Though the federal health insurance exchange — a marketplace created by the Affordable Care Act for people to purchase health care insurance — continues to face technical problems, the Rhode Island exchange has overcome some initial glitches, with advocates expressing optimism about its future.
The state exchange opened Oct. 1 in an effort to facilitate buying affordable health care, since the ACA also requires all Americans to purchase health insurance by Jan. 1 or incur a fee. The federal government created exchanges for states whose governors declined to create local marketplaces.
Rhode Island is one of 18 states plus the District of Columbia to have adopted a state-based marketplace and has had roughly 5,700 accounts created, with around 800 of those users having completed their health insurance applications, said Dara Chadwick, chief of strategic communications and media relations at HealthSource RI, Rhode Island’s marketplace provider. HealthSource RI has a goal of receiving 70,000 to 100,000 completed applications by the end of 2014, Chadwick said.
“We’re very pleased with the level of interest,” Chadwick said. “People are very excited.”
Angela Sherwin, program director of the University’s Executive Healthcare Leadership Program, echoed Chadwick’s sentiment.
“There is more interest than anticipated, and this has put (HealthSource) on a trajectory for higher participation,” she said.
But the Rhode Island Center for Freedom and Prosperity, a conservative think tank, has suggested the exchange will not in fact draw many consumers.
The center has “documented both the financial disincentives created by the ACA when it comes to purchasing insurance and identified and quantified the groups of people who are likely to remain uninsured, perhaps up to 97,000 Rhode Islanders,” the group wrote in a statement on its website. “As a result, Rhode Island should be prepared to see enrollment through the Rhode Island Health Benefits Exchange that is significantly below current expectations,” the center wrote in a report on the ACA.
Rhode Island’s exchange offers 28 health insurance plans, Chadwick said, and the process of selection is “personal, and something different for each individual.”
While HealthSource RI has led the creation of the exchange, the Rhode Island Office of the Health Care Commissioner reviews all the offered plans as well as the insurers included on the exchange to make sure they comply with federal law, said Kathleen Hittner, the state health insurance commissioner.
Rhode Island’s exchange includes plans offered by UnitedHealthcare, Neighborhood Health Plan and Blue Cross Blue Shield. Though those three providers already have strong presences in the state, Hittner said she thinks insurers from out of state may also enter the marketplace.
HealthSource RI has targeted primarily small businesses as well as families, Sherwin said.
Hittner added that she particularly expects young people to sign up for the exchange.
Nationwide, insurance reform efforts have tried to persuade young, healthier people to purchase coverage, since including them in the insurance pool can drive down the cost of premiums.
The size of the state changes the dynamic of health reform, Sherwin said.
“One of the nice things about Rhode Island as a state is that everybody knows everybody,” she said. “The exchange can facilitate conversations between hospitals, insurers and companies in no way that could be done before.”
Technical issues have plagued the establishment of marketplaces on both the federal and state levels. Nationally, the federal exchange suffered significant problems — many were unable to purchase insurance on the site’s launch date, and technical concerns have persisted over the past two weeks. That same day, Rhode Island’s exchange temporarily crashed. But HealthSource RI quickly added new servers, Chadwick said, and it has not faced similar issues since.
Though these issues may highlight the unanticipated level of interest, other potential problems lie within the state-federal health insurance partnership. “There has been a problem connecting to the government,” Hittner said, though she added that those issues were unrelated to the government shutdown.
Sherwin said Rhode Island’s marketplace launch went more smoothly than the federal government’s in part because of the state’s size.
“Rhode Island is smaller,” she said. “The federal government took on 34 states all at the same time. For them, it’s like the big bang.”
Sherwin and Chadwick also said the rollout of the exchange has been largely unaffected by the government shutdown.