The state announced Tuesday that it will stagger enrollment into insurance plans through its health exchange over several days in November as it tries to prevent a repeat of last year's debacle when the problem-plagued website crashed on the first day.
As a result, individuals won't be able to enroll themselves directly through the website until four days after the launch.
The gradual rollout will start with a preview Nov. 9, a week before open enrollment officially begins, when people will be able to browse health plans — something users couldn't do last year without creating an account.
A week later, on Nov. 15, the first sign-up event will be held at which people can enroll at a designated location that has not yet been identified. The next day the call center will begin operations so people can enroll via phone.
Authorized insurance brokers and navigators will have access to enroll residents on Nov. 17, and the following day caseworkers, health departments and social service agencies will begin enrolling people. Finally, individuals will be able toenroll directly on Nov. 19.
At a health exchange board meeting Tuesday, Isabel FitzGerald, Maryland's secretary of information technology, said the "staged rollout" was based on general best practices in information technology. It doesn't appear that any other state exchanges had such soft openings last year or have announced plans for them this year.
Officials insisted that they do not lack faith in the system's ability to perform, and testing of new technology adopted from Connecticut's exchange is going well.
"We can test, but we can't mimic unpredictable human behavior," said Fitzgerald, adding that testing involved many different and complex enrollment scenarios such as large families or households in more than one address. "We'll be able to see problems. The goal here is to get in front of them."
Exchange officials said they are trying to make the enrollment experience better for consumers. The state spent millions of dollars — much of it federal funds — to build the exchange, which had one of the worst launches in the country last year, the first year of federal health reform known as Obamacare. It was so bad that the state replaced the exchange's technology for its second year.
"We did hit all our milestones on target and on schedule," said Fitzgerald, who also addressed a legislative oversight panel earlier in the day. "I believe we have enough time to do the testing. I believe we'll be prepared for the launch."
The exchange has tested, for example, the site's ability to function with 2,000 concurrent users, and will soon test 5,000 or more users at once. Most pages are responding within a second, while more complex functions can take 2-4 seconds.
But Maryland faces a daunting challenge in getting the website running in time for its full-scale debut. Not only does the state face the task of enrolling an unknown number of new applicants, but it must also get out the word to another 60,000 to 70,000 people who enrolled through the exchange last year that they must go through the process again this year to keep their subsidized coverage.
Those people include many who experienced the agonizing system crashes, computer screen freeze-ups and repeated sign-on attempts last year before getting coverage.
Carolyn Quattrocki, executive director of the Maryland Health Benefit Exchange, said the exchange will use all avenues to reach consumers, including social media. She hopes those customers give the new web site a chance.
"We really do expect it will be a much easier experience," Quattrocki said.
Under current plans, individuals who must re-enroll to keep subsidies will have until Dec. 18 to do so. If they don't, they could be re-enrolled automatically in their current plans or similar plans and be responsible for their entire premium payments in January.
Despite last year's fiasco, state Health and Mental Hygiene Secretary Joshua M. Sharfstein said the overall implementation of the federal health care act was having its desired effect. He said that more than 400,000 people had received coverage since Jan. 1 and that the number of charity cases treated at Maryland hospitals had dropped more than 50 percent because more Marylanders have insurance.
Chet Burrell, CEO of CareFirst Inc., praised the state's "extraordinary effort" to rework its website. "The lessons from the first experience have been taken to heart," he said.
The head of Maryland's dominant health insurer coupled his praise with a dire warning, however. Burrell said a disparity between the relatively low rates for individuals under the Affordable Care Act and higher rates for people in small group plans threaten to force many small businesses to increase salaries and tell their employees to go to the exchange to get their own insurance.
CareFirst has been unhappy with the rate increases approved by the Maryland Insurance Administration for its plans next year. The insurer proposed a 22.8 percent increase in individual premiums, but Commissioner Therese Goldsmith allowed only 9.8 percent. Other carriers requested much smaller increases or decreases in rates.
The Insurance Administration said it is still reviewing small group rate filings and has not yet approved any rates. CareFirst requested smaller rate increases of between 5.7 percent and 6.7 percent, and was the only carrier to request an increase.
Burrell said the concern is when a small employer cancels group coverage, typically about half of the employees shift to the individual market.
"We don't know what happens to the other 50 percent," he said.
Del. Susan Krebs, a Carroll County Republican who sits on the oversight committee, also expressed concern that individual health plans were underpriced.
"You can't just hold them down artificially," she said.