Democratic Sen. Jeff Merkley Meets With Oregonian Editorial Board

Democratic Sen. Jeff Merkley on Oct. 7, 2014 discussed his experience with the Cover Oregon health exchange.

(Beth Nakamura / The Oregonian)

Updated with new Cover Oregon response:

As a U.S. senator, Jeff Merkley, D-Ore., makes $174,000 a year. So imagine his surprise a few months ago, when he learned the Cover Oregon health insurance exchange had enrolled him in the Oregon Health Plan, which covers only the poorest of the poor.

Chalk up another embarrassing glitch for Cover Oregon, which remains a troubled work-in-progress after months of triage and more than $300 million in taxpayer money.

A few months ago, Merkley opened the mail at his east Portland home to find he'd been enrolled in the Medicaid-funded Oregon Health Plan.

The Oregon Democrat already had signed up for private insurance about six months before using the exchange, braving an application process that he called "horrific."

"It must have been about half a year after I was on (private insurance) we suddenly got a mailing that said 'Congratulations, you're enrolled!'" Merkley recalled. "And I was like, 'What? You're crazy.'"

The error by the exchange and the Oregon Health Authority, which oversees the health plan, is significant not only because it involves a sitting U.S. senator. It appears to also reveal a new type of enrollment glitch: not just an erroneous enrollment or miscalculation of benefit, but a double enrollment of someone who clearly was ineligible for Oregon's version of Medicaid.

Exchange officials on Thursday said that the problem of "dual enrollment" -- someone enrolled in private insurance as well as Medicaid by Cover Oregon and the Oregon Health Authority -- is not unique to Merkley. They said the group represents a portion of the more than 2,100 enrollment errors announced earlier this fall.

In addition to receiving his salary, Merkley's wife works as a registered nurse. They and their two children also receive income from several rental properties.

For a family of four, the Oregon Health Plan is reserved for incomes of about $32,900 or below.

The Medicaid mistake was one of several he and his family were subject to while applying, Merkley said on Tuesday. He disclosed his story for the first time in response to The Oregonian's questions about his experience with the exchange.

His decision to use Cover Oregon was a personally costly one. Members of Congress received a large subsidy only if they use the Washington, D.C., exchange – more than $900 a month for a family plan.

But Merkley has long made a point of "not living in a bubble," he said, residing in troubled low-income communities in D.C. in the 1980s as a congressional analyst, and later in Portland. With Cover Oregon, "I wanted to have the same experience that Oregonians were having, to see what this was about," he said.

So he and his family signed up through Cover Oregon in November, using a fax machine for their initial application to make sure they had a record that they had applied.

"And then you wait," he recalled. "You have no confirmation from the state that they've received it. And your spouse is going 'Are we going to have insurance when our current insurance runs out?'And you're like 'Well, I hope so but we're waiting to hear from the state.'"

Then his family received a second-stage application telling him his initial application has been approved, and he was eligible to choose between a variety of private plans.

That's when they encountered what Merkley calls "the first mess-up."

The second-stage application instructions were that he had to "exactly" enter the same information that the state had returned to him from his initial application.

But in the slot for his family size in the form sent him by the state was a staggering number.

"They had taken our zip code and put it into the square that was the number of people in your family," Merkley recalled. "So I had 97,000 people in my family."

"The instructions were that you must put exactly this information into the next form," Merkley recalled. "I could have single-handedly increased the sign-ups for Oregon health care by 100,000 people."

Instead, he contacted the exchange, which told him to ignore the mistake and put his zip code in the correct place on the form.

Later, he alerted the state to his family's Medicaid enrollment, and that was fixed as well. He assumes the mistake was one of thousands made by the hundreds of temps hired to manually enroll people when the Cover Oregon website flopped. There wasn't a lot of training or quality control for those people, Merkley observed. "It was some central mess-up," he said, but "I've never gotten the details of what went wrong."

The exchange and the Oregon Health Authority have already acknowledged several other types of errors:

In February, anonymous whistleblowers alerted lawmakers that the exchange had

In August, the state began contacting

On Sept. 1, the state withdrew Oregon Health Plan coverage for

In September The Oregonian broke the news that thousands of Oregonians

As for Merkley, he calls the application process "a nightmare" and calls the Cover Oregon technology project a "debacle." He faults technology vendor Oracle America as well as the state for a project that he says should not have been so complicated.

But he said his experience only reinforced his support of the Affordable Care Act that created the exchanges. He has publicly defended his vote for the law while he runs for reelection against Monica Wehby, a local pediatric neurosurgeon who has criticized the health care law.

Merkley said he was struck by the fact that so many in Oregon were willing to go through the "gauntlet" that he did to sign up. The exchange processed applications for more than 350,000 Oregonians, including 250,000 who enrolled in the Oregon Health Plan.

"It's amazing how many families went through this," he said. "They were locked out of the health care system, and having access to affordable health care was so fundamental to their quality of life that they pursued it through all these frustrations."

-- Nick Budnick