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Life Health > Health Insurance > Health Insurance

PPACA exchanges face daily grind

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State-based exchange boards are still poring over plan enrollment charts, but they’re also spending more time on budget and operations presentations.

Some of the exchange programs that held board meetings this week include the District of Columbia Health Benefit Exchange Authority, Minnesota’s MNsure, Nevada’s Silver State Health Insurance Exchange, and Cover Oregon.

A few months ago, many state-based exchange boards focused heavily on picking website names, fine-tuning exchange plan benefits requirements and addressing demands for translating their websites into Chinese, Russian and Navajo.

Now, the boards are thinking more about the Patient Protection and Affordable Care Act exchange program “sustainability requirement.”

In 2014, exchanges can use federal grants to pay for everything but their navigator programs. But by 2015, exchanges are supposed to support themselves.

In Oregon, where the exchange website is unable to take coverage applications online, the staff has struggled to use paper applications to enroll nearly half of the 50,000 uninsured state residents who’re eligible for private-plan subsidies in private qualified health plans.

Oregon exchange managers want to pay for the exchange in 2015 with a $6.95 per member per month assessment on Medicaid and other public health programs that enroll people through the exchange, and a $9.38 per member per month administrative charge on QHP enrollees.

Because web problems have hurt enrollment, exchange managers are preparing to cut their $60 million 2015 budget by $10 million. The exchange would get about half of the savings by cutting the old $7.5 million communications and outreach allocation to $2.7 million

The District of Columbia is getting good QHP enrollment totals for DC Health Link, in part because Congress is having its members and many of its own employees get coverage through that exchange.

D.C. managers want to create a broad-based assessment that could affect all health carriers — even those in the Medicare supplement market and other markets outside the major medical universe — with more than $50,000 in annual gross receipts.

Dental carriers can sell stand-alone dental insurance for children through the D.C. exchange, but, because all of the QHPs have to offer some dental coverage for children, exchange sales of stand-alone dental have been low.

Ameritas, Delta Dental and other dental insurers are asking why they should have to pay the D.C. exchange assessment when they have little opportunity to sell coverage through the exchange.

In Nevada, John Hager, the exchange executive director, says Nevada Health Link is more likely to enroll 50,000 people in QHP coverage by March 31 than the 118,000 people originally anticipated.

But federal money should get the exchange through 2014, and the exchange is paying its main vendor enrollment-based fees. If enrollment is lower than expected in 2015, vendor payments will also be lower, Hager says.

The Minnesota and Nevada exchanges post call center performance data.

In Minnesota, the exchange has cut the time consumers wait to talk to a rep sharply. But the peak waiting time was about 1 hour 12 minutes, and the average is still 28 minutes.

Nevada has cut its average call center wait time to about 11 minutes, from a peak of more than an hour.

But the Nevada exchange reports that it has a growing mountain of paper mail, faxes and e-mails to go through.

About 15,776 of the 20,582 pieces of mail the exchange has received have been sitting in piles or on desks for more than 21 days. Aging is over 21 days for 4,917 of the 5,996 faxes in the system and 2,632 of the 3,113 e-mails.

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