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Tale of Two Obamacares as Some States Bypass U.S. Site

Tale of Two Obamacares Emerges as Some States Bypass U.S. Flaws
With many Republican-controlled states refusing to build exchanges, supporters of the law from Texas to Michigan to Florida have been relying on the troubled federal site and preaching patience, rather than enrolling the uninsured. Photographer: David McNew/Getty Images

Don’t tell Elisabeth Benjamin it’s tough to sign up for Obamacare. For two weeks, she has been enrolling uninsured people from her New York City office through an online marketplace created by the law.

Most recently, she helped a Bronx home-health worker in her 30s get health coverage for $70 a month.

“By week two, the system was pretty smooth,” said Benjamin, who’s certified to assist people signing up for health insurance.

In Texas, which has more uninsured than any other state, 90 health insurance navigators, doing the same job as Benjamin, haven’t been able to sign up a single person despite a flood of interest, said Tim McKinney, head of the United Way of Tarrant County.

The difference: New York built its own exchange website and it has been running with few technical troubles since the opening week while Texas, and 35 other states, is tied to a federal site plagued by errors and delays.

Three weeks after the sites debuted, a tale of two Obamacares is emerging with perceptions about the effectiveness of the Patient Protection and Affordable Care Act of 2010 varying widely from state to state.

With many Republican-controlled states refusing to build exchanges, supporters of the law from Texas to Michigan to Florida have been relying on the troubled federal site and preaching patience, rather than enrolling the uninsured.

Coming Deadlines

The state and federal exchanges are designed to sell health insurance to millions of Americans under the law known as Obamacare. More than half of about 500,000 enrollees since the Oct. 1 opening come from the 14 states running their own exchanges independent of the U.S. government. While enrollment continues through March, consumers must sign up and choose a plan by about Dec. 15 to get insurance coverage as of Jan. 1.

Elizabeth Watts of Kentucky, which runs an independent exchange, had her application accepted at 12:04 a.m. on Oct. 1, making her one of the first to start the enrollment process. Because of a rare disorder, she has already had a heart attack and a stent put in place. She makes $220 a week working at a Shell service station. Previously, the only insurance she could find was for $300 a month, which was too much for her to afford.

Using the exchange site, Watts learned she was eligible for Medicaid, the state-federal program for the poor that was expanded under the law and will cover most of her costs.

“It’s been such a relief,” said Watts, 31. The last time she saw her heart doctor, “it took 15 minutes and cost $160.”

Texas Troubles

It’s a very different story happening in Texas, said McKinney of the United Way that serves the Fort Worth area. Instead of enrolling consumers, 90 Texas navigators funded in part by a $5.9 million federal grant are spending their time answering caller questions and holding educational events. They haven’t been able to complete the enrollment process on the federal exchange website without encountering errors.

The navigators strongly encourage each caller and visitor to return next month, when McKinney said he hopes the problems will be resolved.

“We knew there would be problems, we didn’t know the extent of the problems,” McKinney said in a telephone interview. “By this time, we expected the navigators to be enrolling a pretty good number of people on the site. But that just isn’t happening.”

Slow Improvement

The delays that have plagued the federal website may be improving, according to Jodi Ray, a project director in the Tampa office of Covering Kids and Families, a nonprofit working to expand coverage. Florida residents must rely on the federal exchange.

Community groups helping to enroll the uninsured are seeing “much better results” on over the past week, said Ray, who heads a group of 10 navigator organizations for Florida. Until this week, the navigators were forced to rely mostly on the government’s call-in line and paper applications to sign up people. This week, they’re using the website more often.

“They’re definitely seeing improvement,” Ray said. “They have been able to get people all the way through to making a plan choice, if they want to go that far, or at least examining their options.”

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