Much of Colorado Obamacare exchange launch happened off-line

DENVER — On Tuesday, much of the action tied to Colorado’s brand-new internet-hosted healthcare exchange happened offline — in homes and on phones and at services centers around the state. That was always the plan and it was a good plan, too.

The state’s new online marketplace,, launched at 8:00 a.m. and the traffic started coming fast. At least 34,000 people had visited and some 1,300 of them had made accounts before noon, when the site crashed, and then came up limping on and off for hours.

Denise de Percin, executive director of the Colorado Consumer Health Initiative, said the network slowdown was to be expected. She said it was opening day for the exchanges and the product for sale turns out to be popular, like tickets for a Broncos game or the hit Broadway play Book of Mormon. Server overloads, service delay error messages and spinning curser icons are to be taken as a sign of success, she said.

“The crash is a good thing,” agreed Mirna Castro, one of the bilingual “health care guides” the state tapped to help people navigate the new health care system. Castro works with Servicios de la Raza and she’ll be holding community informational meetings in English and Spanish and then helping interested Coloradans choose and enroll in insurance plans.

Stationed outside the bustling Westside Family Health Center, Castro and other guides joined advocates and doctors in spreading the word and putting a sense of ceremony on a largely behind-the-scenes affair.

“This is such an exciting and important day for Colorado and especially for latinos and their families,” said Christina Aguilar, director at the Colorado Organization for Latina Opportunity and Reproductive Rights.

“There are 800,000 uninsured people in Colorado and 680,000 of them are latinos,” she added.

The rollout is available to benefit everyone, said Dr. William Burman, director at Denver Public Health.

“In the city and county of Denver alone, there are 100,000 people without health coverage — that’s 1 in 5. It’s bad for them but it’s also bad for our communities and businesses,” he said. “There’s this misperception that our current system doesn’t provide care for the uninsured. It does, in the worst and most expensive way possible.”

Burman repeated the fact, noted often among supporters of health reform but rarely mentioned by opponents, that when uninsured patients come to emergency care, hospitals pay for some or all of the costs, and they do that by raising prices for care throughout the hospital. That’s a major and increasing problem when the number of people with employer-based health insurance dropped by 4 percent in the last year alone. That’s why health insurance costs so much, and that’s why many small businesses, without enormous margins to pay for benefits, have embraced reform.

“We’re shifting great cost onto an increasingly small number of people,” Burman said. “So the net effect of the Affordable Care Act will be an economic boost. In Denver, we estimate that the cost of employee-covered health care will go down by 10 to 20 percent.”  

Many of those who currently don’t have health insurance won’t buy it on the exchange, but they’ll qualify for expanded Medicaid. Burman estimated that 42,000 people in Denver will now qualify for the low-income program, which offers not just basic medical and behavioral care but also preventive-care coverage.

“For the first time next year we’ll be offering adult dental coverage through Medicaid,” said Burman. “I take care of so many patients with disastrous and expensive dental infections. We can prevent that.”

Enrollment for expanded Medicaid also began Tuesday. Anyone who makes less than 130 percent of the poverty line qualifies. Medicaid coverage won’t start until January 1, 2014.

Hillary Jorgensen, political director at the Colorado Progressive Coalition, spent rollout day training volunteer canvassers to go door to door. Although opening applications for expanded Medicaid at the same time as the exchange makes sense to her, she worried that a few kinks in the process might throw-off those who stand to gain the most.

“Basically, you can apply for Medicaid now, but if you only qualify under the expansion, you’ll get a letter of denial,” she said. “Then, on January 1st, they’ll re-run your application automatically… I do worry about that. It’s confusing and there could be a huge backlog of applications in January.”

Hillary said her canvassers aren’t selling insurance on the exchange. Their goal is just to engage in thousands of conversations about it across the state and to encourage people to apply before the purchase cut-off deadline arrives in March.

Becky Weidhaas and Guillermo Carrera, pamphlets in hand, knocked on doors in the working-class Southwest Denver. The latino Barnum neighborhood is a mixture of hairy lawns, ‘Beware of Dog’ signs and the occasional serious reno-job complete with xeriscaping.

“I’m a federal employee, so at least for now we’re insured through my job,” said one resident.

A few houses down a woman chatted with Carrera in Spanish. She said she didn’t have insurance and wanted to make sure the phone number the canvassers gave her would take her to a Spanish speaker. They said it would.

Given the staggering number of latinos in Colorado who are uninsured, a surprising number of people in Barnum had health plans. Some were on Medicaid. Others had just heard of the law and were concerned that the individual mandate requiring health insurance would punish those who couldn’t afford it.

“I don’t know anything about that,” said Weidhaas to a worried father whose daughter, an employee at Good Times, knew she had to enroll and was fearful of the cost. “We’re just here to let people know about the exchange, that it’s open, and that there’s a lot of financial support available.”

“If they do punish people, that would be really fucked up,” said the dad, who is insured through the Veterans Association and uses a wheelchair. “Those are the people who really need health care.”

Weidhaas took down the daughter’s number, promising to call her and talk through the new options.

[ Image: Obamacare canvassers approach a house in Barnum. By Tessa Cheek ]