By Phil Dyer

It has been nearly three years since Washington began to build its state-based insurance exchange and profoundly expanded Medicaid.

It has not been an easily defined road nor a smooth one. Nothing like this had ever been done before, which led to a number of challenges in budgeting, forecasting and other elements prior to the exchange’s launch on Oct. 1, 2013. Now the exchange, known as the Washington Healthplanfinder (WHPF), has completed the open-enrollment period. The WHPF primarily offered only individual and family coverage, leaving small-business coverage until the next open enrollment later this year.

We’ve learned a great deal and already are making changes for next year.

First, new Medicaid enrollment met expectations. In 2011, the projection was that Washington would see nearly 1.5 million people, new and current, enrolled on expanded Medicaid. During the actual open-enrollment period, however, the state saw more new enrollees than expected, but fewer re-enrolled.

Looking now to the upcoming open enrollment period, we on the WHPF board are still in the planning process. There are several major areas of planning including Medicaid, the renewal process and expanding the Small Business Health Options Program (SHOP) statewide.

As in any startup organization, we focused on the core responsibilities of the exchange. Now the exchange is looking to reduce operating costs while improving various aspects of the consumer experience for Medicaid and private insurance enrollees.

In the case of Medicaid, we are looking to change the current approach where enrollees must simply accept the plan assigned to them. Starting in April 2015, we hope Medicaid enrollees will be able to shop for the plan that best suits them.

In addition, I am concerned with more than 75 percent of our enrollment work being Medicaid. The exchange’s funding should be supported more from the Medicaid budget considerations by the Legislature, as opposed to requiring the private marketplace to pay the major part of sustainability of the exchange.

In preparing for the first renewal period for those who purchased plans on the exchange, we need to improve the way subsidies are calculated using income and family information.

Additionally, we need to improve the information available to those searching for a plan that best fits their health needs. Currently, it can be difficult to find out if a plan covers your medicines, your doctor and other details of the plan. As a result, some found costs were higher and access was lower than they expected.

Improving the transparency of the plans on the exchange is one issue we will be discussing to ensure that Washington residents choose the plan that suits them.

Additionally, we are working to create a viable Small Business Health Options Program, with available issuers and plans. This program provides subsidies in the form of tax credits for eligible small businesses and those that are being required to provide health care for their employees.

The next open enrollment period is going to be fast upon us and the exchange board is moving rapidly to address the demands and challenges placed on it. Given the relative success of the Washington Healthplanfinder in the first year, I am optimistic that it will succeed in this first renewal year, providing more health care choices for Washington residents.

Phil Dyer, a resident of Sammamish, is a board member for the State of Washington’s health insurance exchange.