If you want to find somebody who's really happy with the Affordable Care Act, meet Colorado's Medicaid director, Sue Birch.
Colorado has been enrolling just under a thousand people a week in new private health insurance since its Obamacare marketplace opened. But the number enrolling in Medicaid is ten times that.
“We're pleased that those numbers add up to right under 40,000, and that makes us one of the successful states in the country,” she says. And Birch says most of those people who signed up through the state’s new marketplace Connect for Health Colorado actually enrolled in Medicaid.
“We are certainly one of the big successful states that's seen as a shining example of functionality,” she says.
But not everyone sees the process that way. Some people are complaining that Colorado's Medicaid system is getting in their way, slowing enrollment in private coverage. That's because nearly everyone buying on Connect for Health has to file a Medicaid application first, even those who know they make too much money to qualify. Cancer patient Donna Smith told the Connect for Health board she's been waiting more than a month to be cleared by Medicaid, so she can buy private insurance for next year.
“This is a very real human issue, and day 36 is making me really nervous,” she says.
Stories like that are troubling to Connect for Health board members including Ellen Daehnick. “Getting through the system can be more complicated and time consuming than necessary, and there can be points where a user has to wait,” she says. She and other board members worry that people who won't qualify for Medicaid but will qualify for new tax credits to lower their private insurance premiums will get hung up in the Medicaid application and not come back.
Judy Solomon, with the Center for Budget and Policy Priorities in Washington, says Colorado appears unique in its style of Obamacare application. “If Colorado is trying to make sure that no possible door to Medicaid has been foreclosed before passing people on for the premium tax credits, it's really going to slow down the process,” she says.
Connect for Health board members got a feel for that last week during a demonstration of the site. The application they viewed included questions about how much a user's car is worth, and whether he or she has burial benefits. Questions at that level of detail are designed to identify every possible Medicaid recipient, but are not required of the vast majority of people shopping for Obamacare coverage. Those questions were removed from Colorado's application last week.
Connect for Health Colorado's board chairwoman, Gretchen Hammer, says the application still isn't as streamlined as they'd like, but she's not convinced it's pushing people away. “We are seeing a number of Coloradans who have not had access to coverage before, get that access, and get it in a fairly timely manner,” she says.
Hammer says she's aware some people are getting hung up but doesn't think that's the only reason only 3,400 people bought private coverage through Connect for Health Colorado in its first month. She says she thinks a lot of people may be waiting to buy because they can't afford something now that won't go into effect until next year. People can wait until Dec. 15 to buy coverage that starts on Jan. 1. But she admits that Colorado's application process could be a lot more efficient, and the Connect for Health board is working on a major fix for next year.
Meanwhile, Connect for Health is hoping the sales rate goes up significantly. The state is far short of its goal of 136,000 purchasers by the end of March.
This story is part of a reporting partnership between NPR and Kaiser Health News.