By Katie Kerwin McCrimmon
High traffic clogged Colorado’s health exchange website and spurred long wait times on the phones Tuesday as potential customers rushed to investigate new health insurance plans.
Technology glitches and unexpectedly high interest around the country marked “go-live” for Obamacare as millions of people swamped the federal health exchange and state exchanges from New York to Rhode Island and California.
In some states, like Oregon, customers couldn’t use the online system at all. Minnesota limped online late in the day.
- On the phone: 1-855-PLANS-4-YOU (1-855-752-6749)
- Online: Connect for Health Colorado (mobile app will be available initially for Droid smart phones)
- Questions about Medicaid: Colorado.gov/Health
In Colorado, exchange managers gathered at their Denver headquarters just before 8 a.m. to switch the system on. They said about 79,000 individuals had visited the Connect for Health Colorado website and the website had gotten over 12 million hits by 8 p.m. on the first day. In the first hours, many customers could not create new accounts, and technology managers had to re-boot the system to try to handle traffic jams. They said the problems in Colorado related to high traffic rather than to software glitches with the complex system. By 8 p.m. they said 5,500 people had created accounts. Managers declined to say how many had actually purchased insurance.
Elsewhere around the country, Obamacare opponents urged people not to sign up lest they get hooked on the “government sugar” of health care. And conservative groups ran ads showing a menacing Uncle Sam conducting women’s health exams. But in Colorado, groups opposing health care were largely MIA while advocates celebrated “a huge, huge win for health reform.”
“This is not something you can put back in the bottle,” said Dede de Percin, executive director of the Colorado Consumer Health Initiative (CCHI), a consortium of advocacy groups around the state. “The Republicans shut down the federal government over Obamacare because they’re afraid people really do want health care reform.”
- Unique website visitors: 79,000
- Total web page hits: 12 million
- Calls and chats with Customer Service Center Representatives: 3,700
- Accounts created: 5,500
- Average call wait time: 3 minutes 49 seconds
Source: Connect for Health Colorado – Data from 8 a.m. to 8 p.m. on Oct. 1
De Percin said she was surprised by the overwhelming interest that caused system crashes.
“We didn’t just see it in Colorado. We saw it everywhere from Rhode Island to California,” she said.
Consumers are sending a powerful message that Obamacare opponents should heed, advocates said.
“What we’ve seen today is the overwhelming interest in Colorado in getting access to care so people can see their own doctor without unpredictable costs,” said Adam Fox, CCHI’s director of strategic engagement.
Added de Percin: “Ultimately the interest in access to coverage and care is not something you can manufacture.”
Online system offline for tax subsidies
In Colorado, shoppers cannot apply for federal tax subsidies through the online system for the first month. Instead they’ll have to call Colorado’s toll-free number, 1-855-PLANS -4-YOU (1-855-752-6749), which also was slammed on Tuesday.
About 190 customer service agents working at a call center in Colorado Springs handled about 3,700 calls and online chats throughout the day Tuesday, managers said. Exchange CEO and Executive Director Patty Fontneau said she was surprised by the high number of chats.
“We did run into some intermittent error messages as people were creating accounts,” Fontneau said. “We’ve been thrilled with the interest..It demonstrates strong consumer interest in our site. We expect this to grow over time.”
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At the peak, wait times were over 6 minutes as agents spent more than 10 minutes with each caller. Managers said the call times had improved later in the day and had averaged 3 minutes 49 seconds over the entire first day. Chief Operating Officer Lindy Hinman says she plans to evaluate whether Connect for Health has enough agents trained to handle the rush of interest.
Colorado’s exchange is a partnership between Connect for Health, a public entity that operates outside state government, and the state agency that manages Medicaid, the Department of Health Care Policy and Financing (HCPF). Colorado is one of the states that has opted for another key component of the Affordable Care Act, Medicaid expansion. The law allows coverage for a larger segment of lower-income people to qualify for Medicaid.
Overall, Colorado expects to add as many as 160,000 newly eligible Medicaid clients as Obamacare ramps up.
HCPF Executive Director Sue Birch said that more than 2,900 people had applied for Medicaid by late morning on Tuesday.
“Typically we’re around 1,500 a day. In the first four hours, we had 3,000. It’s definitely higher traffic,” Birch said. “We are so thrilled and pleased with how the day has gone.
“We’re one of the few states that have the functionality to make real-time determinations (if people qualify for Medicaid). This is a major distinction. It’s going really, really well,” Birch said.
Both Birch and Fontneau said the two entities had connectivity throughout the day. Melding the two systems has been a struggle, and last minute challenges prompted the delay in allowing Colorado customers to apply for tax subsidies online until November.
‘People are dying because they lack treatment’
Among those eager to sign up Tuesday morning was a refugee from Eritrea who has lived in the U.S. for three years.
“I’d like to have insurance. I’m a diabetic and I need medications and check-ups. Right now, after tomorrow, I will be out of one of my medications,” said the woman, 56, who asked to go by the name Leteberhan because she fears for family members still living her home country.
Leteberhan’s eyes welled with tears as she pondered a life of violence and religious persecution that spurred her to leave her country and come to Colorado with two grown daughters.
“We weren’t allowed to worship in my country. I’m a hard worker. I don’t like war, war, war. I have been through it all my life since I was a teenager,” she said.
She said several family members have died and others are in prison.
Now, she feels like she’ll be winning the lottery here if she gets health insurance, but still, she worries about others who won’t get it.
“This is humanity. It’s not only for me. I’m a human being in a big country. People are dying because they lack treatment. You have a lot of doctors, more than Africa, but you don’t treat people,” Leteberhan said.
She arrived at 9 a.m. Tuesday at the Colorado African Organization near her home in southeast Denver, one of several assistance sites around the state that is offering face-to-face help. There, Sara Maru was ready to help. Maru is from Ethiopia. Speaking in multiple languages, the two women embarked on a journey to sign up that would take hours.
At first, Leteberhan had to go back home to get pay stubs and tax documents in case she needed them to qualify for a tax subsidy.
She returned and, while two other men sat in the waiting room eager for help, the women had some trouble with the Connect for Health website.
“We can’t log in. I don’t know what’s wrong with Connect for Health. We created an account, but now we can’t log in with it,” Maru said. “I just tried to show her the plans.”
Then Maru tried a different avenue. She entered the woman’s name, Zip Code and the very low income she earns working as a caregiver and medication specialist an assisted living center. They got preliminary good news.
“It shows me she’s eligible for Medicaid. So we will start PEAK (the online Colorado system for Medicaid),” Maru said.
Leteberhan first came for help two weeks ago when Maru was still getting trained. Maru had done extensive outreach sessions at schools and public meetings for people who have come to Colorado from Eritrea, Ethiopia, Burma and Bhutan.
Maru has explained that even if she gets signed up immediately, she won’t be eligible to receive care until Jan. 1. Still Letberhan was the first person in line on Tuesday.
“I have the time. I’m off today,” she said.
She never had health problems until she came to the U.S.
“It’s strange. I became diabetic when I came here. I never had any history in my life. My grandma is 101. It’s stress,” she said.
After spending hours working on Leteberhan’s application, the women finally gave up on the first day. Leteberhan is considering going back, but also may not bother trying to sign up again. Most of all, she’d like to be able to go home to Eritrea to bring back herbs that might help her be healthier.
“I know the treatment, but I don’t have a passport to leave,” she said.
So, instead, until she’s covered, she’ll have to spend $60 to get an exam so she can refill her medications.
“It’s not like Africa. If I were in Africa, I would show (the pharmacist) the bottle and they would refill them for me,” she said.
Leteberhan is persistent and well educated. She has an advanced degree in international social science and speaks multiple languages including German, English, Italian, some French and two African languages. Still, the U.S. health system confounds her.
“I’m happy (I might get Medicaid), but I am unhappy also about how the rest of my community or the rest of Americans — even white people who are begging at the road — will do. I am concerned about them,” she said. “What if I qualify and somebody else is not qualified?”
Maru said she has been in touch with other refugees who do not speak English and have tried to call the Connect for Health number in recent weeks.
“It’s a long process. It could take hours for translation. Last time they called, they were told there was a waiting list and they would get a call back. They still haven’t gotten called,” Maru said.
Florian Ezui is a mental health specialist from Togo and a member of the board of the Colorado African Organization. He expects refugees to need a great deal of help.
“The population we serve is not going to be the first jumpers who are signing up for the Affordable Care law because they are still confused,” Ezui said. “We’re going to be working with them to lead them…but most are not going to decide by themselves.”
Latinos targeted for health care
Across town at Denver Health’s Westside Community Health Center, outreach workers who speak Spanish were trying to educate patients about the Affordable Care Act and encourage them to check out Connect for Health.
Olga Portilla was leaving an appointment with her 2-month-old daughter Brianna, when outreach worker, Evon Venitez of the group, Servicios de la Raza, stopped her to talk and hand out a Spanish flyer for Connect for Health.
Portilla currently has Medicaid for herself and her daughter, but is worried that it will expire.
“I have insurance but I have a lot of questions about whether I’ll be able to keep it,” Portilla said to Venitez as the two chatted in Spanish and Brianna dozed in her mother’s arms.
Venitez has been encouraging people to call her and is thrilled that her calendar is full of appointments.
“It’s going awesome,” Venitez said. “If you have questions, I’ll navigate the system for you.”
Latinos will be heavily targeted in Colorado as health reform goes into full effect because so many are uninsured.
“We’ve been having great conversations,” said Cristina Aguilar, interim executive director for the Colorado Organization for Latina Opportunity and Reproductive Rights, who also reached out to patients at Denver Health.
“We have about 800,000 uninsured in Colorado and about 680,000 of them are Latinos. The need could not be greater,” Aguilar said, as she handed out brochures in English and Spanish and urged people to take action.
Aguilar said the lack of insurance in the Latino community is fundamentally related to economics.
“There is a large number of Latinos who are living at or below the poverty line,” she said. Most have jobs that come without health insurance, so they spend little time seeking it out.
“They’re just trying to worry about getting food on the table,” she said. “Today is so important because there is finally an opportunity to access care.”
Dr. William Burman, executive director of Denver Public Health and a specialist in infectious diseases, also came to the Westside clinic to celebrate the launch of Obamacare.
“We finally are starting to address what has long been a gaping hole in our system,” Burman said. “One hundred thousand people in Denver lack insurance. That’s one in five people. We all pay for the care of those who don’t have insurance.”
Burman expects expanded care to improve the lives of individuals who get insurance, but also to help the business community and the greater community at large. Each year, Burman said the percentage of employers who are offering health coverage has declined. Expecting people with insurance to continue to cover the costs of the uninsured is simply unsustainable, he said.
“For those who are eligible, the news is good. They will get preventive care. For those with chronic diseases, like diabetes and asthma, they will get help navigating these diseases,” Burman said. “Today is a big day. I think it’s a really great day.”