Reflecting on the Affordable Care Act’s 2014 open enrollment, former Secretary of Health and Human Services Kathleen Sebelius and Kentucky Gov. Steve Beshear said it was a tough process but in the end yielded impressive results due to some key factors.

Speaking at exchange conference on Tuesday sponsored by Enroll America, a multistate grassroots campaign to help enroll millions of uninsured Americans, Sebelius, in her first public remarks since leaving HHS, said enrolling people in states where state governments didn’t cooperate was difficult and, as open enrollment neared, opponents of the Affordable Care Act had spent nearly $400 million, compared to HHS’s total ACA outreach budget of $70 million.

But in the end, in those states that defaulted to the federally facilitated marketplace, there were 5.45 million who signed up for coverage through the FFM, surpassing Congressional Budget Office estimates of 4 million.

Sebelius said there were key decisions made early on that contributed to the final enrollment success, including having a long six-month open enrollment period. Sebelius said she choose that period because HHS understood the uninsured would need help and need multiple contacts with the exchanges before signing up.

Despite the challenges, Sebelius said that she would rather have a rocky rollout and 8 million signed up than a fully functional website and 4 million enrolled.


In the Commonwealth of Kentucky, often considered an ACA success story, Beshear said that success was a team effort.  Nearly 421,000 people enrolled, 75% of whom were previously uninsured. “That is a life changing experience for them,” Beshear said. “It is transformative for our state.”

Beshear said there were many reasons for his state’s success, including:

  • Keeping the website simple: Kentucky left off the bells and whistles because it was not such an important feature. However, KYnect, the state’s health exchange, allowed users to browse and put in numbers without signing up. It gave people a no-risk way to get estimates of their premiums, the governor said. He remembers telling people “you don’t have to like me, you don’t have to like President Obama because this is about you – you owe it to your families to see what you might be able to get.”
  • They tested the site early and often, working closely with all partners, including HHS, local experts and insurance companies. The state completed a top-to-bottom test three months before open enrollment began.
  • An open door policy that encouraged communication between the governor and all state agencies. Beshear said many governors were caught by surprise with problematic exchanges but he knew of anything before it began.
  • The state used connectors to let people work with those they trusted. Kentucky has a lot of small towns that host a lot of festivals and connectors were everywhere from the bourbon to apple festivals, Beshear said.
  • The state tried as best it could to separate politics from the ACA. “That’s a very fine line to walk and I’m still walking it,” Beshear said.

Looking toward the future, Sebelius said that Sylvia Mathews Burwell, who was sworn in as the next HHS Secretary on June 9, is a “terrific partner” who is “totally committed to making sure our effort [to enroll people] continues on in the strongest way possible.”

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