State health exchange swamped with enrollees

Affordable Care Act
In response to higher-than-expected demand, the Covered California exchange said it is adding staff and expanding its capacity to answer consumer calls. Consumers get information on health plans at an enrollment fair in Pasadena last month.
(David McNew, Getty Images)

California’s health exchange is struggling to keep pace with a surge of applicants who are encountering long waits and website problems as they try to meet a Dec. 23 deadline.

In response to higher-than-expected demand, the Covered California exchange said it is adding staff and expanding its capacity to answer consumer calls. It received 17,000 calls in less than an hour Wednesday, more than it received in an entire day in recent weeks. The exchange is also trying to dig through a backlog of 25,000 paper applications filed in October and November.

Dec. 23 is the sign-up deadline to have insurance starting Jan. 1, and consumers must pay the initial monthly premium by Jan. 5. After that, enrollment in the exchange lasts through March 31. The state postponed the initial payment deadline to Jan. 5 to give cash-strapped consumers more time during the holidays.

“We have been running strong all week, and at times we have exceeded the capacity of our phone lines,” said exchange spokesman Dana Howard. “The demand is more than we projected. But the bottom line is folks will be able to get themselves enrolled for Jan. 1.”


During the first two months of enrollment under the Affordable Care Act, California consistently outperformed the federal marketplace in 36 other states. Through mid-November, the state has enrolled nearly 80,000 people in private health plans, and 140,000 more appear to have qualified for Medi-Cal, the state’s Medicaid program.

But experts warn that even Covered California could be overwhelmed by a surge in applicants the next two weeks.

“Running into these difficulties can discourage people from signing up, and it doesn’t bode well for future enrollment,” said Shana Alex Lavarreda, director of health insurance studies at the UCLA Center for Health Policy Research. “It remains to be seen whether everyone can get through.”

Health insurance agents, key allies of Covered California so far, are also voicing frustration. The California Assn. of Health Underwriters expressed concern Thursday about the exchange failing to process about 25,000 paper applications that agents had submitted weeks ago.


The exchange said those paper applications were filled out in October and November when many agents were unable to access the state’s online enrollment system. Howard, the exchange spokesman, said the exchange will be working with agents to manually enter that paperwork into the state’s computer system and fill in additional information needed to complete the enrollment.

“We have to make a stronger effort to get those applications done with the deadline approaching,” he said.

The agent group said it can take up to 90 minutes to re-file an application, and they worry there won’t be enough time before Dec. 23 to complete that task while also serving a flood of new customers.

“Agents are fully committed to work with Covered California to resolve this crisis,” said Sam Smith, president of the state health underwriters group.

Some consumers trying to enroll on their own still run into numerous roadblocks.

Ben Amante of Costa Mesa said he was eager to sign up through Covered California because the Platinum plan he picked out for himself and his daughter will be about half what he pays now for health insurance through his wife’s employer.

But his experience quickly soured. He tried unsuccessfully for two days this week to enroll on the state website. Then he waited for more than a hour to reach a person at a call center Thursday, going through multiple phone numbers listed on the website.

At one point, he was told he was behind 195 other callers. He said that after six hours he was able to enroll.


“I don’t think the average person could get through the process,” said Amante, a self-employed business consultant. “California still has a lot of work to do. We need Jeff Bezos,” referring to the founder.

California said the average wait time for customers at its call centers climbed to 25 minutes last week, up from 18 minutes the week before. To improve service, the state opened a third call center in Fresno late last month, and it has more than 600 employees overall assisting consumers.

Many of the 1 million Californians who are losing their existing coverage Dec. 31 because it didn’t meet all the requirements of the Affordable Care Act are eager to find a replacement policy in time. Last month, Covered California rejected President Obama’s call to allow insurers to extend policyholders’ current policies for a year.

Ruth Honegger, a small-business owner in Los Angeles, got one of those cancellation notices for her family’s coverage. She went shopping for a new health plan, and the state website initially gave her the wrong premium, double what it should have been. Other consumers reported a similar discrepancy over the last week when seeking a rate quote online.

State officials said they were addressing the glitch. Honegger was eventually able to enroll her family of three in a Silver plan from Blue Shield of California for $649 a month, discounted thanks to a federal premium subsidy. That represents a substantial savings compared with the $1,200 a month she pays now.

“That was kind of a big mistake to get figures that are twice what it really is,” Honegger said. “I started to freak out and think we can’t afford this.”

Twitter: @chadterhune