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Best state: California, for its smooth health-care rollout

The Affordable Care Act’s size and scope led to some incredible flops in states such as Maryland, Nevada, Hawaii and Oregon, where websites intended to help people gain health insurance coverage failed miserably. But other states fared better: Love or hate the ACA, California implemented the complex new law better than every other state. The software worked, red tape was cut, and sign-ups, for the most part, went smoothly.

In the Golden State, more than 2.5 million people signed up for coverage during the first six months of open enrollment. More than 42 percent of those eligible to sign up for care in California did so, a rate second only to Vermont’s. Medicaid enrollment in California jumped almost 16 percent, putting it in the top quartile of states. California was one of only six states to grow their private insurance rolls more than their Medicaid numbers, even after accepting federal dollars to expand Medicaid.

California’s success comes in large part because it broke down barriers between bureaucratic programs, said Edwin Park, vice president for health policy at the left-leaning Center on Budget and Policy Priorities. It was one of five states to simplify Medicaid enrollment for low-income residents who receive federal food stamp benefits. And even before the open-enrollment period began Oct. 1, several California counties expanded their Medicaid rolls, ensuring that about half a million low-income residents would be covered immediately.

“That’s a way where you can really find the eligibles right away. You don’t have to wait for them to apply,” Park said.

California built up enrollment in private plans through outreach and publicity campaigns, funded in part by the federal government and by grants from private foundations. More than 1.4 million people enrolled in marketplace plans, according to data compiled by the Department of Health and Human Services and the Centers for Medicare and Medicaid Services; a little less than 1.2 million enrolled in Medicaid or the Children’s Health Insurance Program.

Rhode Island, Vermont, Idaho and Washington state scored near the top in many metrics. Vermont enrolled more than 85 percent of its potential marketplace population in health-care plans. About 45 percent of the sign-ups in the District of Columbia came from the highly sought-after 18-to-34 age group, by far the highest rate in the nation, fueled largely by Capitol Hill staffers who had to enroll through the District’s exchange.

Among those states that ran their own exchanges, Hawaii, which had software difficulties, performed worst. Under 15 percent of the eligible population enrolled, according to estimates from the Kaiser Family Foundation, and only 20 percent of them were in the 18-to-34 age group. Alaska, Nebraska and Wyoming came in near the bottom as well. Those three states refused to create their own exchanges and relied on the federal exchange.

When the next open-enrollment period begins, those states should make an appointment with California. The Golden State’s solutions have turned out to be just what the doctor ordered.

Reid Wilson is the author of Read In, The Washington Post’s new morning tipsheet on politics.

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