DAVID GREENE, HOST:
OK, the deadline to sign up for health insurance under the Affordable Care Act is approaching. We thought this was a good moment to revisit a decision by 14 states. They opted to create their own health care exchanges rather than using the federal website, Healthcare.gov. Those states got subsidies from the federal government but they also took risks, buying and implementing new technology and overseeing the whole process on their own. All of the states had technical problems and most are behind on their enrollment goals.
We're visiting one this morning: Colorado. Eric Witney looks at whether the decision to build its own health insurance exchange has been worth it.
ERIC WHITNEY, BYLINE: The people who built Colorado's health insurance exchange were sure that they were ahead of the game from Day One. Months before the Affordable Care Act even passed, a big bipartisan health reform study group here had already concluded the state should create an exchange. And on October 1, 2013, Colorado opened its exchange, and there were glitches, as exchange CEO Patty Fontneau explained at day's end.
PATTY FONTNEAU: We did run into some intermittent error messages as people were creating accounts, and we did temporarily suspend the account creation for a short time while we solved them.
WHITNEY: Colorado was hardly alone. Other states and the federal government had even worse problems. Things have mostly gotten better, but some state exchange directors have resigned, some marketplaces still barely function, and enrollment success varies, says Elizabeth Carpenter with the consulting firm Avalere.
ELIZABETH CARPENTER: State-based exchanges, a number of them have really performed, but to be honest, a number of HealthCare.gov states have also exceeded in our analysis. So there's not at this point kind of a direct correlation between whether or not you're a HealthCare.gov state or you're a state-based exchange state when it comes to your enrollment success, or lack thereof.
WHITNEY: Colorado has signed up more 90,000 people. It's among the best-performing states, but its enrollment numbers to date are still below expectations. So is Colorado better off for having built its own exchange?
BEN PRICE: Every day that we get further into this, we're seeing more and more reasons it was good for us to go our own way and have a state level exchange.
WHITNEY: That's Ben Price with the trade group of health insurance companies in Colorado. They've worked closely with government agencies and consumer advocacy groups on building the exchange. They all agree it's been worth the effort. It's given a broad array of interest groups the chance to influence everything from the options users get on the exchange website to specific marketing plans for different audiences and parts of the state.
And when problems pop up, everybody pitches in and they get solved pretty quickly. Price says a lot fewer people in Colorado would have health insurance now if the state had just used HealthCare.gov.
PRICE: It's not perfect. We'd like to see higher numbers. It's going to take some time and we're working out the kinks. But I think we're in a lot better shape than a lot of other states that chose to sit back and wait and see if the Affordable Care Act was going to stand, or just say, well, bring in whatever the federal government brings in.
WHITNEY: A lot of Republican-led states ended up with HealthCare.gov because they thought the law would be thrown out by the Supreme Court, or repealed by a Mitt Romney White House. But in Colorado even some hardcore conservative lawmakers never thought that was a good strategy. Republican Amy Stephens represents one of the most conservative districts in the state, but she co-sponsored the bill that established Colorado's health insurance exchange.
Taking a break from her work on the State House floor, she says it was all about preserving as much state control as possible.
STATE REPRESENTATIVE AMY STEPHENS: I did not see the federal option as an option that was a good option. And to me, and to the business community, creating something here in Colorado with a state exchange close to home in a pro-market manner was the best solution for us.
WHITNEY: Stephens continued fighting to get Obamacare repealed, but wanted Colorado to have a backstop.
STEPHENS: We don't want to have to call some federal government number for our own health care. We want to decide it here. I think we've done a very good job.
WHITNEY: The federal government gave Colorado $187 million to build its exchange. But Republicans have had a hard time attacking it when it has buy-in from the state's business community, including hospitals and health care providers. That broad base of support should serve Colorado well going forward, says consultant Elizabeth Carpenter.
CARPENTER: This was not a kind of go/no-go 2014 decision. This was a decision that states made looking into the longer term.
WHITNEY: The longer term goal is getting as many people health coverage as possible. And Colorado, by building its own exchange, has managed to get groups that often disagree to work together on that. For NPR News, I'm Eric Whitney in Denver.
GREENE: That story from Eric Whitney in Colorado is part of a partnership with NPR and Kaiser Health News.
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