Out For Lunch: The Government Closes Down; Insurance Exchange Marketplace Opens

About six months ago, my family decided to get rid of cable because we wanted to minimize the effect television would have on our two-year-old daughter. It makes it easier to keep a handle on what she watches and the amount of time she watches it. She seems content with watching one Curious George episode a day through Netflix or checking out movies from the library. The rest of the time the TV stays off.

I’m not self-righteous about our limited TV lifestyle. In truth, I miss cable. I miss having hours of football playing in the background. Most of all I miss CBS Sunday Morning. But sometimes shutting off the TV is a good thing.

I was reminded of that last week while visiting a patient with cognitive impairment and some confusion. The news of the government shutdown was on TV and he asked, “Why are they shutdown?” I think many people who don’t have cognitive issues have the same question but it was adding to his level of confusion. We simply said there is a disagreement between the Democrats and the Republicans.

“How long will they be closed for?” he asked. We told him we didn’t know.  Even when with congitive issues, patients can still say some very wise and witty things. My patient’s solution: “Why don’t they put a sign on the door that says ‘back in three days’ like they do at the grocery store?”


While the government was starting its indefinite lunch break, the Health Insurance Marketplace opened for business on Oct. 1, but not without some technical glitches.

According to news reports, like this one from NPR (remember I don’t have cable so I have to get my news from someplace!), some state sites did not go live and others crashed throughout the day. People trying to access the federal site also experienced crashes, long wait times and difficulty accessing the registration form.

I decided to test it out for myself on Sunday, Oct. 5. I went to Healthcare.gov and clicked the Want to learn more? Start here button. It took me through a quick questionnaire that asked for demographics (i.e. does your employer provide health insurance, what state do you live in, do you need to insurance your family or just yourself). Very simple. Then I was taken to the screen that answers FAQs and it provided  me with a link that said, “You live in Illinois. Click here.”

I created an account and went to log in. That’s where the trouble started. Actually it didn’t ever start. It just gave me a blank white screen. I tried three more times with the same result. I asked my husband to try creating an account because I was starting to doubt my computer skills. He had the same result, though, and at one point he got a “system down for routine maintenance” message.

I already have many questions about the ACA and health care reform and the effects it will have on health care in the U.S. I understand the need for health insurance both for health purposes and for economic reasons. But I also wonder if insurance will help people have better access to care and help prevent excessive medical bills.

I know people who are currently insured through their employers but have $50 co-pays for office visits. That can really add up. I know people who have to meet high deductibles before insurance kicks in to help pay medical bills. I have met people who have insurance that does not cover hospice care and are too young to be eligible for the Medicare Hospice Benefit. Thank goodness in those cases there may be financial assistance or charity care available to them, especially if the hospice is non-profit. Will mandatory insurance make those types of situations less frequent? I don’t know and I can only wait and see and hope for the best. But if  people can’t even register without the Marketplace website crashing, how effective will the exchanges be in managing insurance benefits?

I see how front-line clinical staff can connect with patients, build the patient’s trust in the care they’ll receive and help them with their treatment plan. But there is a whole “shadow staff” of health IT professionals who are also essential to patient care. They may never meet a patient in person but because of the work they’ve done with streamlining an EMR charting process or making sure the Pyxis machine is working properly so the patient gets the correct medications, they affect patient care. People often take it for granted, but health IT professionals are essential to the well-oiled health care machine that makes it easier for the clinical staff to build trust with patients.

Unfortunately, the current Marketplace technical issues are likely doing the opposite and there’s probably not a lot of trust being built. Users finding the site frustrating and unusable are probably starting to doubt the quality of the insurance they will get and possibly the efficiency and effectiveness of the health care system as a whole. Open enrollment in the Marketplace ends March 31, 2014, and I hope all the technical bugs will be resolved by then. While you may not hear it often, HIT professionals do have a huge role in building relationships and improving care for patients. Thanks for the work you do!

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Jennifer Thew, RN, MSJ

Jennifer Thew, RN, MSJ, is a registered nurse and journalist who has covered healthcare issues and how they relate to the nursing profession. She began her nursing career as a neuroscience nurse at Rush University Medical Center in Chicago and then transitioned to journalism after receiving a degree from Roosevelt University in Chicago. She has edited and written numerous articles on a wide range of nursing and healthcare topics like Accountable Care Organizations, evidence-based practice and telehealth.

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