Tuesday morning, the non-profit, non-partisan Kaiser Foundation, a longtime advocate for health care reform in America, began soliciting feedback from people in all 50 states and the District of Columbia who were trying to sign up for ObamaCare on its first day of operation.
In Rhode Island, the first response they received came in the form of a tweet from a person identified only as Annabelle Leigh, according to their report released later in the day. She wrote: "Rhode Island site working fine. So many choices at so many price points! Something 4 everyone. I'm ecstatic!"
Not a bad review for something that didn't even exist 33 months ago.
Despite being the focal point of a government shutdown at midnight on Monday, just eight hours later ObamaCare opened for the first time all across the country. And here, HealthSource RI (HSRI), the marketplace set up to enroll Rhode Islanders for affordable health care, many for the first time in their lives, was up and operating on Oct. 1 on schedule.
Although Tuesday was just the start of a six-month initial enrollment period, ending March 31, 2014, business was brisk. HSRI was ready to handle anyone in search of health insurance answers by phone, in person or on the Internet. Small businesses, those employing 50 full-time employees or less, could also get insurance information through a broker.
"By 3 p.m. we had handled 1,444 insurance inquiries by phone. We had 600 e-mails, and over at our Contact Center that just opened on Royal Little Drive, we'd taken 25 walk-ins," HSRI's Communications Chief Dara Chadwick said.
"Our website, healthsourceri.com, was averaging 3,000 views per minute. At one point it reached 6,000 per minute, and the system crashed. It was just too much. But we were right on it and added another server. We were back up and operating in less than an hour," she said. "That was an unscheduled little test, of sorts. Proves the system and our techs are ready to go."
A nearly perfect shakedown cruise.
Not everyone needs to look into HSRI. The vast majority of state residents are already covered by employer-provided insurance plans. Those over 65 have Medicare. Individuals and families whose incomes fall below 138 percent of the Federal Poverty Level have Medicaid. Others have a variety of insurance programs already – the VA, for example.
But for perhaps as many as 100,000 others, nothing has been available outside sometimes wildly expensive private insurance policies. And sometimes, no insurance was available at all. The only source of health care for them was at the emergency room of a local hospital.
The Affordable Care Act, ObamaCare, was designed to help solve that problem for many in America. And HSRI was custom-designed for the residents of this state. There are 12 different plans for families and individuals, and 16 for small businesses. Although the plans are made available through HSRI, the insurance policies themselves are written by insurance companies – Blue Cross Blue Shield, UnitedHealthcare, and Neighborhood Health Plan (soon to be joined by Tufts).
Rates are based strictly on a person’s age and the type of plan selected. Your health is no longer a factor; neither is your sex. People with a pre-existing condition – diabetes, cancer, asthma, etc. – pay the same premium for the same plan as a completely healthy person. Women pay the same as men. In Rhode Island, even smokers and non-smokers pay the same competitive premium.
The premiums themselves are substantially lower than many predicted. Many political pundits had warned of calamitous insurance premium "sticker shock."
That doesn't appear to be the case, even before additional discounts are figured in. People making up to 400 percent of the poverty level – that's up to about $46,000 if you're single, $62,000 for a couple or $94,000 for a family of four – get a subsidy to pay part of the cost of insurance.
"It's taken us nearly three years to put this program together," HSRI Director Christine Ferguson said. "A lot of talented people have devoted a lot of time and energy to get this launched. It's something government isn't used to. It was like developing a product for customers to buy retail. That isn't something you normally see a state doing."