View from PPACA World: Jeff Smedsrud

Jeff Smedsrud (HealthCare.com photo) Jeff Smedsrud (HealthCare.com photo)

The 2015 health insurance open enrollment period curtain is set to come down Sunday, in most of the country, unless government officials sneak in an encore.

Jeff Smedsrud, chief executive officer of HealthCare.com — a strategically named website that helps insurance distributors get sales leads — has been in a position to see HealthCare.gov and the entire Patient Protection and Affordable Care Act (PPACA) both as a competitor and a marketing helper.

Consumers who type dot com after HealthCare, either out of force of habit or because they think all website links end in dot com, get a chance to compare health plans, or other types of insurance plans. A popup notice on the site today advised, "Sign up for a plan now and avoid being fined on your taxes." A consumer could choose between a button with the label "Talk to a live agent now" on the telephone, or a smaller button stating, "No, thanks. I will pay the tax penalty."

Backers of the site include Jeffrey Boyd, chairman of Priceline Group.

Consumers who shop through the site can use HealthCare.com's distributor partners to buy just about all of the qualified health plans (QHPs) available through the PPACA public exchange system and most of the individual plans available outside the exchange system. Because of the standards PPACA has imposed on issuers of new major medical plans, consumers can buy all of the plans without fear of being rejected because of health problems, and without worrying about paying more for coverage because of health factors other than age or tobacco use.

At press time, the U.S. Department of Health and Human Services (HHS) and managers of state-based exchanges were reporting that they had received exchange QHP selection information for about 10.4 million people.

Last year, when glitches plagued enrollment systems early on, the exchanges benefited from a big last-minute surge in plan selection activity.

This year, "we'll see how big the surge really is," Smedsrud said, suggesting that the public exchanges might emerge from open enrollment with about 12 million enrollees.

For a look at what Smedsrud is thinking about PPACA World these days, read on. 

Attack dog

1. He sees no big health insurer in intimidating consumers with a return to full-blown medical underwriting.

Smedsrud said he thinks people in the insurance industry should recognize that PPACA and the PPACA public exchange system have done some good.

PPACA has helped put consumers in charge, by freeing them to shop around, and it's encouraged a wave of transparency efforts of all kinds, Smedsrud said.

The push to reach consumers and get them information about the cost and quality of health care has led to massive investment in technology, and "it's spurred a lot of private exchanges," Smedsrud said. 

Before Jan. 1, 2014, insurers frightened off many healthy consumers as well as consumers with health problems with intimidating medical underwriting forms. Smedsrud said he sees little carrier interest in returning to that way of doing business.

"The carriers have accepted the reality, that customers are in charge," Smedsrud said.

See also: Republicans propose group health exclusion cap.

Dreary window

2. The open enrollment period really has been less exciting.

"It's been much quieter than last year," Smedsrud said.

HealthCare.com has met its goals, but an HHS decision to let many of the 2014 HealthCare.gov QHP coverage holders automatically renew their policies, rather than making them go online to renew, may have contributed to a lack of awareness of the open enrollment period, and a lack of urgency about open enrollment period application deadlines, Smedsrud said.

See also: PPACA exchange users may be standing pat.

Shopping cart

3. Like the consumers who shop on the public exchange, other consumers are open to considering plans with higher deductibles and narrower networks to keep costs down.

Some critics of the PPACA public exchange system have accused it and its managers of encouraging health plans to shift to overly narrow provider networks.

But Smedsrud said he sees many consumers making conscious choices to keep monthly premiums down by choosing high deductibles and narrow networks in the off-exchange market, too, even though they may have many low-deductible and broad-network plan options.

In many cases, Smedsrud said, even consumers who think having a good network is important simply want to see that their own doctors are in the network.

See also: High-performing networks: 4 reasons they're great.

Napping cat

4. The special enrollment period (SEP) market should be about twice as big as it was during the last nap period.

Even after the open enrollment period, during what might be called the nap period, consumers can use many different reasons to get access to a "special enrollment period" (SEP).

Last year, SEP major medical enrollment activity seemed to amount to only about 10 percent to 25 percent of open enrollment period activity.

See also: PPACA calendar slams broker's medical sales.

Smedsrud said he thinks SEP activity should grow to be about 30 percent to 40 percent as high as open enrollment period activity.

The problem is that many consumers who clearly qualify for SEPs don't understand that they qualify, Smedsrud said. 

Decentralized network

5. Smedsrud wishes HHS would decentralize the eligibility verification process and let Web broker entities share the work.

HHS has centralized the process of verifying which exchange applicants are eligible for premium subsidies and other subsidies. If HHS would find a way to share as much of that workload as possible with Web broker entities, that would make the exchange plan enrollment process more pleasant and more efficient, Smedsrud said.

HHS has been looking at sharing the verification workload for two years but has yet to act, Smedsrud said.

See also: Analysts: For States, Federal Exchange Services Might Be Cheaper. 

2017

6. Everything could change in 2017.

PPACA includes a provision that could let states develop exchange program alternatives that year, Smedsrud said.

One change he would like to see is an end to the system that requires consumers to go through the PPACA public exchange system to get premium subsidies and other PPACA subsidies.

"I don't think that stands the test of time," Smedsrud said.

In theory, the federal government could privatize part or all of HealthCare.gov, and states could privatize their state-based exchange programs. Smedsrud said, however, that no one has approached him with proposals for acquiring any of the public exchange programs.

See also: Medicaid alternative architect drafting PPACA 2.0 proposal.

 

 

 

 

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