Nov. 5—Hospitals across the country that were supposed to lead the enrollment of beneficiaries through new health insurance marketplaces had limited early success due to technological failings and other obstacles.

The health insurance marketplaces, also called exchanges, were created by the Affordable Care Act (ACA) to offer individual and small group coverage in each state. The marketplaces are designed to provide a place where most Americans who the law requires to obtain qualifying insurance—starting in 2014—could obtain it. 

Hospital groups pushed for enactment of the law, and Obama administration officials urged them to take the lead in implementing its central provision: enrolling 16 million people in 2014 in either private marketplace plans or Medicaid coverage. Hospitals have responded by signing up as both “navigators” and certified application counselors (CACs)—both of which require federal training and certification to begin signing applicants up for coverage.

But in the first weeks of enrollment, highly publicized technical failings of the federal and state marketplace enrollment websites blocked hospital navigators as thoroughly as the public in processing online enrollment.

Hospitals Try to Lead Enrollment

In August, eight hospitals and health systems were among 105 organizations nationwide to receive the navigator designation, which also came with federal funding to hire temporary personnel trained to steer the uninsured to insurance coverage. However, they struggled to provide marketplace enrollment assistance in the first few weeks following the Oct. 1 start of the 2014 enrollment period.

For instance, the 50 navigators at Wishard-Eskenazi Health, which is owned by the Health & Hospital Corporation of Marion County, Indiana, were unable in the first days to access the federal site——which was set up to enroll applicants in the 34 federally run marketplaces. 

“We have preached patience to our consumers,” said Jordan Jaye, director of patient access services at Wishard.

In the meantime, the health system, which received a $590,985 grant, focused on outreach education to the public, as well as training more navigators. Despite the technical roadblock, officials at Wishard still expected to hit their goal of 80,000 enrollees during the six months of open enrollment because they are more than doubling their originally planned number of navigators to 110.

Open enrollment lasts until March 31, 2014, but shoppers must complete applications by Dec. 15 for coverage to start Jan. 1, 2014.

The eight navigators at Memorial Hospital of Laramie County, Cheyenne, Wyo., also had not enrolled any applicants through the exchanges nine days after enrollment began, but that was because none of the state’s 83,000 uninsured had yet sought coverage, an official said. Since the start of enrollment, the Wyoming navigators, who were awarded $401,281, also have focused education and outreach, Tracy Brosius, the hospital’s community grants operations manager, said in an interview.

Brosius said the navigators anticipated technical problems would be likely in the early days after the federal website was launched, so they had planned to spend the first few weeks explaining the options to target populations and making sure they had the personal information that will be needed to enroll for coverage. They anticipated beginning enrollment in earnest by late October. “So [federal website failure] hasn’t affected our plans much,” she said.

Bigger obstacles emerged for Genesis Health System, Davenport, Iowa, which was awarded $265,713 for navigators at its hospitals in Iowa and Illinois. Craig Cooper, a Genesis spokesman, said the health system’s inability to enroll any applicants in the first week and half of open enrollment stemmed from delays in their navigators’ licensing.

“It’s been frustrating to get through the process of getting the navigators licensed,” Cooper said about both federal and state requirements on the application assistors. “It’s been kind of a slow start.”

The system had hired three navigators, but due to the lack of licensing, they were only been able to provide applicants with basic information and not enrollment assistance.

CACs Also Affected

The problems also affected CACs, which are similarly certified as navigators to provide enrollment assistance but without any federal funding.

The importance of hospitals participating as CACs was underscored in a Sept. 16 webcast with hospitals nationwide, in which Mandy Cohen, MD, senior adviser to the administrator of the Centers for Medicare & Medicaid Services (CMS), joined the leaders of the three largest hospital advocacy organizations to urge all hospitals to enroll in the CAC program.

Officials at St. Francis Health Center, Topeka, Kan., a CAC program participant, reported Oct. 9 that they had been unable to enroll any applicants due to the problems at the federal website. The technical problems also kept the CACs at the hospital from setting up their administrative accounts at

A regional official from the U.S. Department of Health and Human Services contacted the hospital to ascertain its experience but was unable to provide a timeframe for full functionality of the federal website, a hospital official said.

Another CAC program, Methodist Health System, Dallas, Texas, reverted to paper applications in the first days of enrollment due to problems with the federal website, according to a spokesman. Methodist officials believe their guidance to consumers resulted in up 20 people gaining coverage within the first nine days of open enrollment. The health system also has been referring applicants to a local navigator in the hope that the navigator would have better access to coverage tools.

Problem Size and Solutions Unclear

The extent of the enrollment problem is just beginning to become known, even as the Centers for Medicare & Medicaid Service (CMS) touted 8.6 million visitors to the federal website in the first three days after the enrollment period began. Although CMS declined to provide enrollment figures—including navigator and CAC enrollment—until sometime in November, an Obama administration memo released by the House Oversight Committee states that just six people enrolled on the Oct. 1 start date and 248 people had enrolled by the end of the second day of enrollment.

Officials at CMS said they continue to add server capacity while updating software to make the site better able to accommodate large numbers of users.

But similar problems have apparently occurred on the enrollment websites of the 14 states running their own exchanges, with some similarly refusing to report enrollment figures and at least two—Hawaii and Oregon—delaying online enrollment. 


Rich Daly is a senior writer/editor, in HFMA’s Washington, D.C., office. Follow Rich on Twitter @rdalyhealthcare.


Publication Date: Tuesday, November 05, 2013