Five years ago, the Massachusetts Health Connector was broken. People couldn’t sign up for coverage online. Exhausted employees at the state-run insurance exchange used paper to enroll people, but they couldn’t keep up with the demand.
A striking turnaround has taken place: The website works, and more than 282,000 residents signed up for coverage on the Connector this year, the most in the agency’s 13-year history.
That figure is 13 percent higher than last year — and the greatest annual enrollment increase of any state in the country. For states using the federal insurance platform, healthcare.gov, sign-ups dipped about 4 percent.
Connector officials Tuesday attributed the rising membership in Massachusetts to the relative affordability of coverage this year — premiums rose about 4.7 percent on average — and new outreach and marketing efforts.
“[The Connector] is so enmeshed in the landscape now in a way that is unique compared to other places,” said Audrey Gasteier, chief of policy and strategy at the state agency. “We’re not a political topic in Massachusetts. People trust and know we’re available.”
Health exchanges were created as part of the Affordable Care Act to give individuals who don’t get insurance through an employer a place to shop for coverage. Some states run their own exchanges, while others use the federal platform. Massachusetts already had its own exchange when the federal law took effect.
Many of the people new to the Connector this year were previously enrolled in the state Medicaid program, called MassHealth, which covers individuals whose incomes fall below a certain threshold. Others were previously covered by private health plans, and some were uninsured.
The Connector spends $1.1 million annually on marketing and outreach, and another $1.6 million on community organizations called “navigators” that help individuals sign up for coverage.
But this year Connector officials especially targeted Springfield, Lawrence, Lowell, and other communities with lower rates of insurance coverage. Their outreach included buzzy events like hot dog and ice cream giveaways, a flash mob, and a photo opportunity with the Red Sox championship trophy at the Forest Hills MBTA station in Boston.
The Connector offers health plans from several private insurance companies. About three-fourths of its members receive discounted coverage, subsidized by state and federal dollars.
Hannah Frigand, director of the help line at Health Care For All, a Boston consumer advocacy group, credited Connector officials for targeting their outreach in underserved areas.
“We were thrilled to see those numbers,” Frigand said. “I’ve been on the help line since 2006, so I’ve seen how much outreach and enrollment does for the communities that need it.”
Charles Gaba, an analyst who tracks insurance enrollment, also called the Massachusetts numbers impressive, especially because the state already has the lowest rate of people without health coverage in the country.“The overarching thing is Massachusetts is one of the states that really takes the ACA seriously,” he said. “They’ve embraced not just the letter but the spirit.”
But the state was struggling to enroll anybody just a few years ago.
Governor Charlie Baker, speaking at the Connector’s Boston office on Tuesday, credited Louis Gutierrez, the agency’s executive director, for playing a critical role in fixing the website and stabilizing the exchange.
The two previously worked together at Harvard Pilgrim Health Care; Baker was chief executive, and Gutierrez was chief information and technology officer, where he was in charge of fixing a broken technology platform. “Part of the reason why I asked Louis to take the job in the first place is because he was the guy at Harvard Pilgrim when we had a platform problem at Harvard Pilgrim,” Baker said.
“This is a movie you and I know,” he said, turning to Gutierrez. “This is Harvard Pilgrim all over again.”
President Trump and Republicans in Washington have repeatedly tried to repeal the Affordable Care Act, also known as Obamacare. The sweeping law remains in place, but without the national mandate that individuals must obtain insurance.
In Massachusetts, all residents still have to sign up for coverage or pay a penalty.
Baker has split with many members of his party to defend the federal health care law, which was modeled on the 2006 Massachusetts law approved under then-Governor Mitt Romney.
The governor said he remains concerned about national policy shifts that could affect Massachusetts. “I do worry about big changes that are detrimental not just to the Connector but to the people here who are served by it,” he said. “And I worry about them coming in a way where they don’t create time for us to make adjustments to deal with it.”
Jennifer Tolbert, a health reform expert at the Kaiser Family Foundation, said that across all states, the number of people signing up for coverage on the exchanges dropped about 3 percent from 2018 to 2019.
“Between the premiums stabilizing and enrollment only dropping a little bit, I think it shows that this market, while it experienced some volatility, it does seem to be stabilizing,” she said.