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This is MORNING EDITION from NPR News. I'm David Greene.
STEVE INSKEEP, HOST:
And I'm Steve Inskeep. Good morning. We have another plot twist this morning in the gigantic, long-running dramatic series that is the rollout of the Affordable Care Act. In previous episodes, you will recall, a federal website for selling health insurance did not work very well. Its operation has since improved, which allows us to focus attention next on the websites run by many states.
Some of them are working quite well, as we've heard. For example, California says it has already met its projection, even exceeded its projection, for the number of people who will sign up during the six-month enrollment period, even though that enrollment period is not over. Some of the other 13 states, however, which run their own health exchanges are still having serious difficulties. That's the news. NPR's Julie Rovner reports.
JULIE ROVNER, BYLINE: So what makes a state health exchange successful? Joel Ario says the ones doing best are generally the ones doing the least.
JOEL ARIO: The states that said this is complicated, we're going to focus on the most essential issues, those were the states that tended to do better.
ROVNER: Ario, who helped launch the exchange program for the federal government and now consults for states and others working to implement the health law, puts in that successful category not just California but also Kentucky, New York and Connecticut. In fact, he says, he was recently on a panel with the head of Connecticut's exchange, Kevin Counihan.
ARIO: And he said: We told our IT guys about a year ago, tell me what - the two-thirds of things that have to be done, and let's cut out the other third.
ROVNER: Less, in this case, turned out to be more. By contrast, he says, many of the states that are now struggling may simply have overreached.
ARIO: Unfortunately, the states that I once touted as the leaders - Maryland, Oregon, Minnesota - I think the common theme that you see there is, this is a complicated undertaking; and so people who tried to do too much in year one, I think, had some problems with that.
ROVNER: Oregon, for example, has still not gotten its website fully open to consumers. Maryland and Minnesota's websites have both worked only intermittently, and enrollment has lagged as a result. Heather Howard, who's been advising states for the Robert Wood Johnson Foundation, says that just as with the federal website, part of the problem has been on the information technology side.
HEATHER HOWARD: We've seen in some states that some vendors have not been able to deliver, and states have struggled with the IT implementation.
ROVNER: In Maryland, efforts to fix the exchange have been complicated by the fact that two of its IT vendors are suing each other. Massachusetts and Vermont have both had issues with CGI, the vendor that was found responsible for most of the mess with the federal site, healthcare.gov. But experts say blame for failure - and credit for success - doesn't all belong to the outside IT contractors. It's also due in large part to how well those contractors worked with state officials.
Audrey Haynes oversees Kentucky's largely successful exchange. She says putting the exchange in the same department that runs Medicaid was key.
AUDREY HAYNES: Anyone knows that Medicaid has to have a pretty super IT department that supports it. So we had a lot of experience within the cabinet, at bringing up very large IT structures.
ROVNER: And where do state exchanges go from here? Republican members of Congress from Maryland and Oregon are asking federal officials to investigate the limping exchanges in those states. That's because both received millions of federal dollars to set the exchanges up. In principle, says consultant Joel Ario, figuring out what went wrong is not a bad idea.
ARIO: I certainly think we want to look carefully at what happened, and learn some lessons here. I don't think anybody's going to find any improprieties here because they're going to think it was all well-intentioned activity.
ROVNER: And in the long run, experts say that once the states that are lagging work out their IT problems, they will probably end up much like California - doing better than those being run by the federal government. Heather Howard says that's because states running their own exchanges also have more resources for consumer outreach.
HOWARD: They have consumer assistance infrastructures, grants out to community based organizations. And they're building and doing a lot more marketing, and their consumers are hearing much more about the options.
ROVNER: Meanwhile, though, there's one important thing the health law has not changed: What's available to you depends very much on where you live.
Julie Rovner, NPR News, Washington.
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