Health 'navigators' see inconsistent performance from federal exchange

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The Obama administration has said the government's troubled website will function smoothly by the end of Saturday. Those paid to help enroll Americans in Obamacare remain doubtful.

From Florida to Alaska, the "navigators" designated to sign people up for insurance under the U.S. health-care overhaul say that while the online federal insurance exchange has improved in many ways since its Oct. 1 debut, outages and errors continue to prevent many from using it to buy their coverage.

The site is "kind of hit and miss," said Karen Basha Egozi of the Epilepsy Foundation of Florida, a U.S. designated navigator. "There have definitely been more hits lately than in the past. But I know there are cases where people still get locked out when they try to purchase a plan."

Tyann Boling, chief operating officer of Enroll Alaska, a unit of Anchorage-based Northrim Benefits Group, said she now rates the site a four out of 10, with 10 being fully functional. "It's got a long ways to go," she said., which serves 36 states including Florida and Alaska, was designed to help uninsured Americans buy new health plans by March 31, as required under the 2010 Patient Protection and Affordable Care Act. Delays and software problems, though, have plagued the site since its rollout, giving support to the law's harshest critics.

Enroll Alaska has signed up 52 people in health plans out of about 2,200 who have requested help since the site opened. Boling said she is mostly successful on the site with simple cases, like a single adult making a set income. For uncommon financial situations, "the website is not able to function at the capacity yet that capture the complications of people's lives," she said.

On a Nov. 27 conference call with reporters, Julie Bataille, a spokeswoman for the Centers for Medicare and Medicaid Services, reiterated the administration's pledge to have the site working smoothly for "the vast majority of users" by Dec. 1. Technicians working on the site will continue making repairs through the weekend, she said.

The government has added storage capacity to the data center and boosted processing power so it should be able to handle 800,000 visits a day and 50,000 users simultaneously, according to Bataille. Still, she said there will likely continue to be unexpected outages, periods of slowness and times when traffic is heavier than the site can handle.

President Barack Obama said the health-care law will "be a legacy I am extraordinarily proud of," during an interview with ABC News' Barbara Walters airing today on "20/20."

"Obviously my most recent concern has been that my website's not working," Obama said, according to a summary of the interview by ABC News. "We're evaluating why it is exactly that I didn't know soon enough that [it] wasn't going to work the way it needed to."

Recent fixes have made it possible for most consumers to create an account and calculate how much their insurance will cost, according to insurance brokers and non-profit groups helping people enroll. The breakdown often comes at the final step of purchasing a plan, they said.

That's caused some consumers to give up on the federal exchange with less than a month left for them to buy a plan that will put their coverage in effect on Jan. 1. Increasingly, people are bypassing the federal site and turning directly to insurers, even though that means they can't get immediate access to U.S. subsidies, said Raymond Magnuson, owner of Magnuson & Associates, a Tucson, Ariz.-based insurance broker.

"This week has become the breaking point," Magnuson said by telephone. "I have several clients this week that have said exactly that: 'I give up. I don't care what the federal subsidy is. Enroll me in a plan. I'll pay the premium.'"

In those instances, he said, they're guaranteed coverage for Jan. 1, "but they're giving up, in some cases, hundreds if not thousands of dollars in federal subsidies because of it."

Those buying directly through an insurer website would still have to go through to find out if they qualify for a subsidy, federal officials have said. If they're applying with the insurer by telephone, they can apply for a subsidy separately through the federal site and have it applied to their plan. The payment then is sent directly to the insurer.

While accessing the site may be easier as the result of recent software fixes, using it to figure out the actual cost of a plan can be problematic, said John Foley, supervising attorney for the Legal Aid Society of Palm Beach County, a navigator group in Florida.

Some of the data provided on consumer subsidies has turned out to be incorrect in individual cases so people may be charged more or less than they thought. There's no consistency, he said.

The Legal Aid Society has only managed to sign up 10 to 15 people out of "hundreds" who have come to the organization for help, according to Foley. Even those successes are questionable, he said, because the group hasn't yet heard that anyone has received notices from their insurers confirming enrollment.

"It's slow going," Foley said.

Lisa Hamler-Fugitt, executive director for the Ohio Association of Foodbanks, a navigator group, is telling people to log on in the evening after peak hours, recommending paper applications when people get frustrated and the call center, if necessary. "is improving, literally week-over-week and day-over-day," Hamler-Fugitt said. "October was homework month, November is window-shopping month. So we certainly hope December becomes 'let's buy it' month."

In the meantime, navigators are trying to keep consumers calm.

"The message we're giving people is be patient, that yeah, whenever you have something big, it takes awhile," said Sue Berkowitz, director of the South Carolina Appleseed Legal Justice Center. "But there's still time, and you can make this happen."

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With assistance from Bloomberg reporters Alex Wayne and Michael C. Bender in Washington.