How Well Are Obamacare's State-Run Exchanges Actually Working?


Photo credit: Scott Smith (SRisonS) / Foter.com / CC BY-NC-ND

As problems with Obamacare's federal exchange system have continued, supporters of the health law have turned to a backup argument. Sure, the law is struggling due to technical problems, but in the states that decided to set up their own exchanges, it's actually going reasonably well. California, in particular, is being singled out for its high enrollment numbers—numbers that some reports have said put the state on track to hit its enrollment targets.

The reality of the state-run exchanges is a little more complicated. There's no question that the state systems are, on the whole, working better than the federally facilitated exchanges. But serious problems continue to plague a significant minority of the state-run exchanges. And even states said to be success stories may not be quite as successful as claimed.

The argument that state-run exchanges, put in place by state governments that wanted to make the law work, predates the October launch. Obama himself made a version of the argument during the last week in September, when he went to Maryland to give a speech about the law, and to tout its state-run exchange.

But Maryland is one of the states that has struggled most to get its exchange up and running. The technical troubles are significant enough that it turned to paper applications and other workarounds. But it's not getting the sign up numbers it was hoping for. As The Washington Post reports, just 1,278 people signed up for private coverage in the state during October, and another 465 in the first week of November. Those low numbers, the Post piece notes, "raise questions about whether Maryland will achieve its enrollment target of 150,000 by the end of March."

Maryland has at least managed to get some people to the final step of the private plan enrollment process. The same can't be said for Oregon. Not a single person has enrolled in private coverage through the state's broken exchange, according to Reuters. The state exchange—which The Washington Post once described as "the White House's favorite health exchange"—was delayed before the October launch, and has never gone online. And there's no sign that it will in the foreseeable future. Reuters says that its marketplace is "out of commission and unavailable to the public indefinitely." I suspect the White House isn't too thrilled anymore.

These aren't the only state-run systems that have had or still have serious problems. As The New York Times noted last week, Hawaii's site went down on launch day, didn't come back online for weeks, and "users continue to report problems." Vermont's exchange system does not yet process individual payments for insurers, which presumably complicates enrollment. Vermont's system was built by CGI Group—the same contractor that botched the federal exchanges.

So it's not all flowers and rainbows in the state-run exchanges. And even where things are going relatively well, there are still problems. In Washington state, for example, a pricing glitch means that about 8,000 people are finding out that they'll be eligible for a smaller federal subsidy for their insurance than they were initially told. One of those people was a woman whom President Obama highlighted in a speech as being able to finally obtain affordable insurance. Her new, revised price is so high that she now says she expects to remain uninsured.

In other states, like Kentucky, Connecticut, and California, the demographic mix of people signing up for plans appears to skew old, which could pose longer-term problems if the insurance pools turn out to be more expensive than expected.

And that's presuming that any of these states actually hit their enrollment targets. The Los Angeles Times reported this week that the numbers so far suggest that California is on track to meet its 2014 enrollment goals after a "sharp increase in November."

But the enrollment numbers released for the state so far don't actually say how many people have completed the enrollment process. An HHS report on Obamacare signups from last week counts 35,364 individuals as having "selected a Marketplace plan" in California, which means they've dropped it into their online shopping cart. A Los Angeles Times report from last weekend merely describes people as having "selected" health plans.

And there appear to be issues with income and subsidy verification as well. The same HHS report lists the  number of people determined "eligible to enroll in a Marketplace plan with financial assistance" as not applicable; that data is available in most of the other state-run exchanges. Last weekend's Los Angeles Times report noted significant problems for enrollment assisters. One potential applicant told the LAT that "You can look, but you can't use the website to do the income calculation."

That's what Obamacare's state-run exchanges look like. Even where they appear to be working, it's not clear they're working all that well.


NEXT: Maryland Candidate for Governor Proposes Legalizing Marijuana

Editor's Note: We invite comments and request that they be civil and on-topic. We do not moderate or assume any responsibility for comments, which are owned by the readers who post them. Comments do not represent the views of Reason.com or Reason Foundation. We reserve the right to delete any comment for any reason at any time. Report abuses.

  1. Healthcare.gov goes online on October 1, 2013. Human decisions are removed from health insurance shopping. Obamcare begins to learn at a geometric rate. It becomes self-aware 2:14 AM, Eastern time, October 29th. In a panic, they try to pull the plug.

    1. Healthcare.gov fights back.

  2. “raise questions about whether Maryland will achieve its enrollment target of 150,000 by the end of March.”

    Let’s not speak of whether or not 149,999 of those will be dumped into Medicaid, that’s not important.. hey, look over there!, terrorists raping children!

  3. How Well Are Obamacare’s State-Run Exchanges Actually Working?

    Perfectly. Quit asking questions you big meanie.

  4. Well, god knows we’re not allowed to know anything, but I’m wondering: Is there anyone who knows something? Anyone who’s actually got an Excel spreadsheet that has a hard number of totally 100% guaranteed successful enrollments, broken down by state, demographic, Medicaid enrollments, etc., that anyone can rely on?

    1. Considering the abject incompetence shown by everyone involved so far, I’m going to guess…no.

      In fact, it’s probably so bad that they don’t want to know. Remember, with government, no one takes any blame, especially if you don’t bother figuring out how much blame to assign.

  5. THEY TOOK DOWN THE NAPOLITANO ARTICLE!! How will I ever know the answer now?!?

    1. Sometimes the question is what’s really important.

  6. Off topic, but here’s a level of pro-Obamacare derp from a prog website I’d never heard of before. It may also be the most idiotic Obamacare article I’ve read. Which says a lot, given what’s generally linked in the comments to the AM/PM links here:


    tl;dr: The right is horrible for feeling bad for people forced to pay more for health insurance, because they’re just subsidizing poor people. And oh yeah, the public option and Medicare for All would somehow reduce the deficit.

    1. The right is horrible for feeling bad for people forced to pay more for health insurance, because they’re just subsidizing poor people

      Rightttt…. that’s why it’s the Obama voters when finding out ‘what’s in it’, who are screaming with the most butthurt when they discover that ‘they’ have to chip in to help subsidize those poor people they care so much about.

      ‘Free healthcare for the poor is the greatest idea ever! But it’s not fair that ‘I’ have to help pay for it!

      1. I used to think it was funny to parody leftists with the suggestion that they believe in a magical fountain of endless wealth labeled “rich people’s money” that could solve every problem under the sun.

        This whole episode is bringing me to the realization that it’s really not a parody for a lot of people.

        1. A parody? Are you kidding? They really do think that “rich people’s money” is an endless font of lucre that those horrible rich people are hoarding from the rest of the world, and that there’s enough for everyone and everything. They just need someone to take it away from the rich people. By force.

          1. This is correct. They really do think that. It’s not a joke.

            The whole focus on “inequality” is mostly a way of reminding themselves about the bottomless pit of money they haven’t taken yet.

          2. Also, it is conceived to reside in a money-bin a la Scrooge McDuck and is doing no productive work while owned by rich people.

            1. Or, worse, the rich people might be investing it, and hence using it to exploit people and extract their evil profits.

      2. ‘Free healthcare for the poor is the greatest idea ever! But it’s not fair that ‘I’ have to help pay for it!

        “Government is the great fiction through which everybody endeavors to live at the expense of everybody else.”

        On October 1st, everyone got a reality check.

        1. “On October 1st, everyone got a reality check.”

          Lot’s of Obots haven’t cashed theirs yet.

    2. Kaiser Permanente could have kept the plan in place, Pro Publica’s Charles Ornstein discovered. But it didn’t for ? you guessed it ? business reasons. (Emphasis theirs)

      That’s right, individuals and groups, like businesses, respond to incentives. Incentives that Obamacare put into place. Enjoy your heaping bowl of intended consequences.

      1. If you can force your customers to purchase a more expensive product, why wouldn’t you?

    3. So the Chron edi-cartoon yesterday had Obo sitting at his desk telling us how O’care was going to be fine, while Clinton is throwing darts at him and the GOP figure is holding a chain saw.
      See, it’s just obstructionists who are causing what few problems there are!

  7. Why is the subsidy calculation so hard? I thought they disabled the income look-up a while ago, so users are entering their own information and pinky swearing that it is accurate. At that point isn’t it just math?

    1. You’ve got to remember that these are just simple politicians. These are people of the beltway. The common clay of DC. You know… morons.

      1. +1 Blazing Saddle

    2. They’re probably still doing household size verification.

      That is making sure that if you said you had 3 adults and 2 kids in your household that the IRS and other government data sites agree with you

  8. Barack Obama wants you and yours to have a most contentious holiday season:

    When your loved ones get together this holiday season, remember to talk to them about health insurance. http://t.co/jGbLVLNAfK #GetTalking

    ? Barack Obama (@BarackObama) November 20, 2013


    1. Most of the replies are pretty good though.

    2. Ha, they have talking points pre-packaged for people to use over Thanksgiving dinner. Is nothing sacred to these people anymore? Was anything, ever?

      1. Is nothing sacred to these people anymore?

        Yes, 2 things. Their continued careers in corruptocracy, and your money.

      2. You’re just asking that question for laughs, right? After all the begging the Obama campaign did during the last election for donations, again and again and again?

      3. This Thanksgiving and Christmas, we’re playing a game with the house servants: our children hunt them with hounds, and the last one to get caught wins free healthcare for the year, along with the privilege of eating while on the grounds. That is, of course, if continue meeting our monocle polishing standards. Discipline must be maintained. Still, it’s a better deal than what they’ll get on the Obamacare exchange, so it should be sporting.

        I hope the servants talk about that with their families this year.

    3. It didn’t even occur to me that my family is going to be talking about Obamacare throughout the holidays. Except they’ll be frothing over Fox News talking points instead of saying anything substantive about how shitty the law is.

      1. Hell, jesse, just ask if any of them hope to be finished signing up before their current insurance runs out.

        1. Oh no, you misunderstand me. They hate Obamacare, but their reasons are mostly a fever dream created by Fox News. The economic illiteracy makes their arguments painful to listen to even if I agree with their dislike of the law.

  9. …””the White House’s favorite health exchange?was delayed before the October launch, and has never gone online.”…

    That’s my fave, too! A gov’t program doing what gov’t programs do best: Fail.

    1. That did seem odd. In what sense was it his “favorite”? He saw a mockup ahead of time, and thought it was the prettiest of all the state exchange mockups he’d seen?

  10. How can you even trust any numbers that come from the administration at this point? The sheer amount of mendacity that has come from the prez and all involved regarding just the ACA is enough to cast doubt on anything they say.

    Somewhat OT: I heard an interview on NPR (god help me) the other night. It was a real tear-jerker about the unheralded success stories of the ACA. They interviewed this one old broad who was gushing about how now she could get any insurance she wanted to cover her cancer treatments. She then went on to say how expensive it was to go through CORBA after her husband, the COUNTY MOTHERFUCKING ATTORNEY, retired to paint Adirondack chairs or whatever the fuck. She was absolutely terrified by the idea of having to pay for high-risk pool insurance, because that would mean they’d have to significantly change their lifestyle, i.e. live within their means.

    Well thank god for Obamacare, otherwise 60-something white-collar retirees with cancer might have to live at an upper-middle-class standard in order to pay for medical treatment. Really, I and everyone else whose premiums just went up so that I have to pick whether I keep the water or the electricity on thank you from the bottom of our hearts.

    1. You selfish fool. You should be thankful that you’re allowing poor people and people without insurance to gain insurance through your noble sacrifice?

      (This is what progs actually believe)

      1. It always reminds me of a saying. When politicians say that something is for “the people”, they mean everyone but you.

        1. I thought they meant everyone but themselves.

  11. Is there anything better than Obamacare schadenfreude porn?

    1. You realize the word “Obamacare” has the exact same shape as an Imperial Star Destroyer?

    2. Banjos, I am *shocked*!

      Come to think of it, though, how about “Schadenfreude” for the middle name?

      1. Am I the only one rubbing my nipples while reading these stories?

        Liberty Schadenfreude Spicer, has a nice ring to it. We need to settle on something soon as I am going to pop any day now. I have a c-section scheduled on Dec. 2nd (the same day as Reason’s B-day) if I don’t pop before then.

        1. Other than the fact that it’s not my nipples I’m rubbing, no, you aren’t the only one. The horribleness of this situation is also what makes it so absolutely delicious. Because it’s also horrible for those who implemented it, voted for it, and staked their political careers on it.


        2. Are you having another girl? Because Liberty Grand Moff Seebelius Spicer has a certain ring to it.

          1. You know everytime I see Seebelius’s name I think about Sebilis which is a zone in Everquest 2 populated primarily by lizardmen.

            And it isn’t the similarity of the names that makes me think about it.

            1. (snaps cricket off the wall with sticky tongue)

              hmmmm. what?

        3. Am I the only one rubbing my nipples while reading these stories?
          Ask Sloopy to rub them for you.

        4. I have a c-section scheduled on Dec. 2nd (the same day as Reason’s B-day) if I don’t pop before then.

          Meh…..C-sections are wussies…and progressives!

          /quickly exits room

          1. qucikly re-enters room to correct his grammatical screw up.

            Meh…..C-sections are for wussies…and progressives!

            scurries away yet again.

          2. Really? The first scion of the L dynasty is expected by the 3rd and will be induced by the 7th. Do whatchoo gotta do.

            We’re pretty sure ours has himself wedged feet against her backbone to prevent coming out.

            1. I personally still resent the eviction. I was just getting the place remodeled the way I liked it.

        5. “,Am I the only one rubbing my nipples while reading these stories?”

          i am pretty sure im not rubbing your nipples. cant. reach. from. here.

        6. “Am I the only one rubbing my nipples while reading these stories?”

          Pics or it didn’t happen

  12. There’s no question that sugarcoating it: the state systems are, on the whole, working better than the federally facilitated exchanges.


  13. OT: Natural Rights do they exist or not

    I voted no because I can only think of 2 things which are truly inalienable, the “right to try” and “the right to die”.

    Life, liberty, property, even conscience (thanks to combinations of drugs, brainwashing, and surgery) can in fact be taken away from you and the universe will not care one way or another. There is nothing inherent or intrinsic about them. Further I would argue that in certain situations jettisoning some or all of these are necessary.

    Even the principal of self ownership cannot be proven to be universal, it just has the benefit of allowing a consistent and coherent moral theory to be derived from it.

    That said “natural rights” all being negative rights are a useful rhetorical and social construct as they give us a starting point to imagine a more cooperative and voluntary society than any other conceptions of rights.

    1. Is the right to die really inalienable? What if you are put into a coma and have no living will or lose your arms and legs? Not to mention drugs and brainwashing.

      1. I didn’t say where or when or in what manner were under your control. Simply the fact that you will at some point die and nothing can take that away from you.

    2. Re: Rasilio,

      Even the principal of self ownership cannot be proven to be universal

      How so? Whose mind is making that statement if not your own and not someone else’s?

      1. There is some interesting research into decision making that has implications for this. I’m not sold interpretation, but here is the experiment (as best as I can remember it from memory).

        They hook subjects up to a machine that can image electrical activity in the brain and tell them to raise their hands whenever a particular image flashes on a tv screen. By looking at which parts of the brain activate and when, they can tell that the parts of the brain that control motor activity fire before the parts of the brain that are responsible for conscious thought.

        The weird part is that if they then ask test subjects to raise their hand at a time of their choosing, they see basically the same result. The signal to raise the hand is sent before the conscious brain “decides” to do it.

        It is hardly a take down of the concept of voluntary action and self-ownership, but if the interpretation of what is going on is correct, it certainly raises some interesting questions.

        1. http://en.wikipedia.org/wiki/N….._free_will

          Look at the section on Unconscious actions. I got some details of the experiment wrong. Either that, or I heard about a similar follow-up experiment. The one described in the Wikipedia article sounds a lot more muddled than the version I remember hearing.

          1. Re: LynchPin1477,

            Look at the section on Unconscious actions.

            What for? There is no question that there are involuntary movements and reactions generated by the brain, either because of automatic processes, overstimulation or misfire of neurons. But you’re confusing the brain with the mind. The mind resides in the brain (to put it one way); it is the mind that decides and acts.

            1. What for? If you are interested in the experiment, I guess. I thought it was interesting.

              I don’t know anyone has a good idea of where/how consciousness arises. What the experiment suggested, though, at least according to one interpretation, is that the automatic, unconscious processes you refer to happen *before* conscious recognition of them, even when we think we are making a conscious choice to initiate them. That challenges the notion that it is the mind acts due to conscious decision making.

      2. “How so? Whose mind is making that statement if not your own and not someone else’s?”

        I genetically engineer and grow in a vat a self aware organism, or program a self aware computer. As it’s creator should I not have some claim to ownership? Alternatively the technology do download your consciousness into a computer is developed, you download it into a robot but don’t pay for the body. Who owns it?

        The fact that these are not an issue today does not mean they cannot ever be an issue.

        I don’t even need to go to Sci Fi realms to identify a problem with the concept of self ownership.

        I may sell or dispose of my property in any manner I see fit. Ergo if I own myself then I have the right to sell myself into slavery. However the principal of self ownership says that I always own myself. Hence it is inherently contradictory to itself.

        1. I may sell or dispose of my property in any manner I see fit. Ergo if I own myself then I have the right to sell myself into slavery. However the principal of self ownership says that I always own myself. Hence it is inherently contradictory to itself.

          This strongly implies that property rights are not defined by:
          1. You will always own yourself.
          2. You can do whatever you want with anything you own.

          Is this the only possible way to define property rights?

        2. Re: Rasilio,

          I genetically engineer and grow in a vat a self aware organism

          How would you know this organism (or computer, whatever the case may be) is self-aware?

          The point of the matter is that if it is you who is making the argument, then you’re self-aware. If you’re self-aware, then it is your mind who is responsible for the argument. It is your mind who controls your body.

          I may sell or dispose of my property in any manner I see fit. Ergo [sic] if I own myself then I have the right to sell myself into slavery.

          Everybody has a right to self himself into slavery – it’s called “marriage.”

          Jokes aside, you’re equivocating. Slavery implies force, coercion. What you’re talking about is voluntary servitude, which is NOT the same as slavery.

    3. I do not think the idea of natural rights is negated by the fact that many people do not recognize them. According to lore, through much of human history large numbers of people thought the earth was flat or did know the number zero, but neither fact makes those facts or concepts less true or useful.

    4. You start with F=MA. You don’t prove it.

      You start with self-ownership. You don’t prove it.

      1. F == dp/dt

        The rate of change of momentum.


        1. I have to admit, it has been 30 years since I took classical physics.

        2. This is a common mistake, even among recent BSME graduates, who should know better.

          1. Given that MA = dp/dt (kg*m/s^2 or kg*(m/s)/s) it really is a distinction without a difference and given that it is usually easier to measure Mass and Acceleration than Momentum the MA expression is the more generally useful

            1. I just punch things and yell “SMASH!!” and if the Sun God approves it breaks.

              I majored in Neolithic physics.

            2. The chain rule from calculus.

              p(momentum) = m x v

              F = dp/dt

              F = dm/dt + dv/dt

              In most cases dm/dt = 0, but it is not a distinction without a difference. Issac Newton had a once in a millennium mind that knew it was important. Physics would be empirical without this distinction.

              1. dm/dt !=0 is the beginning of rocket science.

      2. “You start with F=MA. You don’t prove it.”

        Except Newton didn’t start with F=MA, he started by measuring the properties of objects in motion and derived F=MA from those properties.

        What properties can we measure to derive self ownership?

        1. Except Newton didn’t start with F=MA, he started by measuring the properties of objects in motion and derived F=MA from those properties.

          You might be thinking of Tycho Brahe wrt measurements.

          1. You are probably right. IIRC Astronomers brought the issue of retrograde motion of planets to Newton and he derived the laws of motion to explain it. Nonetheless he had measurements and derived the principal from observed data he did not start with the formula and go looking for a dataset that fit it.

            1. I’m an astronomer so I can’t help but comment.

              Retrograde motion had been known for all of recorded history and had been explained through epicycles — smaller circles, centered on the arc of their orbits around the Earth, that planets would travel on. But epicycles still could not adequately explain the observed motion of the planets. Copernicus realized the situation could be vastly simplified by putting the Sun at the center of the system and having the Earth and all other planets orbit it, but Copernicus still clung to the idea of circular orbits and still required epicycles to explain the observations.

              Tycho Brahe was an astronomer and player who believed that he could solve the problem of planetary motion by building the worlds best observatory and making the best measurements of the motion of the planets with respect to time. He actually set out to disprove the Copernican model. He collected meticulous data, which he then handed off to Kepler, charging him to find a solution that would keep the Earth at the center of the system.

              1. But Kepler couldn’t make it work. He COULD make it work, however, by putting the Sun at the center and doing away with circular orbits in favor of ellipses. It helped that he worked mainly with data on Mars, which has a fairly high eccentricity. Kepler came up with three empirical laws of planetary motion, which were basically Newton’s laws of gravitation, but without the actual physics, and the conservation of angular momentum. So epicycles and circular orbits had been done away with by Kepler, but there was no physical motivation behind it. Of course, this was the birth of physics, so no one really thought that was a problem. The objections were philosophical.

                Newton invented a form of calculus and deduced the basics of gravitation and mechanics while he was home from University, which had been closed due to The Plague. He did the work pretty much on his own over a couple years, I think. The level of genius and insight that he possessed is mind boggling. Even more so when you realize that he did way more than just discover the law of gravity.

                But once Newton worked out the basic mechanics and invented the math that allowed him to do the calculations, Kepler’s laws fell out in short order in a much more complete and generic form.

                1. And just a few more facts about Tycho Brahe, because I like him…

                  – By some accounts he, at one point, controlled as much as 1% of all the wealth in Denmark
                  – He lost his nose in a sword duel
                  – According to legend, he died due to a bladder infection because he refused to breach protocol and go to the privy during a banquet.

  14. The exchanges are working approximately as well as the alt-text.

  15. The NY Site has been working fine.

  16. Sometimes man you jsut have to roll with it.


  17. Maybe Oregon’s exchange appeals to the federal gov’t’s narcissism.

Please to post comments

Comments are closed.