On the Public Health Insurance Marketplaces: Developments In September 2013

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.

The State Exchange Table continues to provide the latest information on carrier participation and plan rates.

Latest Developments:

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.

Illinois: Illinois will have its own landing page, rather than pointing directly back to the federal healthcare.gov site as part of its unique partnership agreement with the federal government. Site visitors will be walked through a series of questions regarding number of dependents and monthly income before being sent to the federal site to enroll.

Illinois is reporting fairly competitive rates, as measured against the national average.  A single 30-year-old living in Cook County, Illinois who has has annual income of $23,000 will be able to buy coverage for as little as $69 a month next year with the help of $67 in federal tax credits.

Iowa: Iowa’s health insurance exchange, The Marketplace, will offer six plans for Iowans to choose from, provided residents meet federal guidelines. Plans will be offered by the following providers – Coventry Health Care of Iowa, CoOportunity Health, Avera Health Plans, Gunderson Health Plan, and Sanford Health and Health Alliance Midwest.

Commissioner Nick Gerhart said in a recent press release that Iowa should have low rates compared to other states, with a 40-year-old non-smoker in central Iowa who signs up for a medium or “silver” plan paying a monthly premium of $219.69. Commissioner Gerhart’s statement was confirmed by a study from the Kaiser Family Foundation that also lists Des Moines’ premium rates as the third-lowest released for 19 cities across the country.

Kentucky: State officials have launched a mobile tour, among other tactics, to reach Kentucky’s 640,000 uninsured residents and inform them about their eligibility and enrollment options under Kynect, the state’s health insurance exchange.  45% of Kentucky’s uninsured population live in nonmetropolitan counties, making them harder to access. Advocacy groups also have been helping with publicity, reaching out to the Cooperative Extension Service offices of Kentucky’s two land-grant universities to help educate.

Maryland: Thirteen insurance carriers have been approved to sell on Maryland’s Small Business Health Options Program (SHOP), an online small business insurance marketplace.  Businesses with 50 or less employees may shop for plans for their companies and apply for small business tax credits.

Michigan: Michigan kicked off a two-pronged outreach effort to educate the public and aid with enrollment. Michigan Consumers for Health alongside three other community-based organizations will split $2.5 million in federal money to help with enrollment efforts.

Michigan reported having the lowest premiums in three categories of plans, based on recent federal analysis. The state’s lowest cost silver plan will cost an average of $271 a month compared to the national average of $310. This plan would cover about 70% of medical costs for an individual. To see a breakdown of state premium rates based on federal analysis submitted by insurers, click here.

Minnesota: MNSure, the state’s health insurance exchange, has opened a call center to field questions about available plans and enrollment. Callers asked primarily about benefits and eligibility while others asked about small business options and tax credits available to people who shop on the exchange. The call center is scheduled to be open 7:30 a.m. to 8 p.m. Monday through Friday, and 9 a.m. to 4:30 p.m. Saturday.

Agency officials considered postponing the launch of their online enrollment site due to issues of information security. Officials will continue to audit the problem to avoid future issues, but state legislative auditor Jim Nobles attributed this breach to human, rather than technological, error.  The state exchange website is slated to go live on time, pending any future issues.

New Mexico: New Mexico directs individuals, families, and small businesses to visit http://bewellnm.com/ to learn about eligibility and enrollment. The state has partnered with several companies to help educate the public about enrollment, including Xerox Company and Poston & Associates, a PR firm. The exchange will also be promoted via radio and television ads along with 34 billboards posted around the state.

According to a recent study by the Kaiser Family Foundation, New Mexico will be offering one of the lowest cost bronze plans, with, for example, 40-year-old in Albuquerque paying $155 a month. That’s lower than in other states except Maryland, where it would cost $146 a month for a similar individual in Baltimore.

Nevada: Four insurers have been approved to sell insurance on the state’s partnership exchange, Nevada Health Link. Anthem, Health Plan of Nevada, Nevada Health CO-OP, and Saint Mary’s Healthfirst all will offer plans to consumers starting October 1st.

New York: NY State of Health, the state’s health insurance exchange, added three more health insurers to its plan offerings: North Shore-Long Island Jewish Health System, Oscar, and Health Republic. North Shore and Oscar are both private companies, while Health Republic is a non-profit alternative.

President Obama returned to New York to help publicize the health care law alongside former president Bill Clinton at the Clinton Global Initiative event. The two discussed “the benefits and future of health care reform in America and access to quality health care around the globe.”

Vermont: Lindsey Tucker, deputy commissioner at the Department of Vermont Health Access,  in charge of overseeing Vermont Health Connect, issued a statement that the exchange would launch in spite of the pending government shutdown. The state received $171.6 million in federal funding to run its own exchange.

Washington: Two insurance providers, Community Health Plan of Washington and Kaiser Foundation Health Plan, got approval to offer plans on the state’s health insurance exchange.  They join four other insurers that had previously been approved, Bridgespan, Group Health Cooperative, Premera Blue Cross and LifeWise, a subsidiary of Premera.

Washington state opened a call center to field questions about eligibility and enrollment, which has already logged 100 calls within the first hour of opening. The center has a staff of 80 representatives, including bilingual representatives to assist Spanish-speaking callers.

Washington’s state insurance exchange jumped on the bandwagon with others such as Minnesota’s MNSure and Oregon’s Cover Oregon when it released a quirky ad designed to get consumers attention. The ad features a woman venturing into her backyard at night and being attacked by a raccoon, paired with voiceover narration warning consumers not to leave their healthcare to chance.

Federally Facilitated Exchanges –

Alabama: Uninsured Alabama residents will have cheaper alternatives judging by recently released rates for the federally run exchange in the state. Individuals purchasing insurance on the exchange could pay anywhere from an average of $247 a month for the lowest cost, highest deductible plans to $303 a month for a higher premium plan. A study by the Commonwealth fund found that the average individual health insurance plan available in the state prior to Obamacare cost approximately $402.33 a month.

Alaska: Alaska state officials opted out of creating a state-run health insurance exchange, leaving the federal government to run the exchange for the state, where 20.6% of the state’s population is without health insurance. Alaskans will be offered plans from two insurance providers – Premera Blue Cross and Moda Health, based out of Portland, Ore.

Arizona: Five insurers submitted rates of plans to be offered on the Arizona exchange, with average monthly rates ranging from $225 to $334. Aetna, Blue Cross Blue Shield of Arizona, Cigna, Health Net, and Meritus all filed rate plans.

Enroll America, a nonprofit focused on enrolling uninsured Americans in healthcare, has targeted Arizona, along with nine other states because of their large uninsured populations. Volunteers will be manning phones and walking neighborhoods to increase outreach in the coming weeks.

Florida: Florida residents will have an average of 102 plans to choose from when enrolling in insurance on the federally-run exchange. That number varies across counties within the state, but of the five metropolitan areas in Florida, numbers range from 86 in Jacksonville to 137 in Miami-Dade.

Despite resistance, nonprofits and community organizations have organized outreach efforts to inform Florida’s uninsured populations of their options under the Affordable Care Act.  Enroll America, a nonprofit that aims to inform residents about their health insurance options, has focused its efforts on Florida and nine other states that have large, uninsured populations.

Georgia: Enroll America joins community health centers, insurance “navigators,” federal officials and other groups to help enroll uninsured or underinsured populations in Georgia. Enroll America will use a variety of outreach techniques including an event called the “Get the Word Out Weekend.” The two groups that won Georgia navigator grants, Seedco (Structured Employment Economic Development Corporation) and the UGA College of Family and Consumer Sciences and Cooperative Extension Service, will aid in outreach and enrollment efforts as well.

Kansas: Blue Cross and Blue Shield of Kansas City (also known as BlueKC), a non-profit health insurance provider, will become the first insurer to offer a plan on the exchange that will serve Kansas City residents.

Louisiana: Five Louisiana companies, Humana, Coventry, Blue Cross Blue Shield of Louisiana, Vantage and Louisiana Health Cooperative, have applied to provide insurance under the new health insurance exchange (Coventry later withdrew its application).The providers collectively have submitted as many as 90 proposed plans to the state Department of Insurance.

Jan Moller, head of the Louisiana Budget Project, points to those poised to be “winners” and “losers” enrolling in the federally-run exchange in Louisiana. Winners are individuals with preexisting conditions who were previously ineligible for insurance as well as those who are simply uninsured or underinsured. Losers, she said, are those who make too little to qualify for subsidies because these populations would have been covered by the expansion of the Medicaid program.

Missouri: A coalition of healthcare providers, community groups and religious organizations are trying to get the word out about the federally-run exchange, Cover Missouri, using the tagline “Using the Missouri Health Insurance Marketplace is Easy!” State officials placed emphasis on choosing the right plan over enrolling quickly, reminding Missourians that the open enrollment period runs through March.

U.S. Health and Human Services Secretary Kathleen Sebelius visited the state to meet with local leaders and discuss implementation of the Affordable Care Act. The meeting included discussions regarding annual wellness checkups and preventative screenings, which will be covered with no copayments or deductibles for program enrollees.

New Jersey: Horizon Blue Cross Blue Shield of New Jersey and AmeriHealth New Jersey have applied to participate in the exchange, which is slated to be ready in time for the October 1st launch date, but are waiting for approval from the Centers of Medicare and Medicaid Services.

Tennessee: Four insurers will be offering dental plans on the state exchange at coverage prices ranging from $20-40 per month depending on age. The insurers are Delta Dental of Tennessee, BEST Life, Cigna and Humana. Federal health care subsidies do not apply towards dental plans for adults, but having plans available on the exchange will improve access to these programs and dental plans are covered as essential services for children under the age of 18.

Texas: A recent survey released by the U.S. Census bureau revealed that Texas had the highest number of people without health insurance in 2012 at 24.6%, or more than six million residents. The survey also revealed that more than 852,000 Texas children lacked health insurance in 2012.

Texas received nearly $100 million in grants from the federal government to implement health care programs. Of the 35 grants, 25 have either already been spent or were due to expire at the end of September. A full list of grants allocated for services such as breast cancer screenings, aging and disability services, HIV prevention, and Medicare program improvement is available here.

Wisconsin: The federal government released rates for the Wisconsin state exchange, comparing the monthly premium for a 27 year old with an annual $25,000 income and a family of four with an annual income of $50,000 for both the city of Milwaukee and the state as whole.  The state insurance commissioner also released a list of plans available to residents by county.  Residents of all 72 counties will have at least one individual provider and a majority of counties, 59, will have multiple providers available to them.

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