Over the past few weeks, the implementation of a federal health marketplace in accordance with the Affordable Care Act has run into some significant start-up problems. The marketplace, of course, is a website that was set up for states that refused to establish their own health marketplaces for citizens to choose health plans and sign up for coverage. People who choose to get health insurance from the website are able to review a selection of health plans, see what subsidies are available to bring prices down to reasonable levels, and buy coverage.
Unfortunately, site designers failed to fully anticipate a number of issues – not the least of which was the overwhelming demand from Americans seeking coverage – and significant delays plagued the system early on. Happily, things have improved significantly in recent days; I was able to find an affordable, quality plan for myself in just 30 minutes yesterday. Moreover, increased staffing at the phone centers allows people to call 1-800-318-2596 and fill out an application with a trained assistant over the phone.
Perhaps not surprisingly in our politically charged era, however, the delays have provoked outrage in numerous circles in North Carolina (some real, some feigned) – especially from the President’s opponents. But as some may recall, a year ago the idea that people in North Carolina would be better served by a state-run health marketplace wasn’t a mystery on either side of the political aisle in our state.
Back then, the House Appropriations Committee chairman, Representative Nelson Dollar (R-Wake), said  “Clearly, the best thing for our state is to have a state-directed exchange [marketplace] as opposed to leaving it to the federal government and getting a cookie-cutter, one-size-fits-all program.” And state Insurance Commissioner Wayne Goodwin (D) explained why a state exchange was better than the federal one when he said, “So basically the consumer, when they could have easily, quickly done what they do now, which is contact us … will be calling 1-800-WASHINGTONDC [to talk to] someone that doesn’t know North Carolina, doesn’t know our people, doesn’t have accountability to respond quickly.”
As it turns out, Dollar’s and Goodwin’s criticism of Governor McCrory and the General Assembly’s eventual decision to reject not only Medicaid expansion in North Carolina, but also a state-run health marketplace, was prescient. While the federal health marketplace is only now getting up to speed, in states that established their own health care marketplaces, websites have generally been working well and people are enrolling in health coverage by the thousands.
For example, in California , just in the first week of operation, 29,000 Californians have already applied for coverage with an additional 27,000 applications pending. In the much smaller state of Connecticut  the marketplace has already processed almost 2,000 applications. In Kentucky , there are over 45,000 completed applications and more than 15,000 people enrolled in new insurance plans. In a recent CNN appearance, Kentucky’s governor said people in his state were signing up at the rate of 1,000 individuals per week. And in Washington state  nearly 25,000 residents have enrolled in health coverage and an additional 37,000 residents have completed online applications.
In short, in states that set up their own state-run health marketplaces, residents are signing up in large numbers in just the first few weeks. Sadly, North Carolina had the chance to join this success story, was on track to establish its own health marketplace, but was derailed by irrational anti-Obamacare fever.
Now, of course, it’s the same conservative North Carolina politicians who rejected the establishment of a state marketplace (as well as Medicaid coverage for our poorest citizens and $74 million in grant money to upgrade computers, run, and advertise a state health marketplace) who are complaining the loudest about the Affordable Care Act’s current federal website problems. Along with conservative advocacy groups like the Pope Civitas Institute, they are now complaining  about the problems with the federal marketplace website when it was they who led the charge against  the establishment of a state marketplace that could have prevented so many of the problems!
Let’s hope North Carolinians quickly see through this cynical and transparent behavior and demand a change of course from state leaders. It’s past time for the Governor and legislators to reverse their poor decision and establish a state-run health marketplace for North Carolinians as soon as possible.
Adam Searing is the Director of the North Carolina Justice Center’s Health Access Coalition .