Grab Bag: The challenge of enrolling Native Americans; why DC needs their own exchange; Hawaii may have turned the corner on tech woes?

Three ACA-related stories which are all interesting but which I don't have a whole lot to add to:

The trouble with trying to sign people up for health insurance when care is already free

It’s hard work trying to get people to sign up for health insurance when their care is mostly free to them. Andrea Thomas is working to get Alaska Natives in Sitka, Alaska, to do just that. She’s the outreach and enrollment manager at SouthEast Alaska Regional Health Consortium (SEARHC), and it’s her job to sign people up for health insurance coverage through exchanges created as a result of the Affordable Care Act.

To get a sense of just how uphill Thomas’s battle is, consider this: Of the more than 100,000 people who live in Alaska and self-identify as Alaska Native or American Indian, only 115 had signed up for health insurance through an Affordable Care Act exchange as of March 31.  Alaska Natives and American Indians are exempt from tax penalties for not signing up for health insurance.

Here's why D.C. Health Link says the District needed its own health exchange

...But without D.C. Health Link, the city couldn't ensure successful health plans geared to D.C. residents, argues Mila Kofman, executive director of D.C. Health Benefit Exchange Authority, which oversees the exchange.

Kofman, who made it clear she can’t comment on the pending litigation, said generally speaking, D.C.'s patient pool was too different from that of its state counterparts to rely on the federal government's HealthCare.gov. “Decisions we made here reflect the priorities and needs we have here,” she said. “We could be more nimble andmake changes quickly in response to the experience of our users.”

EDITORIAL: Hopeful shifts in Connector fix

Aug. 22--The online medical insurance exchange known as the Hawaii Health Connector got some rare good news. The federal government recently granted an extension for the nonprofit agency to use $75 million in remaining grant money to finish the basic work of establishing the state's health-insurance marketplace under the Affordable Care Act.

According to officials, however, the news does not justify the collective sigh of relief that some may think it does. This means there's a lot more work Hawaiimust do to implement health reform in a way that suits the state's modest needs -- and in a way that taps further state funds as little as possible.