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On State Heatlh Exchanges, Some Successes, Some Failures


There has been a surge in the number of people signing up for health insurance on the California exchange. By mid-November, nearly four times as many people were signing up each day than when the exchange was opened. That's better, though the numbers are still shy of what the Obama administration had originally hoped for.

California is one of 14 states, along with the District of Columbia, operating their own insurance marketplaces. Some, but not all, of those states have been able to keep signing people up even when the federal government's website is out of service, as it was again on Wednesday. While some state websites are seeing a boom in traffic, others are still struggling.

NPR's Scott Horsley has been keeping tabs on the state exchanges, and he joins us now. And, Scott, at last count, there were nearly 80,000 people who had signed up for health care coverage through the California exchange, more than any other state. Of course, it is the most populous state in the country. Where else are we seeing big numbers?

SCOTT HORSLEY, BYLINE: Mostly, Kentucky has enrolled a lot of people, so has Washington State. Like California, both of those started out with a lot of uninsured people. Connecticut has also posted some strong enrollment numbers. If you adjust for population, though, the state that leads the country in signing people up is Vermont. Now, only about 4,000 Vermonters have enrolled through their state's exchange. But for a small state with just over half a million people under the age of 65, that's a big pretty big achievement.

BLOCK: So big numbers for Vermont. Which states, though, are lagging in the enrollment race?

HORSLEY: Well, of course, there are a lot of states that have resisted the health care overhaul, and many of them are relying on that federal website, which continues to have its problems. So, for example, a big state like Texas, which has a lot of people who need health insurance, has only seen a very small number who've managed to sign up through the federal website.

But there are also states like Oregon and Maryland, which thoroughly embraced the health care law. They both set up their own exchanges. They even came up with catchy jingles to promote them. And yet, because of technical problems, those states have really struggled to sign people up. Oregon's website is not working at all and Maryland, at last count, had signed up fewer than 2,000 people.

Hawaii has also had big problems. And just today, that state announced that it is replacing the executive director of its online exchange. Hawaii's website, by the way, was built by CGI, one of the lead contractors on the federal website. It's been plagued by problems. And so far, Hawaii has signed up just 257 people.

BLOCK: Well, what can we learn - if you look at these examples, state by state, what conclusions can you draw?

HORSLEY: On one hand, a state like Kentucky or Vermont shows that even with all the well-publicized problems that the federal website's had, it is possible to make these online insurance markets work. That is the model of having private insurers compete for business is not by itself fatally flawed. It just has to be executed properly. And in general, the states that are succeeding are those where the websites are working more or less as advertised.

Then on the other hand, states like Oregon and Maryland, and for that matter, the federal site, show that just having good intentions is not enough and neither is a catchy jingle. Building these online marketplaces is a big and challenging task and, obviously, some states have done a better job at it than others.

BLOCK: Now, Scott, the federal government is only releasing enrollment figures for its website on a monthly basis. If you look at the state exchanges, do they give us more of a real-time look at how the sign-up process is going?

HORSLEY: They do if you're willing to do some legwork. Not all these states track enrollments in the same way. So, NPR's talented intern, Rachel Quester, has been very persistent in ferreting out some of these numbers for us. What we do see in states like California is an acceleration in the pace of sign-ups. So more people enrolling each week than did the week before. The California exchange also gives us an early snapshot of who is signing up. Not surprisingly, older people, those between the ages of 45 and 64, have been among the most eager to enroll. And they are disproportionately represented in the figures from the first six weeks or so.

On the other hand, younger people are not shying away - 18- to 34-year olds in California have been signing up in numbers roughly proportional to their share of that state's population.

BLOCK: And that's key, Scott, right, if these exchanges are to work financially?

HORSLEY: You've got to keep the young, healthy people in the mix.

BLOCK: OK. NPR's Scott Horsley at the White House. Scott, thanks so much.

HORSLEY: My pleasure. Transcript provided by NPR, Copyright NPR.

Scott Horsley is NPR's Chief Economics Correspondent. He reports on ups and downs in the national economy as well as fault lines between booming and busting communities.
As special correspondent and guest host of NPR's news programs, Melissa Block brings her signature combination of warmth and incisive reporting. Her work over the decades has earned her journalism's highest honors, and has made her one of NPR's most familiar and beloved voices.