The ‘moles’ still infest Nevada Obamacare

LAS VEGAS — In mid-October, two weeks after the launch of Nevada’s Obamacare website — — its director was comparing all the problems surfacing to the Whac-a-Mole arcade game.

 “We punch one thing down, and another thing pops up,” Jon Hager, executive director of the Silver State Health Insurance Exchange, told the Las Vegas Review-Journal’s Jennifer Robison.

That’s about as negative a statement as has been heard from Hager, a constant cheerleader for Gov. Brian Sandoval’s 2009 decision to sign Nevada up for a state-based Obamacare health insurance exchange.

Months later, numerous indicators suggest that the “moles” have proliferated, and many of them — bigger than ever — are harming Nevadans.

Much of the evidence comes from the exchange’s own end-of-December report to Sandoval and state lawmakers.

Written in a studiedly optimistic tone, the report nevertheless acknowledges, in its generalized language, the “numerous challenges” users run into on the web portal.

For Xerox, whose Government Healthcare Solutions subsidiary promised a “consumer-friendly experience, similar to comparison shopping that is so common with other online purchases,” those system bugs require “constant validation, troubleshooting, development of solutions,” and then testing of the attempted solutions, the report says.

It describes three “plan display” errors that frustrate consumers — the pink error, the white screen and the “unresolvable” error:

The pink error [says the report] is a message, highlighted in pink, indicating that the system cannot take the application at this time. Consumers get the pink error when the eligibility engine, provided by the Division of Welfare and Supportive Services is not available.

The white error is simply a white screen with no text or buttons. Consumers received the white error during the first two weeks of December, but the error was fixed and should no longer affect consumers.

The unresolvable error is the catch-all message that occurs when the system cannot proceed due to delays, errors or data mismatches. Often, unresolvable errors are caused by system delays during high system use, unavailability of the Federal Data Services Hub, data provided by the consumer in an unexpected format and other reasons. The development team continues to triage and eliminate these errors as they are reported.

Dwight Mazzone, a member of the exchange’s original consumer-assistance task force, told Nevada Journal, it’s “The people who are supposed to be helped are the ones who are being hurt the most.

“And the biggest reason why it’s happening is because Xerox can’t get their system to work — even after working on it for a year and a half.”

In July 2012, Xerox received a $72-million State of Nevada contract for a turnkey “business operations solution” that would provide the exchange’s information-technology and its call-center services to prospective individuals, employers, employees and brokers.

The call center itself, however, has become notorious for multi-hour wait times, a sore point with prospective consumers. In response to an early surge of traffic in December, according to the report, Xerox increased the number of customer service representatives from 36 to 80. Then, on Jan. 14, an exchange representative tweeted that the call center is “immediately” adding yet another 50 “to provide Nevadans with improved customer service.”

Contacted by the Nevada Journal, a spokesperson for the health exchange said:

Nevada Health Link would like to apologize for any inconvenience or hardship that our residents have encountered with the online enrollment portal and the customer call center.  A corrective action plan that includes increased staffing of call center representatives, business analysts and developers by Xerox has been put in place to fix the problems encountered by Nevadans and increase the level of customer service to the standards that our customers deserve.  Last week, Governor Sandoval spoke with Ursula Burns, CEO of Xerox about the issues consumers were reporting and Xerox has pledged their full resources to rectifying the problems at hand.

Additional call center numbers alone, however, are not a solution, Mazzone said, because few of the customer service reps actually have the depth of insurance knowledge needed.

“The people aren’t trained well enough. They don’t know anything about insurance, or about how this thing [the exchange] works.”

He said because of the confused information coming out of the call center, he’s learned — when seeking information on behalf of a client — to skip the center entirely and call Hager himself or one particular staffer, who’s proven herself reliable.

“If we submitted a case, and the people submitted a premium and the check was cashed, they may not [receive] ID cards, they may not have anything that tells them that they have coverage, other than the check that was cashed.

“I think we’re open to some humongous lawsuits,” said Mazzone.

“It’s even worse when it comes to the Medicaid side,” he added.

Because of the expansion of Medicaid that Gov. Sandoval also approved, the state department of Health and Human Services “had to hire a lot of new people, and those people were giving out bad information.

“We had people denied the ability to get onto Medicaid, because the people that were answering the phones were answering based upon 2013 rules and not on 2014 rules.

“So people were denied — putting them behind the eight ball” in their efforts to get coverage by January 1. “And then we’re told, ‘Don’t worry. All they’ll have to do is appeal and “back-end” the money.’ Well, appeals take 45 to 60 days or more.”

“So people say, ‘Well, what do I do in the meantime?’”

Mazzone said he has one client who’s pregnant, and after signing up for Medicaid, she was told she’d have to pay for a doctor visit up front.

“The doctor says, “We don’t care if you’re pending Medicaid. You’ve got to pay us $1,800 up front. That’s how it works. And then you can ‘back it’ into Medicaid, and Medicaid will do whatever it’s going to do. But we’re not going to take the risk that you won’t recover those funds.’”

Many insurance agents, such as Mazzone, assist people who qualify for Medicaid. They receive no compensation for doing so.

At its December meeting, the Silver State Health Insurance Exchange board got an earful from the former administrator of the state’s own Division of Health Care Financing and Policy, who recounted his own experience.

Christopher Thompson said that he had gone onto the Nevada Health Choices website looking at plans, and then had questions and sought assistance through the website’s “chat” capability. However it did not work satisfactorily.

Then when he sought to telephone in, repeatedly, all he could get was an “all circuits are busy” message.

Eventually, Thompson gave up on the call center and selected a plan without the information he’d sought. It was then the system would not accept his valid credit card.

Again, he made repeated attempts to contact the call center for assistance but all of the calls failed.

“Overall,” he told the board, “I called the call center about 100 times in the past 10 days.”

His last attempt was the night before the board meeting, when he was told he was facing a wait of 86 minutes. Aware he had no assurance that the call would ever actually go through, he hung up.

Said Mazzone, “It’s really time for the state to step up to the plate, and determine what it’s going to do. Because, in all the years I’ve been in the business, I’ve never had people as angry — and I mean pure, unadulterated anger — about this stuff. And nobody has answers.

“These are people who are trying to buy coverage, and they’re on hold for two and three hours. They have to go back in and put their information in two and three times. And I can vouch for them having to do it because I’ve had to do it.”

“The exchange we’re designing in Nevada,” said Xerox’s Will Saunders in 2012, “uses proven solutions from the commercial marketplace and will create a more consumer-friendly experience, similar to comparison shopping that is so common with other online purchases.”

In September 2013, Xerox’s contract with Nevada was amended to add another $3.5 million in compensation “for various potential change-order requests” in support of new rules governing the exchange coming out of Washington, D.C.

That boosted the state’s current financial commitment to $75 million.

Steven Miller is the managing editor of Nevada Journal, a publication of the Nevada Policy Research Institute. For more in-depth reporting, visit and

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