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Exchanges: Travelocity for Health Plans - or DMV on Sleeping Pills?

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Mike Sullivan is starting to feel better about the health insurance exchange system being created by the Patient Protection and Affordable Care Act (PPACA).

Sullivan is the chief marketing officer at Digital Insurance Inc., Atlanta, a national benefits broker that serves small and midsize employers. When lawmakers were in the legislative laboratory assembling PPACA one undead limb at a time, he had concerns. Now that the monster is lurching about, the concerns are starting to dissipate.

First, exchange creators talked big about the exchanges eliminating the need for agents and brokers. Then creators got a reality check and rushed to say that the exchanges will work with brokers, especially to serve small employers. Then the U.S. Department of Health and Human Services (HHS) and state agencies proposed regulations sketching out what exchanges might actually look like: Pretty much whatever the exchange builder can get past a state’s political establishment.

Now many exchange advocates say an exchange will be like a Travelocity website for health insurance, with live humans.

The big question is, “who’s going to answer the phones?” Sullivan asked during an interview.

Sullivan believes, hype aside, the real model may be call centers at state departments of motor vehicles (DMVs).

“If our competition is the equivalent of the DMV at the exchange level, bring it on,” Sullivan said.

Jordan Battani, a principal in the San Francisco office of Computer Sciences Corp., said there is still a noticeable lack of clarity about the exchanges.

“Who builds them?” she asked. “Who uses them? There’s a lot of learning that’s going to happen in the next 18 months.”

PPACA drafters want exchanges to offer “one-stop shopping” system for health coverage. If PPACA takes effect on schedule and works as drafters hope, individuals and small employers will be able to use new tax subsidies to buy coverage through the exchange system starting in 2014. States can choose between setting up their own exchange programs or letting the federal government provide exchange services for their residents.

Exchanges will take over responsibility for paying brokers, and salaried “navigators” will answer questions about how the exchange system works.

HHS says it wants to give the exchange bulders about as much flexbility as the law allows. The upside: Flexibility. The downside: Lack of uniformity could make an exchange program confusing to anyone not familiar with that specific exchange.

The Congressional Budget Office has predicted that a majority of U.S. residents will continue to get their coverage outside the exchange system even after the exchanges are running.

Because the exchange will handle producer compensation for the customer it serves, “insurers will need to find new ways to influence the influencers by demonstrating how their products benefit consumers and by making it easy for brokers, navigators and providers to understand their plans,” according to consultants at the PricewaterhouseCoopers Health Research Institute, New York.

One problem: Health insurance is different from airplane tickets. Producers are asking how well websites and navigators – who may not even be licensed health insurance agents – will warn consumers about policies with low premiums today that could expose them to big, uncovered bills tomorrow.

Stanislaus County, Calif., recently found that consumers who come to its offices to apply for Medicaid and other programs still value working with knowledgeable live humans.

About 45% of the office users said they knew they could apply online – but 29% said they thought an in-person visit would be faster, and 20% had problems the website could not handle, according to the County Welfare Directors Association of California, Sacramento, Calif.

When the applicants were asked about service priorities, they ranked having an individual advisor assigned to their case first.


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