It’s a new year and employers are making some resolutions of their own to improve health and wellness — not for themselves, but for their employees.

New Year, New Goals

According to the 2013/2014 Staying@Work report from Towers Watson, nearly half (49%) of U.S. employers surveyed said health and productivity programs are essential to their overall organizational health strategy and 42% said they play at least a “moderate role.” In the survey, health and productivity was defined to include “physical, psychological and emotional aspects of health.”

Meanwhile, 94% of U.S. employers surveyed said that they plan to have “an articulated health and productivity strategy” in the next three years. According to Towers Watson, programs without a cohesive, articulated strategy run the risk of inadvertently offering program elements that are not coordinated with each other, have low return on investment or do not adequately engage employees. When implemented correctly, these programs have been tied to improved employee health AND company savings.

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Jim Foreman to lead Exchange Solutions, Carl Hess to succeed Foreman as managing director of Americas Region

In a move designed to help employers better navigate the dynamic health care environment, global professional services company Towers Watson announced plans to unite the company-wide expertise and resources dedicated to health care exchanges and administration within its Exchange Solutions segment.

>> Read the press release

With the advent of the ACA, the definition of “churning” in a health care insurance context has been expanded.

The term used to refer to low-income Americans under the age of 65 fluctuating back and forth between qualifying for Medicaid and then, because of an increase in their income, finding that they no longer qualify — and then sometimes back to qualifying again. Now it also encompasses shifting eligibility between Medicaid and being able to buy health plans on private exchanges with a federal subsidy based on income levels.

Prior to the ACA, the options were much more clear: a person either qualified for Medicaid or not. Options now include qualifying for Medicaid under the old rules, for expanded Medicaid in the states that opted into that part of the ACA, and public exchanges.

In 2013, we discussed in this blog the implications of states opting to expand or not expand Medicaid coverage. Since the public exchanges opened for business on October 1, 2013, some states that initially opted out have reconsidered and their governors have petitioned their state legislatures to approve the expansion, such as Ohio and Pennsylvania.

This coming year will be the proving ground for this new definition of churning and its impact on low-income Americans as they try navigate a changing health care landscape. Those who fail to stay on top of their eligibility could fall into coverage gaps, run the risk of having to pay back the federal government for subsidies used when they were not eligible, or both.

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As 2013 came to a close, Americans flooded public exchanges by phone, in person and overwhelmingly online to secure health plans for themselves and their families prior to the end-of-year deadlines. While some states saw record numbers of applicants — as many as 1,000 a day in some cases — others experienced the resignations of their exchange directors and continued efforts to overcome technical issues plaguing their exchanges.

UPDATE: This will be the last “On the Public Health Insurance Marketplaces” post – we hope you have enjoyed regular updates on the exchanges across the United States. Check back throughout 2014 for blog posts on a wide variety of topics related to exchanges, both on the federal and state level.

The Public Health Insurance Marketplaces Table continues to provide the latest information on carrier participation and plan rates.

Latest Developments:

State Run Exchanges and Partnerships –

California: As of December 23rd, 400,000 Californians had enrolled in plans on the state exchange.

Approximately 53,510 people enrolled in plans on the exchange over a three day period the week before the December 23rd enrollment deadline. To accommodate the rush, Covered California enlisted the help of extra staff to man the phones and aid with in-person enrollment as Californians flocked to enroll in plans in the last days before the deadline.

Of the 11 insurers that provided plans on the state-run exchange, 96% of enrollees selected offerings from just four providers, raising the question of whether smaller providers could compete against giants Anthem, Kaiser, Blue Shield, and HealthNet. As of December 13th, Anthem Blue Cross dominated, with 30% of enrollees choosing a plan offered by that insurer.

While demographic information for enrollment were not yet available through the end of the month, it has been reported that just 1,000 Spanish-speakers have enrolled in health insurance. In previous months, less than 5% of the 109,296 people who enrolled in plans identified as Spanish-speakers.

As enrollment deadlines approached, Covered California has opened enrollment “storefronts” across the state to sign up individuals and families on plans. While online enrollment has been steady, an estimated 80% of residents interested in enrolling prefer in-person support, hence the decision to open more physical locations, often located in malls.

California’s small business exchange opened for business, with the target of enrolling 7,000 businesses next year. This successful launch comes in contrast to the federal small business exchange, which has been postponed until further notice.

Covered California sent out 114,000 eligibility letters to plan applicants that contained blank spaces or missing information due to a computer error. Missing information included federal subsidy amount and eligibility for insurance. New letters have since been sent out to correct the error.

Colorado: Colorado did not require insurers to extend cancelled health plans, joining a handful of other states — California, Washington, New York, and Vermont — that have opted out of the extensions.

As of December 23rd, Connect For Health Colorado had a total of 35,356 enrollments. While the 23rd was initially the deadline for enrollment to begin on January 1st, exchange officials extended it to December 27th, clarifying that offices would be closed over Christmas but the website would still be taking enrollments.

Boomers dominated enrollment in the first two months, with 43% of all enrollees being 55 to 64 years old. By contrast, only 17% of enrollees fell into the target demographic — the “young invincibles,” aged 18 to 34.

Connecticut: Connecticut saw a surge in enrollment, with close to 1,000 people enrolling per day in the first week of December on the state-run exchange, Access Health CT. Enrollment on the exchange more than doubled in the subsequent two weeks, with 37,000 enrolled as of December 17th.

District of Columbia: President Obama signed up for health insurance on the D.C. Health Link exchange, selecting a bronze tier plan. His enrollment was symbolic, as his health care will continue to be provided through the military.

D.C. opted not to extend the enrollment deadline for residents, meaning December 23rd was the last chance for people to enroll and receive coverage starting January 1st. Read the rest of this entry »

In a survey of 682 retirees who have Medicare supplemental plans purchased on the Extend Health private Medicare exchange, 70% reported that during the open enrollment period for 2014 they reevaluated their current plans. When asked why, the top reason by far was, “I just wanted to confirm that I have the best coverage” (63%). Another 22% cited premium increases as the reason they reevaluated.

Extend Health fielded the survey from December 8-10, 2013. The annual open enrollment period for the plan year 2014 ended December 7th.

Even though more than two-thirds of plan holders reevaluated their coverage, just 29% reported that after doing so, they either replaced or dropped one or more of their plans. The remaining 71% took no action and allowed their existing plans to automatically renew.

The percentage of retirees reevaluating their plans each year has increased since the last time we asked the question, while the percentage who replace or drop their plans has remained statistically the same. In a similar survey fielded by Extend Health two years ago, in December 2011 for the plan year 2012, 63% of respondents reported that they had reevaluated their plans and 31% said that after doing so they made changes.

These findings suggest that retirees purchasing plans on our exchanges are not taking their existing coverage for granted and are taking action to ensure that they coverage they have is right for them.

Questions and detailed responses from the survey are as follows:

During the annual open enrollment period for 2014, did you actively review and/or reevaluate your existing plans?

Yes 69.9%
No 30.1%

What was the most important reason prompting you to reevaluate your existing plans?

I just wanted to confirm that I have the best coverage 63.4%
My premiums increased 22.4%
My out-of-pocket expenses increased 5.2%
My current plan was no longer offered 3.8%
My benefits changed 2.4%
My prescription drugs changed 2.0%
My health status changed 0.8%

After reevaluating your existing plans, what action did you take?

I let my plans automatically renew 71.1%
I replaced one or more existing plans 28.1%
I dropped one or more of existing plans without replacing them 0.7%