When HealthCare.gov and
some state-run insurance marketplaces ran into trouble with their Web sites in
October and November, they urged consumers to submit paper applications.

Now, it’s time to process all that paper. And with the
deadline to enroll in health plans less than two weeks away, there’s growing
concern that some of these applications won’t be processed in time.

The Associated
Press reported last week
 that federal officials are now advising
navigators — groups paid to assist consumers with enrollment — not
to use paper applications anymore, if they can help it.

“We received guidance from the feds recommending that
folks apply online as opposed to paper,” said Mike Claffey,
spokesman for the Illinois Department of Insurance.

After a conference call earlier this week with federal health
officials, Illinois health officials sent a memo Thursday to their roughly 1,600
navigators saying there is no way to complete enrollment through a paper
application. The memo, which Claffey said was based
on guidance from federal officials, said paper applications should be used only
if other means aren’t available.

Federal health officials also discussed the issue during a
conference call Wednesday with navigators and certified counselors in several
states.

“They’ve said do not use paper applications because they
won’t be able to process them anywhere near in time,” said John Foley,
attorney and certified counselor for Legal Aid Society of Palm Beach County,
who was on the call.

According to an enrollment
report released Wednesday
 by the U.S. Department of Health and Human
Services, about 83 percent of the 1.8 million applications completed between
Oct. 1 and Nov. 30 were filled out online; the rest were on paper. The online
figure was higher, 91 percent, in the 14 states running their own health
exchanges, compared to 80 percent for HealthCare.gov, which processes
enrollments for the other 36 states.

But even outside the federal exchange, paper is proving to
be a problem.

Covered California in
recent days disclosed
 that it had a backlog of 25,000 paper
applications that had to be processed before the Dec. 23 deadline to sign up
for coverage that begins Jan. 1. According to an AP report:

The applications came from individuals, insurance agents and
health exchange agents who were unable to access the online portal in the first
few days after the exchange opened on Oct. 1, said Roy Kennedy, a spokesman for
Covered California, the agency that runs the health exchange. He said the
agency has been working to process the applications since then.

“We’ve added additional staff and redirected existing
staff to input all the paper applications, so we believe that everyone who
properly filled out the application, they will have health insurance on Jan.
1,” Kennedy said.

But for people who enrolled through an insurance agent, those
workers are only entering basic information such as the applicants’ names and
the names of the insurance agents, said Neil Crosby, a spokesman for the
California Association of Health Underwriters. He said agents are now being
alerted to check the Covered California site several times a day to see whether
any of their clients’ applications need to be added.

In Oregon, a state official disclosed this week that more
than 30,000 people who submitted health insurance applications still don’t have
enrollment packets, the
Oregonian reported
.

The concession by Dr. Bruce Goldberg, interim director of the
state’s exchange, raises serious concerns about the state’s ability to meet
Gov. John Kitzhaber’s promise to successfully enroll all Oregonians who need
individual insurance Jan. 1.

Of particular concern are the more than 20,000 individuals
whose high-risk health insurance plans have no chance of being extended past
Dec. 31.

Goldberg, who took
over 
the troubled Cover Oregon exchange last week, said the state’s
manual processing system hasn’t worked through an estimated 65,000 applications
as quickly as officials first estimated.

“We thought we’d be further along than we are now,”
Goldberg said.

In Maryland, another state whose exchange has been plagued
by difficulties, 8,500 paper applications were pending as of last week,
the Baltimore
Sun reported
.

And in Vermont, a
report by VTDigger.org
 said paper applications are “piling up.”

There is a backlog of 1,210 applications, some of which date
back to as early as Oct. 30, [Department for Children and Families] Commissioner
Dave Yacovone said.

Paper applications continue to arrive at a pace of
approximately 100 per day, and the department needs to process them all by Dec.
23, in order for people’s coverage to take effect at the start of 2014.

Editor’s Note: This post is adapted from Ornstein’s “Healthy buzz” blog.
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