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Exchange field report: Oregon, Puerto Rico, New Jersey

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What will it mean if part or all of the operations of a public exchange start late?

Residents of Oregon may soon find out.

Managers of the state-based Cover Oregon exchange have said that they hope to get their individual Web portals open in “mid-October,” but they aren’t giving a date. Before the portal opens, consumers who want to sign up for coverage will have to talk to one of the state’s 2,000 agents.

Mike Cox, a spokesman for the exchange, said managers delayed the opening of the site because they want to make a priority of getting it right the first time, not because of any specific technical problems.

The program “should not be thought of as being late,” because all of the significant features will be in place, and Oregonians will be able to compare plans online and actually sign up for coverage starting Oct. 1, Cox said.

No coverage bought during the initial Oct. 1 through March 31 exchange program open enrollment will take effect until Jan. 1 anyway.

But Corey Pulver, a partner at CDA Insurance LLC, a Eugene insurance agency, said he thinks a lack of timely guidance from the federal government has put exchange managers in a bad position.

“The online marketplace will have huge issues being able to communicate relevant information to carriers, and also such trivial things as associating consumer applications to the agents that assist them,” Pulver said. “Most consumers are clueless about what is coming. Some people simply believe that they will be getting free health insurance, and others have no idea the depth of information that will be required of them to complete the application.”

Pulver said the biggest problem with the exchange open enrollment period is that it’s happening at the exact same time as the Medicare Advantage plan annual enrollment period (AEP).

“AEP was hectic on its own prior to the exchanges,” Pulver said. “Frankly, we have no idea how we will adequately service our clients and prospects. That is not so much of a Cover Oregon problem as it is a problem at the federal level in the planning and implementation of this thing,” he said. “In the end, I fear that the agent community will be held up as sacrificial lambs when things go badly.”

In other state and territory exchange implementation news:

  • Puerto Rico, like four other U.S. territories, has the option of setting up an exchange but is not required to do so. But territory officials know that PPACA provides just $925 million in Medicaid expansion money for Puerto Rico, and that the U.S. Department of Health and Human Services (HHS) will not set up exchanges in territories that fail to start their own. Meanwhile, the new PPACA restrictions on insurer uses of personal health information in selling and pricing coverage will apply. Because of the combination of a lack of risk pool expansion and the tough new underwriting rules, coverage “will cost even more than it does now,” said Justin Velez, executive director of the Puerto Rican Chamber of Commerce. Velez and Pedro Pierluisi, Puerto Rico’s U.S. House representative, said PPACA-related Medicare Advantage cuts will also hit hard. About one-eighth of Puerto Rico’s population is in the Medicare Advantage program.
  • In New Jersey, a state letting HHS provide exchange services, agents are not quite sure what to expect. Desmond Slattery, legislative chairman at the New Jersey Association of Health Underwriters, said he thinks all the hoops people have to jump through will make ensuring that consumers get their coverage and insurers get paid difficult. “There is a lot that needs to be done in a short period of time,” Slattery said. “Our tech people keep saying this is going to be a ‘heavy lift’ to implement this system bug free … Don’t know what it will look like. Don’t think anyone does. But the federal government is sticking to their deadline.”

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