Understand how we got here — and how to move forward.

Blog Post

Three states wanted to lead on Obamacare. One is setting the pace.

October 11, 2013

    Dan Diamond, Managing Editor

    In California, officials didn't want to settle for being the "pace car" on Obamacare—they wanted to be the "lead car."

    In Maryland, Gov. Martin O'Malley had vowed that his state would "lead the nation" when implementing the Affordable Care Act.

    But through week 1, a surprising state has left the other two in the dust.

    Even the namesake of Obamacare agrees.

    "The president said ... the place that has done best is Kentucky," Rep. John Yarmuth (D-Ky.) told the Courier-Journal, after Obama held a private meeting with House Democrats this week and discussed the rollout of the ACA's insurance exchanges.

    Early numbers have been trickling in from the exchanges, and the Bluegrass State—despite being a state that leans red—has reported high levels of applications and successful enrollments.



    The data isn't perfectly comparable; for example, California has only reported figures through last Saturday, while Kentucky's numbers include enrollment through this past Monday.

    But it's still a striking surprise. California and Maryland's health care systems have gotten national attention over the years, while Kentucky is usually overlooked, although Gov. Steve Beshear did make waves last month after penning a New York Times op/ed on why his state is moving quickly to implement the ACA.

    And consider this contrast: California has 7.1 million uninsured residents—more than ten times the 640,000 uninsured residents in Kentucky—and threw many more millions of dollars toward awareness.

    American Healthline's ACA tracker notes that Covered California spent $37 million on grants for outreach, and the exchange has budgeted $45 million through March for its ad campaign. Kynect, meanwhile, has just an $11 million outreach and ad campaign, a spokesperson told American Healthline.

    And the Web visitors count is interesting, too. I'd bet that the higher applicant-to-page view ratio in Kentucky reflects the fact that Kynect was generally functional last week, while the other states struggled with keeping their sites live. Basically, Kentuckians didn't have to reload, reload, reload in hopes of filing applications, as they did in California, Maryland, and many other states.

    Kentucky's secret? The Wall Street Journal's Arian Campos-Flores writes that it was servers, simplicity, and state agencies' structure. (And California and Maryland's struggle? Mostly with servers and simplicity, too—their sites' lack of it. Here's more background on Covered California's bumpy first week.)

    Don't judge the exchanges' fate too soon: Join us for a conversation on November 15 as our experts perform a pulse check on Obamacare.

    So what does it all mean? Some frustration for O'Malley, who is generally considered a top candidate for the Democratic party's presidential nomination in 2016. And some plaudits from the current president and a higher profile for Beshear, who's in his second and final term as Kentucky governor.

    But beyond optics, it's tough to know whether the early results will ultimately add up to much. Open enrollment stretches through March, and Covered California's numbers will likely (and quickly) outdistance Kynect's as the IT glitches keep getting ironed out. It's still too soon to understand the impact on payers, patients, and providers. 

    Although Kentucky officials can take heart in their ACA rollout—even after it was opposed by the state's most prominent national politicians, GOP Senate Majority Leader Mitch McConnell and Sen. Rand Paul.

    "My state needs Obamacare," Beshear wrote in his New York Times op/ed. "Now."

    "We couldn’t afford not to do it."

    How do health insurance exchanges work?

    Government officials often compare the exchanges to online travel sites like Expedia or Orbitz. But given that many exchange websites aren't fully functional yet, I find it helpful to picture a big box store.

    For more: Read our primer, or our white paper, for answers to eight key questions and implications for providers.

    Have a Question?


    Ask our experts a question on any topic in health care by visiting our member portal, AskAdvisory.