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October 01, 2014 at 10:10 AM
Two health policy groups brought the leaders of 85 public exchange assister programs together for a conference this summer and discovered something shocking: Managers of the assister programs found that getting poor, uninsured people insured is difficult.
Assister program managers took note of the challenges “associated with helping consumers match their health and financial needs to plan characteristics.”
Analysts at the Kaiser Family Foundation and the Robert Wood Johnson Foundation organized the assister program manager roundtable, in June, to see what was happening at the country’s 4,400 Patient Protection and Affordable Care Act (PPACA) exchange assister programs.
Originally, when policymakers designed the exchange system, they thought the new, standardized qualified health plans (QHPs) would sell themselves. Brokers and agents had to fight to get any opportunity to sell QHPs.
PPACA called for exchanges to offer a nonprofit Navigator program, or ombudsman program, to provide low-income people and people unfamiliar with private insurance a little independent technical support. Once the U.S. Department of Health and Human Services (HHS) and states with state-based exchanges began thinking seriously about enrollment, and realized that the PPACA Navigator provision requirements made hiring Navigators difficult, they created other types of exchange helpers, or “assisters,” to provide a stripped-down version of the services that licensed agents and brokers have traditionally provided to consumers enrolling in health plans, without the involvement (or expense) of producer sales commissions.
At one point, for example, Nevada was hoping it could get uninsured people enrolled in QHPs for $35 per buyer helped by a live human.
Brokers themselves estimated — even before the exchange enrollment systems opened for business and system glitches began wasting enrollers’ time — that helping an intelligent, well-organized consumer enroll in QHPs with a smoothly functioning enrollment system would take a minimum of 30 to 45 minutes of agency time, at a minimum cost of about $50 per hour. Brokers warned that helping unsophisticated consumers with complicated profiles could take far longer.
Here are five startling conclusions assistance program managers came to after actually “facilitating enrollment” in QHPs.
1. A QHP enrollment process and plan design system that was difficult for insurance companies and veteran insurance producers to understand was difficult for low-income, uninsured consumers to understand.
The assister program managers said assisters faced “huge” insurance literacy barriers, with consumers having a hard time understanding basic concepts such as “deductible,” let alone the new PPACA cost-sharing reduction subsidy program.
Assisters tried to translate terms such as “advanced premium tax credits” into terms that seemed easier for consumers to understand, such as referring to the tax credit as a “monthly discount coupon.”
2. For assisters, getting complete, accurate, up-to-date information about exchange rules and procedures was a headache.
Groups for exchange agents and brokers have complained that the Centers for Medicare & Medicaid Services (CMS) — the HHS agency that supervised the entire PPACA exchange system and managed operations at the HHS-run exchanges — sent regular e-mail newsletters to the nonprofit exchange helpers but not to licensed producers.
