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TIP SHEET: Investigating the Obamacare exchange in your state

Glitches, crashes and problems with the rollout of the federal government’s Obamacare exchange website have captured headlines across the country. Receiving far less attention are the exchanges in the states that chose to create their own.

About half the states are at least partially running their own exchanges with 14 of those fully divorced from the federal website. Are these exchanges accomplishing the goals for which they were created?

You can help uncover truth if you know what to look for:

What the numbers tell us
Accessible Documents
State Legislation And Regulations
The Exchange on Social Media
Advertising and Outreach Campaigns



What the numbers tell us

Most of the exchanges will periodically release data related to the operation of the exchange. Part of the challenge is to separate the wheat from the chaff in these numbers.

Site Visits: Site visits is not a very useful statistic. Especially with the high profile of the exchanges, many people visit them with no intention of purchasing insurance. So the number of visitors to an exchange site does not reflect the number of people interested in purchasing an insurance policy through the exchange.

Enrollment Applications: Other metrics may be a little more revealing but still fall short of telling the story. Enrollment applications started and applications completed are more useful than site visits, but there are still many people who go through the application process as an academic exercise or simply to satisfy their curiosity.

Insurance Plan Selection: Another number that may be released is the users who have selected a plan. This step is at least one short of enrolling in a plan and purchasing insurance, so this may overstate the number of people who have enrolled through the exchange.

Confirmed Enrollees: The most meaningful metric is the number of enrollees. Even when that number is available, more digging may be required to find out the whole story.

In order for the health care exchanges to achieve their goals, a certain number of people must purchase policies from the providers offering them on the exchange. So it is necessary to separate the number of people who have enrolled in Medicaid from the overall number. Medicaid enrollees do not actually purchase insurance through the exchange but participate in the government-run Medicaid plan.

Some states release these numbers much more frequently than others – some do not release enrollment figures, but only provide that number at the end of the open enrollment period. One source to obtain enrollment information is EnrollMaven.com, which compiles publicly-available data from media reports and from the exchanges themselves.

Accessible Documents

The board or committee that is in charge of creating and overseeing the exchange is a public body, subject to your state’s Open Records laws. In most states, the agendas and minutes from their meetings, reports, presentations, contracts, requests for proposals (RFP) and a host of other documents are posted on the exchange website.

The website that contains this information is normally separate from the website used to purchase insurance but can be accessed from there. For instance, in Nevada the website to purchase insurance through the exchange is nevadahealthlink.com, but the exchange website with documents and other information is exchange.nv.gov. The website healthinsurance.org contains links to some of the sites containing documents for each of the states.

These documents can contain a wealth of information. They can reveal how much money is allocated to set up and run the exchange and how that money is being spent, who is receiving or has received taxpayer money and for what purposes.

They can also contain reports that reveal the enrollment goals for the exchange, the number of navigators (who have access to enrollees’ personal information) to be hired and the requirements to gain this status. Additional reports may come from contractors hired to create and maintain the exchange and others with updates about the progress of the development of the exchange, detailing any problems or concerns they had during the process as well as how or if they were resolved.

State Legislation and Regulations

In each state that created its own exchange, a number of pieces of legislation had to pass to create the exchange, allow it to operate, and provide funding for it. In addition, regulations that implemented this legislation had to be developed.

Your state’s exchange website and your state Legislature’s website will likely contain the legislation and regulations that were adopted in order for the exchange to operate. Members of the exchange’s board may also have been required to submit presentations to your state’s Legislature with updates on the budget and progress of the exchange, which may include expenditures made and taxpayer funds received and other interesting information.

The Exchange on Social Media

In today’s world, many people take to social media to express their opinions about products and services. And many companies and government entities use social media to release statements and provide updates to the press and the public.

Many users of your state’s exchange may use the exchange’s Facebook page or their Twitter feed, for instance, to post comments, complaints and compliments about their experiences on the exchange and their opinions of available plans and prices and how those compare to their current plans. If you use any comments from a social media page, make sure you cite that in your story.

Advertising and Outreach Campaigns

Each state uses a variety of methods to advertise its exchange and encourage uninsured residents to enroll. States have contracted with marketing, advertising and public relations firms to promote the exchanges on television, radio, newspapers, billboards, community events, seminars and other avenues.

These contracts and the RFP that spell out the requirements of the contract may be available online or through an Open Records request from the exchange.

In addition to these marketing, advertising and public relations firms, some states have awarded contracts or grants to community organizations, unions and other groups in order to promote Obamacare and the exchanges. Documents available from the exchanges can reveal who these groups are, how much they are awarded and the conditions they are expected to adhere to.

Michael Chamberlain

Michael Chamberlain is the Editor of Watchdog Wire - Nevada. Please contact him at Nevada@watchdogwire.com for story ideas or to get involved in citizen journalism in Nevada. Follow Michael on Twitter: @michaelpchamber

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Categories: Government Transparency, Healthcare, Quick Tips
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