WASHINGTON -- The dead-tree version of health insurance enrollment is turning out to be surprisingly popular.
Unable to use new government insurance websites that have been plagued by technological problems, those tasked with helping the uninsured sign up for health coverage are bypassing the sites altogether, relying instead on old-fashioned paper applications.
It is a slow and labor-intensive substitute for what was supposed to be a snappy online application, similar to Amazon.com or Travelocity. But faced with a flood of people eager to get health benefits for the first time, what had been considered Plan B has become the plan -- at least until the sites are operating more reliably, according to consumer guides and community groups.
It is one way the frustrating, persistent glitches on some state websites as well as the main federal portal serving 36 states have had a ripple effect around the country. Community groups, insurers and consumers have been forced to adjust their strategy on the health care law, which entered a critical period Oct. 1 with the opening of the health insurance "marketplaces," also known as exchanges.
Insurance companies are steering people to their own websites, promising a smoother experience than healthcare.gov. Advocacy groups that planned to encourage people to enroll this month are also holding back, treating this period as an educational time instead.
In the case of the paper applications, the work-around could have significant consequences. Processing paper is likely to create more delays and will further complicate a process that was supposed to be one-stop shopping.
"We have gotten a few [applications] in -- by persevering," Carol Jameson, associate chief executive officer for HealthWorks of Northern Virginia, said in an email Friday. The nonprofit group operates health centers in three Fairfax County, Va. communities serving nearly 10,000 low-income patients. On Wednesday, a counselor was able to submit an application, "but it took four hours because the system kept shutting down," Ms. Jameson wrote. Virginia is one of the states relying on the federal exchange.
The Affordable Care Act, derided by critics as "Obamacare," requires most Americans to have health insurance starting Jan. 1 or face a fine. Initial open enrollment extends through March 31; the earliest coverage can begin is Jan. 1, as long as consumers sign up by mid-December.
But community groups and others working on enrollment have been dismayed at the severity of the problems on the federal exchange and on some exchanges run by states themselves.
Officials have declined to release enrollment data for the federal exchange. They have said they can handle applications that come in through their call center, online and by mail. Online bottlenecks are greatly reduced, and call center wait times are down from minutes to seconds, they said. In the first 10 days of operation, the federal website has received 14.6 million unique visits, officials said.
But getting online has been hard, even for special consumer guides known as "navigators" whose jobs are to sign people up for coverage. When navigators can't enroll consumers online, they offer people a choice: Come back another day or apply on paper. Many people choose paper.
"These are low- to moderate-income people, stopping by on their lunch break, between picking up their kids. They don't have time to mess with a website that doesn't work," said Marie Hurt, executive director of Southern United Neighborhood, a New Orleans-based charity that is helping people enroll in coverage in three states. She is encouraging people who stop by her center, inside a church, to avoid the federal website for now and use the paper enrollment form. "You don't want people to get frustrated and give up."
Timothy Jost, a law professor at Washington and Lee University who specializes in health policy, said filling out paper applications does give people the sense that the "process is underway," he said. But, he added: "It will add to delay. It will add to errors."
Personnel reviewing paper applications need to manually type data from paper into the same Web-based marketplaces that consumers are using. Reviewers are entering through a different "portal" than one consumers use. But it's the same online system.
"If you don't have a working [online] system, paper doesn't do you any good. It's almost worse because there's this illusion that you've finished something," said Kevin Counihan, executive director of the Connecticut exchange, Access Health CT. "When in fact, it's just getting stacked up waiting for the system to work."
The paper process is clunky and prone to errors. And it provides "a substandard user experience," he said. In the Connecticut marketplace, a completed paper application takes at least a week and a half to process, he said. "We get online in less than a second."
The Connecticut marketplace has performed well. So officials there are discouraging the use of paper (and faxes) and launching an advertising campaign in a few weeks to emphasize online enrollment, he said.
In the 36 states that make up the federal exchange, paper applications will be reviewed by Reston, Va.-based Serco, which received a $1.2 billion contract to hire 1,500 workers to do the work. Once a paper application is reviewed, the consumer will receive an eligibility determination in the mail, federal officials said. At that point, the consumer can log onto healthcare.gov, or contact the call center or a consumer guide to shop and enroll in a plan.
If consumers choose to log in online, they will need to start an application from scratch.
First Published October 12, 2013 8:00 PM