As last-minute sign-ups poured in, the director of the state-run insurance marketplace on Monday called Rhode Island a national leader in its efforts to implement the federal health care overhaul, with some states even looking to HealthSource RI for help.
Director Christine Ferguson said at mid-day that just over 26,000 individuals had signed up for private-plan coverage through HealthSource RI, with most having paid the first month's premium.
While HealthSource has not released a specific enrollment goal for the period, that's more than double the unofficial federal target of 12,000 by March 31.
"We really are the envy of the rest of the country and the federal government," Ferguson said. "People should embrace that — but we still need our feet to be held to the fire. We're holding our own feet to the fire to make sure we keep this up."
Monday is the final day of the first open enrollment period; another will be held this fall. Small business and Medicaid sign-ups will continue on a rolling basis. As of March 8, state health officials had reported 48,602 Medicaid enrollments, well above the number expected by that point.
The marketplace was experiencing what officials described as exceptionally high call volumes and walk-in traffic ahead of the 11:59 p.m. deadline. People unable to complete enrollment in time because of a "system issue" may be eligible for an extension to avoid the Affordable Care Act's fine for being uninsured.
In an interview, Ferguson said the Rhode Island marketplace has outperformed most other state-run exchanges on several measures, including how many of those eligible for federal subsidies have enrolled and per-capita small-business enrollment.
Implementation of the federal health care law has been a relative disaster in states including Maryland, Massachusetts, Oregon and Vermont. The federal government's healthcare.gov website, used by states that opted not to build their own marketplace, also has been problem-plagued.
Ferguson said she was pleased, but not complacent.
"I am satisfied with where we are given all of the barriers, challenges and opportunities we had. Am I satisfied that this is it? No," she said. "There are plenty of places where the processes can be improved and the focus on affordability and small business needs to be much higher."
Rhode Island has offered guidance to several states, including Oregon and Virginia, and to the federal government, and more such conversations are planned, according to Ferguson.
One issue that's far from settled is how Rhode Island's marketplace will be paid for once federal funding dries up. Ferguson has told lawmakers HealthSource will be allowed to stretch its use of federal dollars through all of next year, even though they were supposed to expire at the end of 2014.
Legislators have been questioning the best way to finance it, and whether the state can afford its estimated annual price tag of $23.9 million.
She sees the marketplace as part of the effort to stop sky-rocketing health care costs.
"None of the ways that we have tried to address it to now has got us very far," she said. "This is a new kind of approach and model to put into the equation. I think it's a healthy, good conversation for the state to be having."
Ferguson says people can enroll in an insurance plan by going online and confirming coverage by 11:59 p.m. or calling 1-855-840-4774 and confirming coverage by midnight.
HealthSource RI offices in Providence and Warwick also will be open until 10 p.m. Monday.
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