Colorado capitol by Jesse Varner via Flickr
Being an early adopter can be rewarding. Remember how amazing it was to have the first iPhone? But then, sometimes early adopters pay a price, like that early version of the Apple map tool that led to some wrong turns.
Colorado is one of 14 states going through their own version of this with the health law. The first shot at signing up millions for health insurance wraps up at the end of the month, and the vast majority of states are using the federal marketplace, healthcare.gov.
Those states which built exchanges of their own took tremendous financial risks setting up the marketplaces, working out everything from insurance plan offerings to advertising strategies.
Some states, like Connecticut and California, are reaping the rewards, leading the country in signing up people for insurance. Others, like Minnesota, Maryland and Oregon, have spent lots of money only to see technology fumble, contractor turnover, and director resignations.
Then there are some states in the middle. The people who built Colorado’s health insurance exchange were sure that they were ahead of the game from day one. Months before the Affordable Care Act even passed, a big bipartisan health reform study group here had already concluded the state should create an exchange.
On Oct. 1, 2013, Connect for Health Colorado opened — and there were immediate glitches. As CEO Patty Fontneau explained at day’s end: “We did run into some intermittent error messages as people were creating accounts, and we did temporarily suspend the account creation while we solved them.”
By March 10, Colorado had signed up 90,000 people. It’s among the best-performing states, but its enrollment numbers to date are still below expectations.
There are lots of factors in judging enrollment success, says Avalere Health’s Elizabeth Carpenter.
“State based exchanges, a number of them have really performed, but to be honest a number of healthcare.gov states have also exceeded in our analysis, so there’s not at this point kind of a direct correlation between whether or not you’re a healthcare.gov state or you’re a state-based exchange state when it comes to your enrollment success, or lack thereof,” she says.
Ben Price with the trade group of health insurance companies in Colorado says the state is definitely better off for building its own exchange.
“Every day that we get further into this, we’re seeing more and more reasons it was good for us to go our own way and have a state level exchange,” he says.
Colorado’s insurers, worked closely with government agencies and consumer advocacy groups to build the exchange. They agree it’s been worth the effort, giving a broad array of interest groups the chance to influence things like the options users get on the exchange website as well as marketing plans for different audiences and parts of the state. When problems pop up, everybody pitches in and they get solved pretty quickly.
Price says a lot fewer people in Colorado would have health insurance now if the state had just used healthcare.gov.
“It’s not perfect,” he says. “We’d like to see higher numbers. It’s going to take some time and we’re working out the kinks. But I think we’re in a lot better shape than a lot of other states that chose to sit back and wait and see if the Affordable Care Act was going to stand, or just say, well, bring in whatever the federal government brings in.”
Some states ended up with healthcare.gov because their Republican governors and/or legislatures opposed it. But in Colorado, even some hardcore conservative lawmakers never thought that was a good strategy.
Amy Stephens represents one of the most conservative districts in the state, but she co-sponsored the bill that established the exchange. “I did not see the federal option as an option that was a good option,” Stephens says. “And to me, and to the business community, creating something here in Colorado with a state exchange close to home in a pro-market manner was the best solution for us.”
Stephens wanted the law to be repealed but thought Colorado needed a backstop.
“We don’ t want to have to call some federal government number for our own health care,” she says. “We want to decide it here. I think we’ve done a very good job.”
The federal government gave Colorado $187 million to build its exchange. State Republicans have had a hard time attacking it when it has buy-in from the business community, especially hospitals and doctors.
That broad base of support should serve Colorado well going forward, says consultant Elizabeth Carpenter.
“This was not a kind of, go, no-go 2014 decision, this was a decision that states made looking into the longer term,” she notes.
The longer term goal is getting as many people health coverage as possible. And Colorado, by building its own exchange, has managed to get groups that often disagree to continue to work together.
This story is part of a partnership between NPR and Kaiser Health News.