Maryland's Obamacare Website: Female Doctor, Male Patient Examination is... Funny?

    Via Maryland's Obamacare site: Watch this clip and imagine if a male doctor and a female patient were portrayed:

        Funny? Outrage? I honestly don't know currently in our society.


UPDATE: If the video above doesn't work for you, try this link.

After One Month, 1,284 Individuals Enrolled in Private Health Plans Through Maryland Obamacare Site

    The latest weekly report for the Maryland Health Connection reveals that the Obamacare marketplace for the state is continuing to under-perform versus expectations.  Two weeks ago, the state reported that through November 1, enrollment had reached 4,651 for the first month of open enrollment, and an additional 84,273 Marylanders would be automatically signed up for Medicaid as of January 1, 2014.  The following week, as I reported, the state withheld enrollment figures because the "Maryland Health Connection is revising its approach to providing numbers of enrolled Marylanders."  The current report reflects the revised approach and the result is rather stunning.  Only 1,274 individuals were enrolled in plans they had chosen during the first month of enrollment.
    A footnote in the weekly report explains the reason for the revised numbers:

In previous reports, we included Marylanders who chose managed care plans among “enrollments.” Because Medicaid coverage does not require plan selection (unlike coverage through qualified health plans), the eligibility determination is a better representation of insurance status than plan selection for this population. 

    Here is the official breakdown:

On Wednesday, the U.S. Department of Health and Human Services reported that from October 1 through November 2:  

• 10,917 applications were submitted in Maryland for coverage;
• Among Marylanders included on submitted applications, 5,923 were determined eligible for Medicaid and 3,498 were determined eligible to purchase private health insurance; and 
• 1,284 Marylanders had selected a health plan for enrollment.

    A chart accompanies the breakdown that shows enrollment by age bracket.  Included in the breakdown of the 1,284 Marylanders that have selected a plan are 108 listed as "< 18." This signifies that minors are included in the 1,284, meaning that the 1,284 literally represents totals persons covered by selected plans; the number of households coverage then would be somewhat less.
    Also revealed in the numbers in that in addition to the 84,273 automatically being added to Medicaid rolls, another 5,923 were determined eligible for the program as well, bringing the Medicaid total to over 90,000.  So for every one person enrolled in an individually selected private health plan, 70 have been added to Medicaid.
    Another worrisome aspect of the report is the rate of creation of verified accounts, the first step toward obtaining coverage through the exchanges.  Before the first two weeks were finished, 30,000 verified accounts were created.  But by November 9, that total had only grown to 53,000, an increase of 23,000 in twice the time.  After an average of 15,000 a week for the first two weeks, the increase slipped to about 6,000 a week since then.
    In spite of the problems, the report remained optimistic:

Through November 9, 1,743 Marylanders have chosen to enroll in private health plans through Maryland Health Connection. This is a 36% increase over the total through November 2.

     While 36% sounds substantial, it represents only 459 individuals.  Even if the exchange added 1,000 individuals per week for the remaining 20 weeks of open enrollment, the total as of March 31 would be about 22,000, far short of the 150,000 Maryland hoped to sign up during the first year of Obamacare.

Maryland Obamacare Exchange Suspends Bill Pay Option

    The insurance marketplaces established by the Affordable Care Act, or Obamacare, have been billed as a one-stop shopping experience.  However, in Maryland, two stops will be needed, at least for the time being.  Originally, individuals had been told that they would be able to make their first payment through the Maryland Health Connection, but this option has been suspended indefinitely, per a press release last Friday:

Bill payment. Accepting payment is not required of a state-based marketplace, and the Board approved deferring this option until after the core items are addressed. The ACA requires insurance carriers to be ready to accept the first payment from consumers, and our carriers are prepared to bill and receive the first payment from our enrollees.

    Although bill payment is optional for individuals per the Affordable Care Act, we reported back in September that, according to Betsy Charlow (communications manager for the Maryland Health Connection,) "employer bills get handled by Maryland Health Connection (federal requirement)," and not just the initial paymen, either.  Ms. Charlow went on to say that "the employer would not get multiple bills. The SHOP would aggregate all carrier bills so the employer can make one payment. The Maryland Health Benefit Exchange would then distribute payment to the appropriate carriers on behalf of the employer."
    If the exchange has delayed even the relatively simple feature of accepting initial payments from individuals to be remitted to insurance carriers, the more complex aggregation of premium billings from multiple carriers and the collection and distribution of those dollars on an ongoing basis will certainly require far more resources and planning.  As I reported at The Weekly Standard, the launch of SHOP in Maryland has been postponed until April 1, 2014.  The Maryland board is counting on the additional three months to make sure that the opening of the SHOP Marketplace does not mirror the debacle that accompanied the debut of the individual insurance exchange.

Maryland Obamacare Website Offline for a Day and a Half

    Just a few days after announcing a number of delays in various aspects of the Maryland Health Connection (MHC) website, the state's Obamacare website, a belated press release issued late Monday [update: apparently posted around 10 AM Monday morning] noted that the site would be offline for almost a day and a half, from Sunday night to Tuesday morning of this week.  The advisory reads in part:

    Attempts to set up an account are currently met with the following message:

    Although the advisory says this was a "planned update" and the current greeting calls it "scheduled maintenance," the most recent press release on Friday, November 8, made no mention of the current shutdown.  That press release, however, did mention the delay of the site's bill pay feature, as well as a three month delay in the opening of the SHOP (small business) exchange.  Also, as Speak With Authority reported on Saturday, the MHC also withheld updated enrollment numbers because the state is "revising its approach to providing numbers of enrolled Marylanders."

Maryland Obamacare Site Withholds Updated Enrollment Numbers

    Last week I noted on Twitter that the Maryland Health Connection had only managed to enroll 4,651 in the first four weeks of open enrollment.  That figure remains the latest available total because this week's report contained no update as the Maryland Health Benefit Exchange Board revises its approach to providing enrollment numbers.  Maryland's goal for the six-month enrollment period is 150,000, but at the current rate, only about 28,000 would be enrolled by the end of March 2014.  This graph from the Maryland Health Connection's November 1 report shows that the rate of signup had been relatively consistent for the first four weeks:

    This week, however, it is impossible to know if the trend improved or not because the Maryland Health Connection did not release any new figures on enrollment.  Totals were provided for unique visitors to the website, calls to our call centers, accounts created with verified identity, and those who have learned whether or not they are eligible for financial assistance.  However, revisions to the way enrollment data will be presented in the future precluded the release of an update this week:

Maryland Health Connection is revising its approach to providing numbers of enrolled Marylanders. Future reports will separate individuals versus households, qualified health plans versus Medicaid, and other information. For this reason, there is no updated enrollment data this week.

     One figure that has remained consistent throughout the reports is the 83,991 Marylanders who will be signed up automatically for Medicaid coverage beginning January 1, 2014.

After 10 Days, Maryland Obamacare Exchange Reports 1,121 Enrollments

    The Maryland Health Connection released updated statistics today for the state's Obamacare insurance exchange.

Unique website visitors, 10/1-10/10: 217,091 

Calls to call center, 10/1-10/10: 15,952 

Accounts created with verified identity, 10/1-10/10: 25,781 

Enrollment, 10/1-10/10: 1,121

    The report includes the follow graph on enrollments which does show some signs of acceleration:

    Based on total number of unique website visitors and calls to the call center, accounts with verified identity are running at 11%, and enrollments at less than one-half of one percent (.48%).

Obamacare Marketplace: Personal Data Can Be Used For "Law Enforcement and Audit Activities"

    Maryland's Health Connection, the state's Obamacare marketplace, has been plagued by delays in the  first days of open enrollment.  If users are able to endure long page-loading delays, they are presented with the website's privacy policy, a ubiquitous fine-print feature on websites that often go unread.  Nevertheless, users are asked to check off a box that they agree to the terms.
    The policy contains many standard statements about information automatically collected regarding internet browsers and IP addresses, temporary "cookies" used by the site, and website accessibility.  However, at least two conditions may give some users pause before proceeding.
    The first is regarding personal information submitted with an application for those users who follow through on the sign up process all the way to the end.  The policy states that all information to help in applying for coverage and even for making a payment will be kept strictly confidential and only be used to carry out the function of the marketplace.  There is, however, an exception: "[W]e may share information provided in your application with the appropriate authorities for law enforcement and audit activities."  Here is the entire paragraph from the policy the includes the exception [emphasis added]:

Should you decide to apply for health coverage through Maryland Health Connection, the information you supply in your application will be used to determine whether you are eligible for health and dental coverage offered through Maryland Health Connection and for insurance affordability programs. It also may be used to assist you in making a payment for the insurance plan you select, and for related automated reminders or other activities permitted by law.  We will preserve the privacy of personal records and protect confidential or privileged information in full accordance with federal and State law. We will not sell your information to others.  Any information that you provide to us in your application will be used only to carry out the functions of Maryland Health Connection. The only exception to this policy is that we may share information provided in your application with the appropriate authorities for law enforcement and audit activities. 

     The site does not specify if "appropriate authorities" refers only to state authorities or if it could include the federal government, as well.  Neither is there any detail on what type of law enforcement and/or audit activities would justify the release of the personal information, or who exactly is authorized to make such a determination.  An email to the Maryland Health Connection's media contact seeking clarification has not yet been answered
    The second privacy term that may prompt caution by users relates to email communications.  The policy reads:

If you send us an e-mail, we use the information you send us to respond to your inquiry. E-mail correspondence may become a public record. As a public record, your correspondence could be disclosed to other parties upon their request in accordance with Maryland’s Public Information Act.

    Since emails to the marketplace could conceivable involve private matters regarding finances, health history, and other sensitive issues, the fact that such information could be made part of the "public record" could prevent users from being as free with their information than they might otherwise be.  However, as noted, any requests for such emails would still be subject to Maryland's Public Information Act which contains certain exceptions to the disclosure rules.


Note: A version of this post first appeared at The Weekly Standard.

State of Maryland Enlists Students to Promote Obamacare

    On August 27, the Maryland Health Connection, the state's Obamacare Marketplace, retweeted the following from a parent with students in school in Maryland:

What my kids brought home from school on the first day @MarylandConnect @HCAMaryland pic.twitter.com/vNBloFhGYj
— Joshua Sharfstein (@drJoshS) August 28, 2013

     The parent, according to his Twitter profile, is Dr. Joshua M. Sharfstein, a pediatrician and the Secretary of the Maryland Department of Health and Mental Hygiene, but presumably children of non-state-health-officials were given the same flyer.  Here's a larger version:

    It's encouraging to know they are offering "unbiased" information.  According to the MD Health Connection, the state expects 180,000 Marylanders to sign up for coverage during the first year, so I guess they need all the help they can get.