When HealthCare.gov and some state-run insurance marketplaces ran into trouble with their Web sites in October and November, they urged consumers to submit paper applications.
Now, it's time to process all that paper. And with the deadline to enroll in health plans less than two weeks away, there's growing concern that some of these applications won't be processed in time.
The Associated Press reported last week that federal officials are now advising navigators 2014 groups paid to assist consumers with enrollment 2014 not to use paper applications anymore, if they can help it.
"We received guidance from the feds recommending that folks apply online as opposed to paper," said Mike Claffey, spokesman for the Illinois Department of Insurance.
After a conference call earlier this week with federal health officials, Illinois health officials sent a memo Thursday to their roughly 1,600 navigators saying there is no way to complete enrollment through a paper application. The memo, which Claffey said was based on guidance from federal officials, said paper applications should be used only if other means aren't available.
Federal health officials also discussed the issue during a conference call Wednesday with navigators and certified counselors in several states.
"They've said do not use paper applications because they won't be able to process them anywhere near in time," said John Foley, attorney and certified counselor for Legal Aid Society of Palm Beach County, who was on the call.
According to an enrollment report released Wednesday by the U.S. Department of Health and Human Services, about 83 percent of the 1.8 million applications completed between Oct. 1 and Nov. 30 were filled out online; the rest were on paper. The online figure was higher, 91 percent, in the 14 states running their own health exchanges, compared to 80 percent for HealthCare.gov, which processes enrollments for the other 36 states.
But even outside the federal exchange, paper is proving to be a problem.
Covered California in recent days disclosed that it had a backlog of 25,000 paper applications that had to be processed before the Dec. 23 deadline to sign up for coverage that begins Jan. 1. According to an AP report:
The applications came from individuals, insurance agents and health exchange agents who were unable to access the online portal in the first few days after the exchange opened on Oct. 1, said Roy Kennedy, a spokesman for Covered California, the agency that runs the health exchange. He said the agency has been working to process the applications since then.
"We've added additional staff and redirected existing staff to input all the paper applications, so we believe that everyone who properly filled out the application, they will have health insurance on Jan. 1," Kennedy said.
But for people who enrolled through an insurance agent, those workers are only entering basic information such as the applicants' names and the names of the insurance agents, said Neil Crosby, a spokesman for the California Association of Health Underwriters. He said agents are now being alerted to check the Covered California site several times a day to see whether any of their clients' applications need to be added.
In Oregon, a state official disclosed this week that more than 30,000 people who submitted health insurance applications still don't have enrollment packets, the Oregonian reported.
The concession by Dr. Bruce Goldberg, interim director of the state's exchange, raises serious concerns about the state's ability to meet Gov. John Kitzhaber's promise to successfully enroll all Oregonians who need individual insurance Jan. 1.
Of particular concern are the more than 20,000 individuals whose high-risk health insurance plans have no chance of being extended past Dec. 31.
Goldberg, who took over the troubled Cover Oregon exchange last week, said the state's manual processing system hasn't worked through an estimated 65,000 applications as quickly as officials first estimated.
"We thought we'd be further along than we are now," Goldberg said.
In Maryland, another state whose exchange has been plagued by difficulties, 8,500 paper applications were pending as of last week, the Baltimore Sun reported.
And in Vermont, a report by VTDigger.org said paper applications are "piling up."
There is a backlog of 1,210 applications, some of which date back to as early as Oct. 30, [Department for Children and Families] Commissioner Dave Yacovone said.
Paper applications continue to arrive at a pace of approximately 100 per day, and the department needs to process them all by Dec. 23, in order for people's coverage to take effect at the start of 2014.
Editor's Note: This post is adapted from Ornstein's "Healthy buzz" blog. Have you tried signing up for health care coverage through the new exchanges? Help us cover the Affordable Care Act by sharing your insurance story.