups has increased this month. California’s insurance marketplace Executive Director Peter V. Lee said nearly 60,000 people had signed up as of Tuesday.
The much lower federal enrollment figure was in line with the “very low” numbers that Health and Human Services Secretary Kathleen Sebelius projected in recent congressional testimony. Technical problems with the website have frustrated users. Many became stuck and were unable to create the personal accounts required for enrolling in coverage.
In a hearing Wednesday before the House Oversight and Government Reform Committee, David Powner, director of Information Technology Management Issues at the Government Accountability Office, said, “A delay in the (website) rollout would have made sense.”
But after six weeks of site repairs by government and private IT experts, HHS has begun asking those thwarted applicants to return to the website and try again.
In a telephone briefing Wednesday, Sebelius tried to put the best face on the disappointing start. The former Kansas governor and insurance commissioner said interest appears high.
Across all the marketplaces, more than 975,000 people have applied for coverage but haven’t selected a plan, according to the enrollment report. Marketplace open enrollment for individual and small-group coverage in 2014 runs until March 31.
“The promise of quality, affordable coverage is increasingly becoming reality for this first wave of applicants,” the health secretary said. “Interest is strong.”
The new enrollment data also found that nearly 400,000 marketplace applicants are eligible for Medicaid or the Children’s Health Insurance Program, known as CHIP. When coupled with the new marketplace enrollees, a full 502,446 people already are positioned to gain health coverage in 2014, which would cut the nation’s uninsured to less than 47.5 million.
“That is more than half a million people who, come Jan. 1, will no longer have to choose between paying the utility bill or paying for preventive care, who will no longer have to worry that a surprise illness might result in bankruptcy,” said Anne Filipic, president of Enroll America, a national organization working to sign people up for marketplace coverage.
Yet many in Missouri and Kansas, two states that chose not to expand Medicaid coverage, are likely to find that they make too much money to get the free government coverage and don’t earn enough to qualify for tax credits designed to make private coverage affordable.
The administration wants to enroll 7 million people into coverage by March 31 of next year, but the slow start for the federal exchange puts that goal in jeopardy.
Insurance industry consultant Robert Laszewski, president of Health Policy and Strategy Associates in Alexandria, Va., said the government is “in a deep, deep hole, not just in terms of enrollment but in terms of people having confidence in this program.”