Oregon might be seen as a complete failure or a surprising success when it comes to its health insurance exchange.
One the one hand, the state's website has yet to allow a single person to enroll. That's a big problem for the folks who are hoping to qualify for subsidies and buy insurance that will start Jan. 1.
But for the state's poorest residents, a workaround has helped 70,000 people secure coverage in Oregon's version of Medicaid. The state is one of 25 expanding Medicaid to adults who haven't previously qualified.
One of them is Kyle Thompson, who lives in the farming community of Jefferson. Since his work as a tile cutter ended during the recession, he hasn't been able to afford health care. But his two children qualified for Medicaid (the Oregon Health Plan), and the state had all the family's income and other details on file.
So when the state sent out about 260,000 applications to families like the Thompsons — with incomes less than 138 percent of the federal poverty level — to enroll them in Medicaid, they jumped on the opportunity.
"I filled it out. I sent it off. Me and my wife are really excited in having the health care coming up because it's not something that's been an option for us," he said.
Oregon Health Plan spokeswoman Patty Wentz says the letters were so successful, another batch will go out any day now. There's already been a big response. "People will call and ask if it's real," she says. "Can I really get health care coverage? When they hear that they can, they're so grateful. One call center staff told me that, the person she was talking to said, please tell everyone there, thank you, thank you."
Here's why the Medicaid side of this is working for Oregon: When the state set up its exchange website, it paid more than $43 million to software specialist Oracle to make a one-stop shop for health insurance for everyone in the state, including people buying private policies (with or without subsidies), children qualifying for the Oregon Health Kids Plan as well as the Oregon Health Plan (Medicaid).
"I guess one could argue in retrospect we bit off more than other states," Gov. John Kitzhaber recently said. But, he added "it was an intentional decision. We've got a single portal for Medicaid and for the people who are coming in that are not Medicaid eligible. And once we work out these difficulties I think the people in Oregon will be ahead of the pack."
Officials with the website says they're cautiously optimistic insurance agents and navigators will be able to help customers determine their eligibility for a tax subsidy and choose a health plan by Dec. 1.
But the public won't have access for a while, because of problems with the website. Instead, a series of application fairs have been arranged so that everyone can use old-fashioned paper to apply in time to get covered starting in 2014.
Meanwhile, in Texas, the get-out-to-the-people approach hasn't had much success. Only about 3,000 Texans have signed up for private insurance and the state isn't expanding its Medicaid program.
Navigator Alysia Greer has been trying to encourage sign-ups from a folding table in the lobby of a medical building in northwest Houston. As people walk by, she offers them brochures and asks, "Does everyone in your household have health insurance?"
Most walk right by, but Dorothy Green, who already has Medicaid, grabs a packet for a neighbor who doesn't drive. Greer helps Green, but her hands are a bit tied.
A Texas law doesn't restrict navigators yet, but it gives state regulators that option.
Texas Attorney General Greg Abbott says he's still concerned and has asked the Texas Department of Insurance to regulate the navigators. He thinks they might misuse confidential information they gather while helping people sign up for health plans. "We need to have better training for these people who are — may be completely unversed in how to deal with someone's private information," he says.
Alysia Greer takes issue with Abbott calling her unprepared. She says patient privacy and security were a big part of her navigator training, which lasted over 20 hours and involved several tests. She adds that Abbott may be unnecessarily frightening uninsured people.
"I do think it will scare some people away. Because there are a lot of people who are very influenced, of course, by what the attorney general and other people of political status say," she says.
Greer says when she assists people while using a computer, she turns the screen towards them and away from herself, and never even sees Social Security numbers or income information.
In any case, the Affordable Care Act prohibits disclosure of personal information, and imposes a $25,000 fine for doing so.
And navigators who did steal information would also face 15 years in prison under federal identity theft law. Nevertheless, the Texas Department of Insurance is currently working on more rules for the navigators in Texas.
This story is part of a reporting partnership among NPR, KUHF, Oregon Public Broadcasting and Kaiser Health News.
ROBERT SIEGEL, HOST:
We're going to two states now to get two very different views of the health care rollout. Oregon has embraced the health law. Though computer troubles have all but shutdown its own online exchange, the state has managed to enroll thousands of people into Medicaid.
AUDIE CORNISH, HOST:
But we're going to start in Texas where only about 3,000 people have signed up for insurance through the federal online exchange. Governor Rick Perry opposes the health law, and Texas is one of at least 16 states that is restricting navigators. They're the workers who help people sign up for health coverage. And that's one more reason advocates say in Texas, the ACA rollout has been especially rocky.
Carrie Feibel of member station KUHF in Houston reports.
CARRIE FEIBEL, BYLINE: Alysia Greer is a health care navigator. She has set up her folding table in the lobby of a medical building in northwest Houston. All she has with her are brochures, her smile and her voice.
ALYSIA GREER: Does everyone in your household have health insurance?
FEIBEL: Most patients walk right by but Dorothy Green stops. She already has Medicaid, but she grabs a packet for a friend.
DOROTHY GREEN: Yeah, my neighbor because she doesn't drive and she's asking me about it and I have no idea, you know, as well as the other folks, you know.
FEIBEL: Texas has already passed a law to restrict navigators but it won't go into effect until the insurance department writes the specific rules. Attorney General Greg Abbott says he wants more regulations that goes beyond those already in the Affordable Care Act. He fears navigators could misuse confidential information they gather while helping people enroll.
GREG ABBOTT: We do need to have criminal background checks. We need to have better training for these people who are maybe completely unversed in how to deal with someone's private information.
FEIBEL: But federal and state laws already address consumer privacy. And Alysia Greer says navigators learn about it during their training. She fears all this talk from politicians could damage the rollout effort.
GREER: I do think it will scare some people away.
FEIBEL: Justin Giovannelli, of Georgetown University, is tracking efforts by states to regulate navigators.
JUSTIN GIOVANNELLI: It's interesting to note that many of the states that have been relatively reluctant to act and implement the federal health law in many other respects have been fairly quick to adopt these laws and regulations on consumer assisters.
FEIBEL: He says some of the regulations may have a chilling effect, making it hard for navigators to do their jobs.
For NPR News, I'm Carrie Feibel in Houston.
KRISTIAN FODEN-VENCIL, BYLINE: This is Kristian Foden-Vencil in Portland.
Oregon's health insurance exchange webpage has yet to enroll one single person, but a workaround has allowed about 70,000 to secure coverage in Oregon's version of Medicaid.
Kyle Thompson lives in the farming community of Jefferson. He can't afford health care, he says, because his work as a tile cutter evaporated when the economy tanked. But his children qualified for state public assistance, so Oregon had the family's details. After the health care law passed, the federal government gave Oregon permission to send Medicaid applications to families like the Thompsons with incomes less than 138 percent of the poverty level.
KYLE THOMPSON: Me and my wife were just really excited in having the health care come up, because it's not something that has been option for us.
FODEN-VENCIL: Thompson got a letter in the mail, answered a few questions then returned it. Talk that nobody in Oregon has been able to enroll via the health insurance website has Oregon Health Authority spokeswoman, Patty Wentz, a little miffed.
PATTY WENTZ: You know, you've seen some national numbers about how people haven't enrolled in the new coverage available in Oregon. That's not accurate. We have 70,000 people.
FODEN-VENCIL: That's out of the 260,000 the state estimates are newly eligible for Medicaid.
WENTZ: That's often the number one question: Is that real? Can I really get health care coverage? When they hear that they can, they're so grateful. One call center staff told me that when she got one of the forms back, and they had drawn a big heart on it saying thank you for this.
FODEN-VENCIL: Oregon embraced the Affordable Care Act, and wanted the website to be a one-stop-shop for both private insurance plans and Medicaid. Governor John Kitzhaber was recently asked whether that might have been a stretch.
GOVERNOR JOHN KITZHABER: Well, I guess one could argue in retrospect we bit off more than other states. But it was an intentional decision. And once we work out these difficulties, I think the people in Oregon will be ahead of the pack.
FODEN-VENCIL: The public still needs to fill out paper applications instead of use the website to get individual insurance. But the state says the Medicaid letters were so successful another batch will go out soon.
For NPR News, I'm Kristian Foden-Vencil in Portland.
CORNISH: Both of those stories are part of a collaboration among NPR, local member stations and Kaiser Health News.
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SIEGEL: This is NPR News. Transcript provided by NPR, Copyright NPR.