On the Public Health Insurance Marketplaces: Developments In November 2013

December 13, 2013

In November, President Obama reversed a controversial provision of the Affordable Care Act, making good on his “if you like your plan, you can keep it” promise by allowing extensions for plans that otherwise would be cancelled under the ACA’s requirements. While some states have rejected the offer to extend plans, many have approved the extensions and it is now up to individual insurers to decide whether or not they want to offer them. Blue Cross Blue Shield has already approved the extension in several states, pushing off plan changes and potential premium hikes to 2015.

Though enrollment on the federal managed exchange website was disappointing, California’s results improved: by November 19th, 80,000 people had enrolled through its state-run exchange, Covered California. 

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

Latest Developments:

State Run Exchanges and Partnerships –

Arkansas: Arkansas’s health insurance exchange board unanimously approved an application for a $3.5 million grant to study creating a state exchange, as opposed to relying on the one run externally by the federal government. This marked the state’s first step towards creating its own state-run exchange.

Jay Bradford, Arkansas’ Insurance Commissioner, also confirmed that insurers in the state will have the option to extend health insurance plans. Extended plans that were slated to be cancelled will now be good through December 30th, 2014.

California: Despite requests from California Insurance Commissioner Dave Jones, California state officials have rejected Obama’s offer to permit insurers to extend plans poised to be cancelled in 2014. Exchange executive director, Peter Lee, explained that allowing extensions could delay program implementation in the state.

California enrolled more individuals in health insurance plans on its state-run exchange, Covered California, than all 36 states on the federal exchange, according to recently released numbers. As of November 19th, 80,000 Californians had enrolled and state officials expect that number to continue to climb.

According to recent reports, 23% of enrollees in Covered California, the state-run exchange, are aged 18 to 34 years old, a demographic considered key to offset the cost of older and potentially less healthy enrollees.

Covered California prepared to launch the online enrollment portal for small businesses after repeated delays. Enrollment for the Small Business Health Options Program (SHOP) was supposed to open on October 1st. Once employers enroll via SHOP, their employees can browse online and select a plan. [Note: The program officially launched on December 2nd]

The California attorney general’s office recently shut down 10 websites masquerading as Covered California, the state’s health insurance exchange. The plans sold on these fraudulent sites were not eligible for subsidies and Attorney General Kamala Harris urged shoppers on the exchange to visit coveredca.com – the official site – and not any other sites that might have similar names that falsely imply affiliation with the state site.

Colorado: Controversial ads aimed at young uninsured Coloradans continue to air in the state, despite criticism around their depictions of the use of alcohol and sex to catch the attention of so-called “young invincibles.” A recently released ad campaign featured a woman clutching her birth control pill pack and ogling an attractive man accompanied by the controversial tagline, “Let’s hope he’s as easy to get as this birth control.” The ads have gotten national attention, but the question remains whether the ads, created by two Denver-based nonprofits, will be successful in upping enrollment.

As of November 18th, Colorado reported just 6,001 successful enrollments, significantly lower than the 11,000 plus number predicted by state officials.

Almost 250,000 Colorado residents are poised to have their current policies cancelled, due in part to non-compliance with new standards under the Affordable Care Act. Twenty-three carriers cancelled plans in the state, however it was reported that some of these cancellations might have been due to normal business practices.

The mandatory Medicaid application step in Colorado’s health insurance enrollment has been a boon for the Medicaid program, but its 45-day approval process has become a time-consuming obstacle for individuals attempting to enroll in plans on the exchange. Members of the Connect for Health Colorado advisory board expressed their concern that the lengthy approval process could be driving away potential customers.

Connecticut: Connecticut has enrolled 7,572 individuals in private insurance plans as of November 19th. Recent reports show higher enrollment numbers for people over the age of 55, which could be problematic for the state since a high percentage of young, healthy enrollees helps offset costs for older enrollees.

Connecticut’s state exchange, Access Health CT, opened a new storefront in New Britain to aid residents with enrollment. The storefront joins another location in New Haven. These outposts for the exchange, apparently styled after Apple stores, are intended to help reduce pressure on the online enrollment system – which relies on the federal site for identity verification – and has faced delayed enrollment as a result.

Delaware: Delaware successfully enrolled just four people in health plans as of November 6th, despite being open since the October 1st launch date. A total of 31 people have completed applications and 218 accounts were started. State officials cited trouble with the federal website, which does identity verification for the state exchange, and delayed background checks for navigators as reasons for the low enrollment numbers.

District of Columbia: Chester A. McPherson has been named acting insurance commissioner after the now-former commissioner William White was fired, following his criticism of Obama’s announcement allowing for plan extensions. This decision, according to White, “undercuts exchanges.” While White’s comments were not cited as the reason for his firing, many speculate that they were at least partly responsible because of how quickly he was let go following the remarks.

DC insurance officials have declined to extend cancelled plans, leaving more than 20,000 residents to find new plans for the coming year.

Members of Congress and their personal staff will be required to give up their plans on the Federal Employees Health Benefit program and enroll in plans on the District’s small business exchange, DC Health Link, according to provisions in the ACA that included federal officials in the mandate. Congress members and staff will not be eligible for subsidies, but will be eligible for federal employer contribution towards the cost of their premiums.

Hawaii: Hawaii’s chief insurance commissioner announced her intent to resign, effective December 6th, following dismal enrollment numbers and continued software issues with the online enrollment portal. Just 257 people successfully enrolled in the first month on the state-run exchange, Hawaii Health Connector.

Illinois: According to recently released numbers, 1,370 Illinois residents enrolled in plans on the state-run exchange, the Illinois Health Insurance Marketplace, in the first month since enrollments began.

Illinois state officials have accepted President Obama’s offer to let insurers in the state temporarily extend plans that do not meet ACA standards. This could affect approximately 185,000 Illinois residents who received cancellation notices, but it is still up to the insurers to decide whether or not to grant the extension.

Illinois hosted outreach events across the state on November 2nd to encourage residents to enroll in the exchange, Get Covered Illinois. The outreach was part of the “Cover Your Community” day of action, with information sessions and booths set up statewide.

Kentucky: Three insurance providers, Humana, United Healthcare, and Assurant, have opted to extend plans for their policyholders after state insurance commissioner Sharon Clark approved the option for insurers to offer extensions. So far, Anthem and Bluegrass Family Health, two of the state’s largest insurers, have rejected the extensions.

Maryland: Two Maryland insurers, CareFirst BlueCross BlueShield and Kaiser Permanente, have decided to allow individuals to extend their non-ACA compliant plans through 2014. Maryland insurance commissioner Therese Goldsmith approved extensions for insurers in the state as long as the renewals kick in before January 1st, 2014.

Exchange enrollment increased 36% in the second week of November, with strong representation from female and middle-aged enrollees. Despite the increase, enrollment remains lower than anticipated in the state with 1,278 people enrolling in private plans in the first month of enrollment.

Approximately 73,000 Maryland residents will be dropped from their current plans, due to compliance issues with the new ACA standard. In total, nine insurers have cancelled plans not grandfathered in under the law.

Maryland has postponed the rollout of enrollment for small businesses on the state’s health exchange website to April 2014 in light of continued technical problems with the site. State officials originally intended to open exchange enrollment to small businesses in January.

Massachusetts: Massachusetts residents will not be able to keep cancelled plans, with state insurance commissioner Joseph Murphy reporting that almost no plans failed to qualify under ACA standards. This fact, according to Murphy, makes extensions unnecessary and potentially disruptive to the law’s implementation in the state.

The online exchange portal faced continued technical issues, with consumers reporting dead links and error messages, among other problems. Long wait times on over-the-phone enrollment assistance also contributed to the complaints being leveled at the site and the exchange as a whole.

Michigan: Blue Cross and Health Alliance Plan (HAP) will not extend plans for Michigan consumers, with the exception of one Blue Cross plan, the Keep Fit plan. Blue Cross will be cancelling about 140,000 policies by the end of the year and HAP will cancel approximately 1,000.

Minnesota: MNSure signed up nearly 11,000 people in the first month of enrollment. Most of those who enrolled will end up on the state’s low-income programs, MinnesotaCare or Medical Assistance, rather than on private insurance plans.

Governor Mark Dayton announced that he would not grant extensions to cancelled plans that do not comply with ACA standards. About 140,000 Minnesotans are currently on plans slated to be cancelled and will have to find other coverage for 2014.

Individuals previously eligible for federal subsidies to help pay plan premiums have expressed confusion about they were not awarded any subsidy money. This has to do with the fact that plans for Minnesotans may have some of the lowest premiums in the country. However, because the plans are more affordable, fewer people qualify based on their income for federal subsidies to pay for them.

State officials have increased outreach efforts to Latino residents, who make up just 5% of the state population, but more than 13% of the uninsured population. Outreach includes TV spots on Spanish-language programs, but efforts continue to reach Latinos living in rural areas due to access issues.

Nevada: Nearly 2,000 people have signed up for health insurance plans on Nevada’s exchange, the Silver State Health Insurance Exchange. A little more than 500 of those have already paid their premiums for the coverage, which will begin January 1st. State officials do not anticipate reaching the target enrollment number of 118,000 by December 15th but expect enrollment numbers to continue to climb as the March 31st deadline nears.

State officials will not allow insurers to extend cancelled plans that do not meet ACA requirements. Nearly 25,000 Nevadans received cancellation notices from their insurers and will need to find new plans for 2014.

New Mexico: Nearly 400 small businesses in New Mexico have signed up for health insurance on the state exchange and 144 of those have submitted payment for coverage beginning January 1. By comparison, state officials expressed frustration with the individual enrollment portal, which continues to have issues, partly because its identity verification process goes through the glitch-ridden federal site, Healthcare.gov.

The exchange has introduced a new cost comparison tool on their website, BeWellNM.com.  According to exchange CEO Mike Nunez, the tool will allow site visitors to compare plans by metal level, carrier, out-of-pocket costs or deductibles without going through the application process first.

New York: The New York enrollment website continues to run smoothly amidst chaotic rollouts in other states. Approximately 257,414 have completed applications and of those, 76,177 have successfully enrolled in plans as of November 25th. State officials have seen steady enrollment since the October 1st launch and expect to enroll 1.1 million of the state’s 2.7 million uninsured residents through the state-run exchange.

Oregon: As of November 11th, the beleaguered Oregon state exchange still had not enrolled a single person in health insurance on the state exchange. State officials have been refocusing on manual enrollments as the online enrollment site continues to have technical issues. Manual enrollment, however, has been hindered by long processing times. As of November 20th, 25,000 individuals and families had submitted paper applications, but none had been successfully processed and enrolled.

Cover Oregon communications director Amy Fauver made an unofficial prediction that the site would be up and running before December 15th, the deadline for enrolling in order to have coverage that would kick in on January 1st. Adding to the site’s woes, it was revealed that the website was “built and tested for use on Internet Explorer,” and may not work on other browsers such as Safari and Firefox.

Oregon Insurance Commissioner Laura Cali has confirmed that the state will allow extensions for cancelled plans. Nine Oregon insurers have opted to extend plans, covering the majority of the 140,000 residents who previously received cancellation notices.

Rhode Island: Health insurance commissioner Kathleen Hittner and HealthSource RI director Christine Ferguson announced that the state has rejected Obama’s offer to permit insurers to extend cancelled plans. The state will stick to ACA standards for plans offered on the exchange and noncompliant plans will no longer be offered as of 2014.

Vermont: Vermont’s health insurance exchange, Vermont Health Connect, has faced continued scrutiny following reports of multiple data breaches from back in mid-October. The exchange issued three notifications of security lapses on its website, but questions remain about the actual status of security on the site after exchange officials denied in a legislative hearing that such lapses had occurred.

Washington: The Washington state exchange continued to enroll residents and has been held up recently as a success story amid issues with the federal site. In the first month, the state successfully enrolled 49,000 people and another 92,000 had started an application. The state has announced plans to ramp up youth outreach, as just 5% of enrollment from the first month was from residents between the ages of 18 and 25.

State exchange officials apologized to the 8,000 people who were told that they qualified for higher subsidies than they were actually eligible for, based on income. The average discrepancy between promised subsidy and actual was $100 per month. Officials blamed a system glitch that has since been corrected.

Federally Facilitated Exchange-

Alabama: The ubiquitousness of BlueCross in the state may be responsible for high premium rates for residents on the federally-run exchange. BlueCross provides insurance plans for 90% of individuals and families who buy plans directly. Many Alabama residents are reporting significantly higher premiums on the exchange, though this does not compare coverage to previous plans, meaning expanded coverage under the new plans may be responsible for the increased cost.

According to a recent study, an estimated 270,000 Alabama residents will be eligible for subsidies under the new exchange.

Alaska: Alaska governor Mark Begich proposed adding a lower tier of “copper” plans to provide more affordable options for Alaskans. The tier would cover at least 50% of health care costs, slightly better than many of the cancelled plans that covered 40% coverage.

Florida: Florida Blue, the state’s oldest and largest insurer, informed 300,000 members that their plans would be cancelled or changed to comply with federal requirements for plans. Representatives from the provider stipulated that they are cancelling plans, not coverage for these individuals. To many, this feels like a small distinction as they experience “rate shock” in response to higher premiums under the new plans.

The Department of Health and Human Services reported that in the month of November about 3,500 people had enrolled in health plans in Florida on the federally-run exchange. While initial enrollment numbers have been lower than anticipated, officials said they expect enrollment will most likely speed up as the March 31st deadline approaches.

Florida insurance commissioner Kevin McCarty agreed to let insurers in the state extend cancelled plans in 2014 under the ACA. While many insurers (Cigna, Aetna, Humana, and Coventry) already had state approval to extend plans, Florida Blue, the state’s Blue Cross Blue Shield branch, joined their numbers soon after President Obama’s announcement.

Indiana: Just 701 Indiana residents chose insurance plans through the federal exchange, despite the fact that the exchange received approximately 16,000 completed applications from the state. Released figures did not disclose how many of the enrolled 701 have started paying premiums.

Kansas: Blue Cross Blue Shield of Kansas will continue to offer plans that were set to be cancelled in 2014, good news for the approximately 10,000 policyholders who would have had to find new plans.

Louisiana: Most Louisiana congressional staff will get health insurance through the federal exchange, thanks to the Grassley provision, an amendment that requires DC congressional staffers designated as “official” to enroll in health insurance through DC Health Link. Senator Dave Vitter, Representatives Steve Scalise, Bill Cassidy, and John Fleming all identified their entire staff as “official,” while several others opted to identify just part of their staff or none as “official,” citing opposition to the ACA as their reason.

Maine: Maine’s branch of Anthem Blue Cross Blue Shield has reported that they will extend plans one year for policyholders with cancelled plans.

Missouri: Missouri Foundation for Health, a non-profit helping to publicize the federal exchange, opted to postpone its mass media launch of the Cover Missouri campaign in light of continued technical issues with the federal website. The campaign was set to include radio ads, banner ads online, and short “pre-roll” ads at the beginning of YouTube videos. Officials said mass media outreach to Missourians should resume once site functionality improves.

Missouri governor Jay Nixon announced that insurers may extend plans slated to be cancelled due to non-compliance with ACA requirements. Because Missouri does not require insurers to notify the state insurance commission of policy changes, the exact number of Missouri residents this affects remains unknown.

North Carolina: North Carolina’s largest insurance provider, Blue Cross and Blue Shield of North Carolina, has decided to allow individuals not grandfathered in under the ACA to keep their current plans. This extension was made possible by insurance commissioner Wayne Goodwin, who opted in to President Obama’s offer of a temporary reprieve to insurers with plans that do not meet ACA requirements.

Ohio: One of Ohio’s largest insurers, Medical Mutual of Ohio, announced that it will not be extending cancelled plans through next year as many insurers in other states have opted to do. It remains to be seen whether the state’s other large insurer, Anthem Blue Cross Blue Shield will offer extensions.

Pennsylvania: Philadelphia has announced the launch of a citywide outreach effort to inform residents about their options under the ACA. The effort will be a partnership with nonprofit organization Enroll America, which has been spearheading efforts across the country. Enroll America representatives describe the collaboration with Philadelphia as their largest partnership with a city thus far.

South Carolina: South Carolina state officials have opted to allow insurers in the state to extend insurance policies that do not meet ACA requirements. This decision could affect up to 150,000 South Carolina residents. It is now up to individual insurers to decide whether or not they will be extending the plans.

At least 12 insurers reported that they would no longer offer policies in South Carolina, affecting an estimated 33,000 residents. One insurance provider, Carolina Care Plan, accounts for most of the people affected. The company also no longer offers policies in Georgia and Indiana, scaling back efforts and refocusing on providing plans in its home state of Ohio.

South Dakota: State insurance director Merle Scheiber announced that insurers would have the option to offer extensions to policyholders with cancelled plans. It remains to be seen which insurers in the state will offer the extension.

Tennessee: BlueCross BlueShield of Tennessee, the state’s largest insurance provider, has decided to extend coverage to individuals and small businesses on plans deemed invalid under the ACA. This decision comes on the heels of state officials’ November 19th decision to grant insurers a 1-year reprieve for plans that do not meet federal requirements.

Texas: Fewer than 3,000 Texans have chosen plans on the federal exchange in the first month of enrollment. Approximately 54,000 have completed applications according to federal figures.

President Obama visited Texas on November 6th, meeting with organizers of educational outreach around exchange enrollment in Dallas, a city with the largest uninsured population in the state (670,000, or 28%, of Dallas County’s population).

Virginia: The Virginia Farm Bureau, a farmers advocacy group, joined the effort to educate uninsured Virginians about their options on the federally-run exchange. Trained volunteers will be available at Farm Bureau offices throughout the state to help residents explore their options.

Wisconsin: According to official tallies, 877 people have enrolled in plans on the federal exchange as of November 13th. A total of 19,098 electronic and paper applications have been completed and of those, 8,911 are eligible for federal subsidies.

Wyoming: Health care navigators had to change tactics as glitches in the federal website drove more individuals to file paper applications. This process, which has individuals submitting the paper applications, then receiving a response letter detailing their plan options, is time-consuming, but it has been the most viable alternative to online enrollment in the state.

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