November 14, 2013
Federal officials, state representatives, nonprofit organizers, and uninsured individuals alike waited with baited breath for the October 1st rollout of public health insurance exchanges under the Affordable Care Act. Now that we’ve let out that collective breath, let’s look back on the first month and learn what it meant for the states.
All 34 states with exchanges run by the federal government faced challenges as the website, Healthcare.gov, was plagued by technical issues relating to higher traffic than anticipated. States running their own exchanges, on the whole, had more success in enrolling people in plans. Enrollment numbers continue to creep upwards as technical issues are resolved and more Americans enroll online, over the phone or in person.
State Run Exchanges and Partnerships -
California: As of October 8th, 28,000 people had enrolled through Covered California, the state’s health insurance exchange, via the online portal, over the phone, and in person. Program executive director Peter Lee predicts that 500,000 to 700,000 Californians will enroll with subsidies by the March 31 end of open enrollment.
Covered California has removed a much-hyped online tool that would have allowed people to search by zip code for doctors available through plans in their area. Program representatives cited technical glitches as the reason for removing the tool.
Outreach efforts continue with state officials stating they plan to train and certify 20,000 enrollment counselors and 12,000 insurance agents. Only a small fraction of those already trained have received official approval, often leaving healthcare consumers to navigate the system alone or be subject to long wait times for over-the-phone assistance.
The diversity of the state has made bilingual outreach the focal point of education campaign efforts. Bilingual ads and door-to-door education campaigns aim to reach hard to access populations. Health clinics are another popular location for outreach. To aid in this effort, Covered California has awarded millions of dollars in grants to organizations helping Latinos and other ethnic groups enroll.
While support is available online and via over the phone helplines, state officials report that 80% of consumers will want in-person help and this has been problematic due to the shortage of enrollment assisters authorized to handle applicants. Of the 16,000 assisters envisioned by the state, only 20% have been trained and authorized.
As many as 700,000 Californians have been informed that their previous coverage plan does not conform with ACA standards and will be cancelled. While approximately a third of these will receive subsidies from the federal government, others will be faced with new plans and in some cases, higher premiums.
The Covered California website has faced some technical issues, but has had considerably more success than the federal site, Healthcare.gov. The state site received 987,000 visitors in the first five days, with high traffic volumes causing pages to load slowly at times.
Covered California chief Peter Lee defended continuing to withhold enrollment data for the state exchange, citing a need to “make sure the numbers are right.” A lack of transparency has been a continuing criticism of both state and federal exchanges. The state has also not released quality ratings on eight of the twelve insurers offered on the exchanges. Exchange officials stated that ratings would be available in October 2015, after examining patient reviews and other data.
Covered California gets help from cities and counties across the state in the form of volunteer outreach efforts. The state exchange has money to authorize community organizations as enrollment assisters, but does not have similar funds for cities or counties.
The Children’s Partnership launched a campaign specifically targeted at reaching uninsured children and their families and enrolling them in health insurance through Covered California. The ALL IN campaign focuses on outreach and education at schools, afterschool programs, and child care centers.
Colorado: Colorado released its metrics for the first week of its exchange, Connect For Health Colorado, reporting 162,941 unique visitors. Of those visitors, 18,174 created accounts, but only 226 bought plans. State officials attribute this lack of enrollments to technical issues and expect higher numbers by the time open enrollment ends in March 2014.
Exchange CEO Patty Fontneau considers the first week a success, citing visitor numbers as an indication of how much interest there is in the program and insisting that the low enrollment is only a temporary setback. The health exchange board, in the meantime, expressed frustration at the slow enrollment and many wondered how much higher the enrollment numbers would be without all the delays.
USA Today interviewed uninsured Coloradans, in a piece titled “Microcosm of Confusion on Health Law.” While interviewees did mention feeling underinformed about the options available to them, many also expressed hope that the new health care system would help alleviate the stress of being uninsured and save them money.
The Colorado exchange has embraced a new character in encouraging Coloradans to enroll – the college bro. Ads featuring beer kegs and red cups have one bro asking, “Yo, mom, do I got insurance?” Whether these humorous ads will be successful in encouraging enrollment is yet to be seen.
Connecticut: Almost a third of enrollees in Connecticut’s health exchange are under 35, according to program CEO Kevin Counihan. This is good news since insurance providers depend on high enrollment from younger, healthier people to support more costly care for older enrollees. The state-run exchange, Access Health CT, received 1,157 applications its first week, with the majority split between the silver and gold plan options.
According to state officials, 4,065 individuals have enrolled in private insurance plans on the exchange since October 1st. The state aims to enroll 100,000 people by the end of open enrollment on March 31st.
Many Connecticut residents are having to change plans, as many of their current plans will not be offered under the new system. Major carriers such as Anthem Blue Cross, Cigna, and Aetna are discontinuing existing plans, some for non-compliance with federal standards, and are working to migrate their customers onto new plans with similar benefits.
The state exchange site has been hit with at least five unsuccessful hacker attacks in recent weeks. Security of consumers’ personal health information remains safe and data security remains a major concern for state officials running the exchange. The site faced another setback on October 27th when the federal hub, which verifies individual’s identity to determine eligibility for subsidies, went down for a time.
Read the rest of this entry »
November 6, 2013
With the amount of money being spent on health care in America — and our general enthusiasm for all things mobile — you’d think there would be a huge and successful market for mobile apps that empower consumers to take control of their health and wellness.
But according to a report by the IMS Institute for Healthcare Informatics, of the 40,000+ health care apps now available for download on the U.S. Apple App Store, over 50% of them get downloaded fewer than 500 times.
The report is based on an analysis of these apps and an assessment of the potential value they provide at various stages of a patient’s journey to better health. The study was conducted in June 2013.
So what’s the problem?
According to the IMS report, the following issues are holding us back.
1. There are just too many apps!
Forty thousand apps are available on the App Store alone — with reports of at least another 60,000 available from other sources. Seriously? How can we possibly sort through them and decide which ones might meet our needs… let alone which ones are any good.
The sheer number of apps available suggests that app developers are well aware that if they can strike the right chord with consumers, the potential rewards are great. But so far, few seem to have found that magic formula.
Maybe developers should try asking consumers what we want. And perhaps they should also do a better job working with health care providers to determine what we need.
The payday developers are seeking — and the results consumers and their health care providers are looking for — might very well lie at that intersection.
2. For all of the health apps out there, just 54% have a legitimate health-related function, and therefore have the potential to help us stay healthy or manage existing conditions.
Of the 43,689 apps identified as falling into either the “health and fitness” or “medical” categories in the IMS study, 20,007 were excluded early on from additional analysis because they were not really related to health care. According to the study, examples of those include apps related to beauty or fashion or “apps that use gimmicks with no real health benefits.”
Of the remaining 23,682 apps, 16,275 were for consumers and 7,407 were for health care professionals. Of those for consumers, the majority focus on diet and exercise.
The analysis further showed that two-thirds of the apps available for consumers simply provide information. Smaller subsets give instructions, capture data entered by consumers or have an alert/reminder feature.
In other words, the majority of apps for consumers simply move general information from websites and/or printed materials to our mobile phones — and do little else.
3. We have no way to tell the good apps from the bad apps.
The report notes that another issue is that consumers have few options for guidance on the quality of the various apps available. While physicians see the potential benefits of these, they are wary of recommending them to their patients. They too need information about which ones are helpful and which ones aren’t.
With so many apps available, it’s a sure bet that many, many of them are not very good. The report quotes Dr. Israel Green-Hopkins of Boston Children’s Hospital, saying “…40,000 apps within any store is the definition of poor design, because you know that 90% of them are terrible designs.”
Other reports show that some doctors have recommended apps as helpful tools for their patients – to track pollen counts in allergy season, brush teeth for the recommended amount of time or resist urges when quitting smoking. But physicians warn that these apps are supplements and not replacements for in-office care, with most of their benefit coming from encouraging good behavior, not actually improving health.
For the apps evaluated in this study, the App Stores’s popularity rankings do provide one small measure, but it is ultimately insufficient.
4. The vast majority of these apps are completely disconnected from the rest of our health care providers and systems.
The report notes that over time, health care apps will mature from being self-selected by consumers or physician-recommended on an ad hoc basis to being used systematically in health care delivery as an integrated component of our system. But they are not there yet.
What’s working now
Still, amidst this mass of underperforming apps, it is interesting to note that just five of the 40,000+ apps in the App Store make up a whopping 15% of all downloads.
One of these, Calorie Counter by MyFitnessPal, was the second most popular app in the App Store at the time this analysis was conducted and is the most popular free calorie counter and fitness tracker on Google Play. What does it do? And why is it breaking through?
Positive reviews of the app suggest that its primary strength is its community aspect, which allows users to share their progress, weight-loss goals and calorie counts with friends via social media channels like Facebook and Twitter.
While this might not be appealing to everyone, it has been a powerful differentiator in a sea of competitors. An attractive and intuitive interface also allows it to stand out from the crowd.
Despite these distinctions, the Calorie Counter app simply counts calories and nothing more! And counting calories alone has not been proven to improve overall health.
Bottom line, developers need to build better apps and consumers need better ways to find the good ones.
And the health care community needs to fully embrace mobile apps and integrate them into our health care system — empowering consumers to take charge of their own health.
In the meantime, if you’re using apps to get fit, it’s all about finding what works for you – whether it’s tweeting your latest weight loss milestone or tracking your speed on your morning jog.
October 21, 2013
Much happened in the month leading up to the October 1st launch of public exchanges. Here is an overview of some of the notable events and announcements made by the states around the launch of their health insurance exchanges in the month of September:
Outreach efforts continued as states running their own exchanges and states with exchanges run by the federal government alike ramped up their efforts to inform uninsured and underinsured residents about their options for health insurance under the Affordable Care Act.
State Run Exchanges Or Partnerships -
California: Thanks to a new calculator feature, Californians can now get a more accurate estimate of health insurance premiums under the plans available through the state’s exchange marketplace, Covered California. The calculator factors in age and region, which are two of the primary determining factors for premiums. The Covered California exchange previously only offered statewide estimates.
Covered California faces a steep learning curve as a recent survey reported that three out of four Californians who “earn modest incomes and could buy government-subsidized private coverage” do not believe they would qualify for federal assistance. California will also be dramatically expanding its Medicaid program. Uncertainty still exists among California’s illegal immigrant population, many of whom erroneously believe they are covered under the state run exchange.
Colorado: At the final hearing before the October 1st launch, Colorado legislators walked back initial skepticism about operating a state health insurance exchange and expressed confidence in exchange leadership within the state. Republican Representative Bob Gardner, despite voting against the exchange bill back in 2011, said he had “become convinced.” The committee remains concerned about access to premium subsidies for family coverage for employees of small businesses, but will continue to work on this issue in the wake of the rollout October 1st.
Connecticut: Connecticut is going far off the beaten path to inform people about its health insurance exchange marketplace, Access Health CT. Program representatives are approaching potential consumers at outdoor music concerts in an effort to reach new populations.
To facilitate enrollment, Access Health CT has partnered with the state’s Office of the Healthcare Advocate to launch the Navigator and Assister Outreach program. The program will train 300 volunteers, librarians, hospital and clinic workers, health department staff and community volunteers to educate residents about the exchange and the options available to them.
District Of Columbia: The District of Columbia’s health insurance exchange, DC Health link, has announced that they will be partnering with DC United, D.C.’s professional soccer team. The soccer team will help with outreach and education efforts around the exchange. The partnership between the team and the exchange is set to include an on-field presence, a public address announcement and tailgating at RFK Stadium.
Idaho: Idaho officials announced that the state will offer 161 health insurance plans at various coverage levels from eight providers. The plans include 76 individual health plans, 55 small-group health plans for small businesses, 13 individual dental plans and 17 small-group dental plans. While Idaho received approval to run its own exchange, the exchange will initially be run as a partnership since its IT platform is still in the works and will need federal assistance with implementation at the outset. Read the rest of this entry »
October 14, 2013
October 15th marks the beginning of the Medicare Annual Enrollment Period (AEP) for 2014, which runs through December 7th. For seniors on Medicare, this is the time to evaluate current Medicare coverage — including the private Medicare supplemental plans they might be enrolled in — and decide whether to make changes or keep the coverage they have.
What might cause you to consider making changes? Extend Health fielded a survey this past weekend asking its customers who are currently enrolled in plans purchased on its private Medicare exchange whether they plan to re-evaluate or just keep the plans they have, and why.
Of the 449 respondents who completed the survey, 56.7% said they plan to reevaluate one or more of their existing plans and consider replacing one or more of them. Of those who will reevaluate, 23.8% cite their premiums increasing as their reason for reevaluating. However, 62.3% who said they will reevaluate their plans say they will do so simply because they want to confirm they have the best coverage available.
Not all respondents plan to reevaluate their plans: 37.5% said they plan to renew their existing plan or plans without going shopping. Among respondents who do not plan to reevaluate, 69.2% said it was because they are satisfied with their existing coverage.
Willingness to reevaluate plans indicates that Medicare retirees are actively engaged in gaining the best value and most fitting coverage for themselves, as opposed to simply deferring to the status quo and staying with existing plans.
Q1: The 2014 Medicare Annual Open Enrollment Period will begin on October 15, 2013. During the enrollment period, you have the option of renewing your existing private Medicare plans, purchasing new private plans (from your existing insurance provider or from a new provider) or dropping plans without replacing them. During the enrollment period, do you plan to:
|Reevaluate one or more of my existing plans and possibly replace one or more of them||
|Renew my existing or plans without reevaluating them||
|Definitely replace one or more of my existing plans with a different plan||
|Drop one or more of my plans without replacing them||
Q2: If you plan to reevaluate one or more of your existing plans, what is the most important reason prompting you to do so?
|I just want to confirm that I have the best coverage||62.3%|
|My premiums increased||23.8%|
|My out of pocket expenses increased||6.6%|
|My prescription drugs have changed||3.0%|
|My current plan is no longer offered||2.6%|
|My benefits changed||1.7%|
Dorothy stands at the gates of Oz, where the gatekeeper declares, “Welllll, that’s a horse of a different color.”
The idiom has come to describe a situation that takes on new meaning based on new contextual information. Case in point are the state-run and federally-managed health insurance exchanges, which opened for business on October 1st. These public exchanges mean different things to different constituencies, depending on whether you are a large or small employer, an insurance company, or a consumer.
So before you traipse down the yellow brick road to affordable health care, you should know that the exchanges are indeed “a horse of a different color,” depending on who you are.
1. Large Employers: 3 big opportunities
Public exchanges will create a viable market for individual health plans for the first time in American history. This presents three big opportunities for large employers.
First, part-time and seasonal workers now have a viable and federally funded alternative to selecting their company’s so-called “limited medical plan” or going uninsured. This has the dual benefit of providing access for more of these workers to insurance they need, without the additional cost being absorbed by the company.
Second, if a company chooses to sponsor health benefits for its early retirees (under the age of 65), it has a once-in-a-generation opportunity to compare early retiree group plans with individual plans in state exchanges and determine which option offers more value.
Third, COBRA participants, who pay 102% of the premium for their company’s health plan, now have access to plans that offer equivalent or better plans, probably at dramatically lower cost.
2. Small Employers: First-time opportunity
State exchanges provide employers with fewer than 50 workers a great first-time opportunity to evaluate whether to continue their group plans (which can be subject to large annual premium increases) OR allow their employees to tap into state exchanges for individual plans. If they choose state exchanges, many small employers are looking at grossing up pay to assist their workers in purchasing individual plans.
In addition, although delayed this year, the 2015 SHOP exchanges will provide more attractive small group health insurance alternatives.
3. Insurance Companies: Bigger market opens opportunities
Insurances companies have the opportunity to participate in a much bigger market for individual health plans with sustainable profits as millions more Americans purchase plans on public exchanges.
The transition to exchanges also invites change to the delivery model from business-to-business (B2B) to business-to-consumer (B2C). Alongside the opportunity to access a larger market, there is also the opportunity to deal directly with health care consumers.
4. Consumers: Take steps to find the best plan
The millions of Americans who will shop for insurance for the first time starting October 1st would be well-advised to Stop, Wait, Look, and Ask for Help.
STOP: Don’t be in a hurry to buy a plan. Start your research and plan comparisons when exchanges open on October 1st. But since the plan you purchase will not go into effect until January 1, 2014, there is no rush to make your final decision right away. The advisors and agents handling enrollments on the new exchanges will be more skilled at helping you a few weeks after enrollments begin – and you’ll be more familiar with your exchange. Don’t wait too long, though: there will likely be lots of people who will wait until the last minute to enroll and you don’t want to be part of the last-minute rush. And be aware that you must enroll by December 15, 2013 if you want your coverage to start on January 1, 2014.
WAIT: First, set a budget for your health plan. Use the online tools and offline support available to you to find out whether you qualify for a federal subsidy for health insurance based on your income. If you do qualify, the amount of your subsidy will help you figure out how much you can spend on a health plan.
LOOK: Do a thorough comparison of your plan options. Most exchanges will offer plans at four levels based on the coverage and price: platinum, gold, silver and bronze. Don’t fall into the trap of buying the plan with the cheapest premiums. Instead, use the help available to you to figure out what kind of coverage you need based on your health, the doctors and hospitals available in your area and your expected out-of-pocket expenses.
ASK FOR HELP: Lots of help is available to you in the form of online tools and telephone support — take advantage of it. Buying health insurance can be complicated. But help is available to make it less confusing. Your exchange will provide online tools and telephone support. In addition, community organizations in many states have been enlisted to act as “navigators,” guiding consumers through the process. If you live in one of the 36 states that have chosen to have the federal government run their exchanges, some independent companies have been authorized as brokers to help you select and enroll in plans. You are not alone!
In this brave new world of exchanges, you can’t just click your heels three times and end up at home. To get the most out of the state exchanges, it’s all about identifying the choices and opportunities unique to who you are and starting to take advantage of them.
October 3, 2013
Public exchanges, a key provision of the Affordable Care Act, opened for business on October 1st, and millions of Americans went online to check out their health plan options on either state- or federally-managed exchanges.
As expected, there were glitches – more even than were anticipated. But the overwhelming demand signals the potential success of these public health insurance marketplaces.
How many people visited the public exchanges? On the first day, 4.7 million people visited HealthCare.gov, the federally-managed exchange, and 133,000 called the federal portal’s call center. About 104,000 requested live chats.
While the federal exchange, which serves 36 states, was inaccessible for much of the day, administrators “added capacity and made adjustments” to put it back into service by late afternoon.
As for state exchanges, New York officials said 2.5 million people visited the New York State of Health exchange in its first half hour. California reported as many as 16,000 hits a second on CoveredCA.org. Kentucky’s Kynect exchange website had a more modest 24,000 visitors by 9:30 am, but by midday Wednesday had successfully enrolled 2,600 individuals and families in plans.
Some states running their own exchanges, including Colorado and Oregon, failed to open their online enrollment portals for business as scheduled, but assured that this delay is only temporary and both states are enrolling people over the phone in the interim.
Citizens have until December 15th to enroll in health plans to guarantee that they have coverage by January 1st, when the tax penalty applies for those who have not enrolled in some form of insurance.
Precise enrollment numbers are still unclear, and it is not yet known if the technical glitches deterred consumers from enrolling. Despite criticisms and access issues, the takeaway from October 1st is that people are visiting public exchanges in huge numbers, giving an early indication that a viable new market for health plans on public exchanges will develop over the next months and years. We will continue to monitor the status of these exchanges and report back here.
What Do Paul Bunyan, A Pair Of Portland Songsters, and The Boston Red Socks Have In Common? They All Want You To Enroll In Health Insurance Exchanges.
September 26, 2013
With state- and federally-run exchanges due to open for business in just a few days, how are states reaching out to maximize enrollments? You might be surprised.
Maryland has chosen to trade on the popularity of reigning Super Bowl champs, the Baltimore Ravens, while Oregon has decided to capitalize on its image as a friendly, outdoorsy state with abundant natural resources and a love of flannel. Others have employed quirky, yet iconic characters in hopes of being memorable. For example, Minnesota’s campaign features folklore hero Paul Bunyan and his companion, Babe the Big Blue Ox.
While it’s fun to check in on some of these efforts, at the end of the day it’s serious business. As everyone knows, for public exchanges to be successful, lots of people must visit them and buy insurance plans.
Which of these campaigns do you think will be winners?
Colorado was the first state to launch an ad campaign for its health insurance exchange back in May. One ad features a woman jumping up and down surrounded by baseball players as if celebrating a sports victory while a voiceover intones, “When health care companies compete, there is only one winner: you.”
Maryland, mentioned earlier, has enlisted the Baltimore Ravens to help boost awareness by running ads before and after the team’s Gameday TV show. Why football? Research revealed that 71 percent of the uninsured population in Maryland has watched, attended or listened to a Ravens game in the past 12 months. State exchange officials faced some controversy, however, when they attempted to recruit Baltimore Ravens players to appear in the ads — an idea that did not fly.
Taking a different tack, neither Kentucky nor Oregon mention exchanges directly in their ads, beyond links to their exchange websites. Kentucky’s animated commercials are meant to evoke empathy for those who have difficulty obtaining insurance. Some Oregon ads feature guitar-toting musicians walking through idyllic Oregon scenery singing original songs with folksy melodies and lyrics reminiscent of American folk anthems. Others have a more urban theme with a rap song as their centerpiece.
Playing against type, California takes a no-nonsense approach to advertising its health insurance exchange. It runs ads in both English and Spanish that feature people going about their everyday lives, foregoing the flashier tactics of other campaigns. “You won’t be seeing movie stars,” says the exchange’s Executive Director Peter Lee. “You won’t be seeing rock stars. You’ll be seeing real people.”
New York takes a similar approach, with its ads depicting a cross-section of New Yorkers from diverse age groups, ethnicities, and geographies.
But our favorite campaign so far is Minnesota’s, which features Paul Bunyan and Babe the Big Blue Ox getting into various scrapes that just result in the need for medical attention. These ads feature gems like a distressed Paul Bunyan calling out, “Babe, get your blue ox over here!” In keeping with the state’s tagline of “Land of 10,000 Lakes,” the ads conclude with, “Minnesota, Land of 10,000 reasons to get health insurance.”
For a good laugh, check out this ad, in which Paul Bunyan has an accident while water skiing.
September 24, 2013
Less than two weeks remain until state health insurance exchanges under the ACA being accepting enrollments. As states prepare to either implement their own exchanges or let the federal government set up shop on their behalf, some states are expressing concerns that they will not be ready in time, while others are confident. Advertising and informational campaigns are amping up in anticipation of the launch, with all states working to educate their residents about their options under the new system.
The State Exchange Table continues to provide the latest information on carrier participation and plan rates as they occur.
State Run Exchanges-
California: Politico identified California as one of the three “swing states” – states with the largest uninsured populations that play an outsized role in the success or failure of Obamacare. Together, Texas, Florida, and California make up one third of the nation’s 46 million uninsured. State officials in California have already provided $43 million for consumer outreach and have hosted numerous town halls and other informational events.
California also faces a potential delay in launching its online enrollment for Covered California, the state’s health insurance exchange. A spokesman for the exchange cited continued testing of the technology for enrollment as an obstacle to timely implementation. Despite the projected delays, a Covered California rep confirmed that consumers will be able to enroll over the phone or in person on time, beginning October 1st.
Colorado: Colorado recently released finalized rates for plans on its public health insurance exchange, joining 13 states and the District of Columbia in doing so. The state operates a clearinghouse exchange, meaning they approved all 242 plans submitted under its state-run program, Connect for Health Colorado.
Colorado state insurance commissioner Marguerite Salazar expressed concern over the approaching “bumps in the road” to implementation of the state’s health insurance exchange. Yet unknown are the robustness of the online system and residents’ level of familiarity with buying their own insurance. As the October 1st deadline approaches, an estimated 200,000 uninsured Coloradans wait to enroll. Despite her concerns, Salazar is confident that Colorado will have a functioning exchange by the deadline.
Connecticut: Connecticut announced plans to open “storefronts for Obamacare,” boutique-style spaces with the aim of educating the public about the state’s health insurance exchange, Access Health. The first wave of storefronts will be in low-income areas, with the goal being to inform “hard to reach” populations that spend less time online or watching the news. The eventual goal is to have locations throughout the state.
The intent behind the storefronts is to address the issue of “How do we bring health care into the community?” Styled after Apple retail stores, the locations will have brokers on hand to walk consumers through their options and advisors similar to Apple Geniuses to help individuals with more complicated and specific issues.
Florida: Florida, identified by Politico as a “swing state” in determining the success or failure of Obamacare, has an estimated 3.9 million uninsured individuals under 65. Enroll America, a non-profit group dedicated to encouraging Floridians to enroll, currently has 27 staffers on the ground, with plans to hold information sessions, knock on doors in neighborhoods with high concentrations of the uninsured, and set up tables at community gatherings.
Idaho: Idaho recently debuted a new health insurance exchange website, www.yourhealthidaho.org. The state only voted to approve a state-run exchange in March, so the site will initially serve simply as a gateway to the federal website, but Idaho officials hope to have a state-run online enrollment site up and running by the end of the year.
Illinois: To be prepared for the impending open enrollment period, Illinois is hiring a team of 800 temporary workers to serve as “in-person counselors.” These counselors will help consumers apply for coverage and will answer questions and explain differences between the insurance policies offered on the new online marketplace. Training sessions began in July and will continue through the October 1st enrollment start.
Kentucky: Health workers in Kentucky are doing outreach amidst the corn dog stands and cotton candy vendors at state fairs to educate Kentuckians about the state’s health insurance exchange, called Kynect. Workers attempted to simplify the complexities of the new system, distilling the program down to three simple phrases: “We are Kynect – part of the new health care law,” “Do you know anyone who doesn’t have health insurance?” and “You may qualify for Medicaid or a tax credit based on your income.”
Michigan: Michigan’s newest health insurance company, Consumers Mutual, has launched an educational campaign around enrolling in health insurance that features “billboards, radio spots, TV spots, and print and digital advertising.” The ads center around “Healthee” – a red and black animated character that guides viewers through the enrollment process.
Despite resistance from Michigan Republicans in the legislature, Governor Rick Snyder is advocating for increased outreach to inform individuals about health insurance exchanges. Coalitions such as Michigan Consumers for Health Care support the outreach effort aided by the $2.5 million federal grant for “navigators.”
Nebraska: Nebraska released its health insurance exchange rates, which initially appeared to be higher than other state exchanges. However, rates do not take into account the yet-unreported federal subsidies to be made available and therefore may be subject to change. The rates also do not apply to individuals covered by employer health plans or Medicare.
The state convened for the first meeting of the Nebraska Exchange Stakeholder Commission, a panel of Nebraskans in charge of oversight and advice for the new health insurance exchange. The 11 member panel includes “consumer representatives, small-business owners, a farmer and taxpayer advocate, a health insurance agent, a hospital administrator, a doctor and an insurance company representative.”
New Mexico: State officials announced that implementation has begun on outreach efforts to educate the state’s residents about their options under the new, state-run exchange in advance of the open enrollment date. J.R. Damron, M.D., Chair of the New Mexico Health Insurance Exchange (NMHIX) Board, stated “We are launching this comprehensive system to make sure that all New Mexicans understand the new health coverage options and give them the information as well as local help to get signed up.”
New York: Health insurance company Aetna pulled out of the New York state health insurance exchange, called New York State of Mind. This is the latest in a series of opt-outs by Aetna. Other states it has opted not to participate in include Maryland, Ohio, Georgia, and Connecticut. The health insurance company sites risk associated with the initial launch as the reason for opting out. “We have taken a prudent risk-based approach to both our overall exposure and exposure within a given marketplace,” Chief Executive Officer Mark Bertolini said.
Rhode Island: Rhode Island released its final rates for individuals and small businesses under the state-run exchange, known as HealthSource RI. Health insurance providers for the state are Blue Cross & Blue Shield of Rhode Island, United HealthCare, and Neighborhood Health Plan of Rhode Island.
Tennessee: Tennessee is calling on churches as well as secular channels to inform individuals about the federally-run health insurance exchange. Experts estimate that 30,000 uninsured individuals will enroll in the exchanges come October 1st through one of the state’s four health insurance providers – BlueCross BlueShield of Tennessee, Cigna Healthcare, Coventry Health & Life, and Community Health Alliance.
Washington: Washington state launched an ad blitz to publicize its online health insurance marketplace, called Washington Healthplanfinder. The goal of the advertising is to sign up 130,000 uninsured people by the end of 2013 and 280,000 in 2014 via the online enrollment tool. The state has received $26.3 million from the federal government allocated for marketing and outreach efforts.
Federally Facilitated Exchanges-
Alaska: Alaska regulators have approved two companies to provide health insurance under the state’s federally-run health insurance exchange: Premera Blue Cross Blue Shield of Alaska, the state’s largest insurance provider, and Moda Health. Senator Hollis French has high hopes for the exchange – the details of which will remain relatively in the dark until the January 1st start. State law prohibits releasing the rates until that time, but French is hopeful they will reflect the savings experienced by other states. “We hope that Alaskans experience the same reduction in cost that other states have seen as the exchanges go into effect and roll out their estimates,” he said.
Arizona: The Department of Health and Human Services (HHS) and AARP will be taking the lead on helping Arizona residents sign up for the federally-run health care exchange come October 1st. A combination of bilingual resources and “user-friendly” websites will be used to walk Arizonans through selecting and enrolling in a plan.
Georgia: College administrators at the University of Georgia received a $1.66 million federal grant to train and deploy “navigators” to walk Georgians through the process of enrolling in health insurance under the new federally-run exchange starting October 1st. According to federal requirements, the navigator will dispense “fair, impartial and accurate information that assists consumers with submitting the eligibility application, clarifying distinctions among (qualified health plans) and helping qualified individuals make informed decisions during the health plan selection process.”
Missouri: A St. Louis-based non-profit, Missouri Foundation for Health, will vote “to supply $1.1 million worth of posters, wallet cards and other promotional materials about the exchange” to educate Missourians about the federally-run exchange. Missouri residents largely remain in the dark as the open enrollment period nears. Missouri is one of the 19 states that has opted to let the federal government run its exchange and has done little thus far to publicize the program within the state.
Montana: Montana released rates for its federally-run insurance exchange. Rates are available from three carriers offering plans to state residents – Blue Cross Blue Shield of Montana, PacificSource, and the Montana Health CO-OP. Montana Commissioner of Securities and Insurance, Monica Lindeen, said she was “pleasantly surprised” by the rates despite initial concerns about the program. She also appreciated the fact that Montanans with preexisting conditions will not denied coverage or priced out of the market.
Texas: Politico identified Texas as a “swing state” that could make or break Obamacare depending on how many of its residents enroll in insurance exchanges starting October 1st. With the second highest uninsured population after California (Texas has an estimated 5.8 million uninsured people under 65), Texas is essential in reaching enrollment goals set by the federal government.
In an effort to educate Texans about how to use the federally-run health insurance exchanges, the local branch of the United Way (Tarrant County) applied for grant money to help train and deploy navigators. The United Way received $5.9 million and aims to reach 62,000 Texans in face-to-face meetings and 500,000 through phone calls and community meetings, according to the organization’s president, Tim McKinney.
Utah: According to state insurance officials, Utahns will have at least 99 plan options through the new online health insurance marketplace. Participating insurers are Altius Health Plans, Arches Mutual Insurance Co., BridgeSpan Health Co., Humana Medical Plan of Utah, Molina and SelectHealth. Utah is unique in that it is the only state that will be splitting coverage between the state and federal government, with the federal government running the marketplace for individuals and the state of Utah operating Avenue H, an exchange that caters to small businesses.
September 18, 2013
A recent article in the Washington Post highlighted states that have opted not to expand Medicaid eligibility to previously ineligible populations under the ACA. While these states will have an increase in the number of uninsured people who have coverage starting in 2014, the numbers will not be nearly as high as they would be if they had chosen to expand Medicaid to more people.
This could have a huge impact on the perceived success or failure of the ACA. Here’s how.
Impact of states opting out
Simply put, the main goal of the ACA is to get millions more Americans covered by health insurance. A key provision for achieving this in the original law was to provide a continuum of affordable healthcare coverage by 1) providing federal funds to states to expand Medicaid to include people under 65 years of age living at 138% or below the poverty line and 2) offering private health plans for sale on public exchanges with federal subsidies available for people under 65 years of age living at 400% or below the poverty line.
Another provision of the ACA for meeting this goal was the “individual mandate,” which requires all individuals to have health insurance by 2014 or pay a penalty.
When the U.S. Supreme Court ruled on the constitutionality of the ACA in 2012, it upheld the individual mandate but allowed individual states to decide whether to expand Medicaid. According to data from the American Health Line, as of September 6, 2013, 16 states have opted out and another 7 are leaning toward opting out.
According to an Urban Institute report, 7 million adults ages 19 to 64 would have qualified for Medicaid in the states that have opted out, had they chosen to expand the program.
Recognizing that individuals who qualified for Medicaid in the opt-out states would not be able to afford the private plans that will be offered on the public exchanges even with federal subsidies, the federal government exempted them from the individual mandate.
So even though the individual mandate was left intact by the Supreme Court ruling , the net effect of states being able to opt out of Medicaid expansion is that fewer uninsured people will end up getting insurance as a result of the ACA.
Magnitude — and locations — of the problem
The two maps below illustrate the magnitude of the impact. The first map shows the percentage of people under 65 living at or below 138% the poverty line who do not have health insurance. These individuals would benefit most from Medicaid expansion.
The second map shows the percentage of people under 65 living at or below 400% the poverty line who do not have health insurance. This individuals would qualify for either Medicaid or for federal subsidies they could use to purchase private health plans on public exchanges.
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With both supporters and critics of the ACA eager to point to its success or failure, the number of uninsured people who get coverage under the ACA will no doubt be a talking point for both sides on cable news shows starting in January 2014.
September 5, 2013
A new study asks and answers three essential questions about the ACA-authorized public health insurance exchanges scheduled to open for business on October 1, 2013: Can people select the best policies? Do they know how well they are doing? Does the design of the sites change their performance?
The study, “Can Consumers Make Affordable Care Affordable? The Value of Choice Architecture,” was based on six experiments asking people to choose the most cost-effective policy using websites modeled on current exchanges. According to the study’s co-authors, professors from Columbia Business School, Hebrew University of Jerusalem, University of Pennsylvania Law School, Columbia University Department of Psychology and University of Miami, the results suggest, “there is significant room for improvement.”
Their conclusions: “Without interventions, respondents perform at near chance levels and show a significant bias, overweighting out-of-pocket expenses and deductibles. Financial incentives do not improve performance, and decision-makers do not realize that they are performing poorly.”
That’s the bad news. The good news is that the study also showed that performance can be improved “markedly” through the use of just-in-time education, defaults that pre-select options based on individuals’ usage, and cost calculators.
In other words, when public exchanges use “smart” web-based tools, individuals end up with a much more realistic estimate of their expected health care costs and are able to select plans that better meet their needs.
In our experience operating the nation’s largest private Medicare exchange, we agree that sophisticated profilers, calculators and decision support tools can help people make better health care coverage decisions. But even in a world where automated help systems, interactive websites and specialized mobile apps are now capable of performing a wide variety of tasks that used to be the domain of live human help, we believe there are still situations that require a human touch. Buying health insurance is one of them.
On that front, there is also good news.
CMS Authorizes Web Brokers
In early August, the Centers for Medicare & Medicaid Services (CMS), which supervises the federally facilitated marketplace — the health insurance exchange operated by the federal government in 36 states – signed web broker entity agreements with several firms, including Towers Watson.
These agreements allow these firms to integrate with federal eligibility systems so that they can assist individuals every step of the way as they shop for and enroll in subsidized coverage through the federal exchange – including by offering live access by telephone to licensed benefit advisors. Once an individual selects a plan, his or her enrollment will go to the federally run exchange for processing.
Some firms plan to serve individual consumers directly. In contrast, Towers Watson will help employers provide health insurance education and enrollment services to their part-time and seasonal employees, pre-65 retirees and their dependents.
Federal Government Awards $67 Million for Navigators
In addition, on August 15th, the federal government announced that it has awarded $67 million to train “navigators” – non-profits, businesses, universities and local government institutions state and local communities enlisted to walk residents through the process of evaluating and selecting health plans that meet their needs.
Of the 105 navigators in 34 states awarded funding, United Way and Planned Parenthood are among the “big name” organizations chosen presumably to serve a broad audience. Other organizations such as Migrant Health Promotion, Inc. and the National Council of Urban Indian Health will cater to smaller, more targeted populations.
As the study referenced above points out, and most observers agree, the success of the public exchanges will rest on two things: the first is that consumers will be able to select the best policy for their needs. The second is that price competition, driven by effective consumer choice, will lower prices.
With web brokers authorized and navigators funded – and more likely on the way – that vision takes another step closer to becoming reality.