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Local legislator joins the effort to reform Cover Oregon issues

“I don’t know a single person who went through Cover Oregon without an error,” Rachael Duwe said after the state health insurance exchange entered a higher deduction that incorrectly put her husband in a poverty-level tax bracket.

Duwe, 28, called Cover Oregon to try to resolve the issue, but she was told that she couldn’t do anything for her husband’s Oregon Health Plan account, even though they are legally married. Adding insult to injury, her husband, Gregory Berkholtz, 35, suffers from narcolepsy and is hearing impaired, so he couldn’t call Cover Oregon without special assistance.

“I couldn’t even make an appointment until I had proof of insurance from OHP, and I was concerned about my infection that had started before the end of the year,” Duwe said. “We were freaking out because of my husband’s medications, but I luckily worked with my state legislator to help get us temporary OHP coverage through March 1 so that he could fill his prescriptions and so I could get antibiotics.”Fagan

Duwe’s experience was indeed a common one. Cover Oregon’s website failed just as thousands were trying to apply for health coverage. That forced many folks like Duwe to go through the insurance exchange’s overloaded phone system. Cover Oregon hired contractors to reduce hold times and help process applications manually, but all types of errors occurred in the transcription process.

Not all the errors gave lower premiums like in Duwe’s case. Other applicants through Cover Oregon received large initial overestimates in their deductibles that resulted in New Year surprises of several hundred dollars more in monthly premiums than they had budgeted for their chosen health plans.

When Amy Evertz of West Linn went to pick up a prescription Jan. 8, the pharmacist told her that, according to their records, she was 28 years old — far off her actual age of 45. Her husband, Mark, had just paid the bill for the family’s first month of coverage under Moda Health and Dental — a new plan he had found using the Cover Oregon exchange agency, so their family’s premium would skyrocket once the mistake was corrected. They filed a formal complaint at the Oregon Department of Consumer and Business Services Jan. 13 against both Moda and Cover Oregon.

Some Cover Oregon applicants were put on different health plans from what they chose; others have not paid for the health coverage they chose, maybe because they decided coverage wasn’t worth it after all, or maybe because they never received their bills.

We may never know all the reasons Cover Oregon applicants end up without insurance. Although there were many applicants who successfully were able to go through the manual system and begin paying for their chosen health provider, Cover Oregon spokesman Michael Cox said technical difficulties also are preventing them from estimating how many of those actually received coverage. About 170,000 people signed up for health insurance for January through Cover Oregon or the Oregon Health Plan by the enrollment deadline.

Legislators taking action

Shemia Fagan (D-East Portland/Clackamas), the state representative who helped Duwe, wants to get to the bottom of the Cover Oregon debacle. Fagan expects that an independent audit will come out this spring detailing the sources of the problems.

Meanwhile, she and other legislators are pushing bills that would allow for swift action. A proposed change in statute would allow Gov. John Kitzhaber to remove the entire Cover Oregon board of directors in a single year. Right now the statute states that Kitzhaber can only replace three members of the board over a four-year period.

“I’m sure other legislators will join me in encouraging him to use that new authority, after that audit shows multiple problems in the system, including lack of accountability,” Fagan said. “In the end, this is too important to screw up.”

Oregonians who purchased a qualified health plan, but weren’t able to do so through Cover Oregon, would still be able to access federal insurance subsidies under this bill.

“We should hold Oregonians harmless through technical problems in the website,” Fagan said.

Fagan considers the status quo of half a million Oregonians without health insurance as unacceptable. Raised by a single dad, Fagan and her brother grew up without health insurance, but were lucky to get away with just broken bones. When she was only 24, her dad died from a heart attack, which she thinks could have been prevented with treatment for his high cholesterol.

To increase insurance enrollment numbers, she and other lawmakers are trying to pass several initiatives at once during this short session. They want Cover Oregon to seek a waiver from the federal government extending enrollment deadlines to April 30, take steps to extend tax credits to small-business owners who have selected a plan under the Small Business Health Options Program and cover costs for the extension of coverage through March for former Oregon Medical Insurance Pool members that were not enrolled prior to the beginning of the year.

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