Managers of the Patient Protection and Affordable Care Act (PPACA) public exchange programs are trying to get their systems, including HealthCare.gov, ready to go live tomorrow — Saturday.
The second PPACA exchange plan enrollment is supposed to extend from tomorrow until Feb. 15.
Drafters of PPACA created the exchange system in an effort to create an open, highly competitive, high-tech, cheap “Amazon.com for health insurance” — to ward off demands from liberal Democrats that they have the country shift to a government-run, “Medicare for all” health insurance system for most or all Americans, or at least offer all Americans an option to buy into a Medicare-like program.
A year ago, the U.S. Department of Health and Human Services (HHS) and the organizations in charge of the state-based PPACA exchanges were advertising heavily, predicting confidently that their exchanges would be ready to enroll consumers in health coverage, with an occasional technical hiccup here and there.
Instead, in the states with HHS-run exchanges, consumers faced frozen screens for weeks. They had to enter, and re-enter, application data many times just to see how much coverage cost. Some states, including Colorado, Connecticut and Kentucky, had exchange systems that worked reasonably well from the beginning, but others took months to get their enrollment systems working. Instead of offering a cheap, efficient, high-tech system, they ended up shifting to using armies of temps in warehouses to process paper applications. One state-based exchange after another fired its top executive, or faced a hole when the top executive quit.
The system has been so low-tech and so lacking in transparency that the U.S. Government Accountability Office (GAO) says even its investigators still cannot get data on Small Business Health Options Program (SHOP) exchange enrollment from HHS.
The Congressional Budget Office originally predicted the exchange system could have 13 people enrolled in exchange qualified health plans (QHPs) by the end of 2015. HHS recently said 9 million to 9.9 million might be a more reasonable target.
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A weak open enrollment period effort could help traditional health agents and brokers by creating opportunities for them to swoop in where the exchanges have failed — or hurt traditional producers, by reducing the overall level of interest in insurance.
For some of the factors that could affect the enrollment period, read on.
1. Plenty of people still need and want health coverage, or want to get better coverage.
Gallup believes the exchanges and another PPACA program, Medicaid expansion, have reduced the percentage of U.S. adults who lack health insurance to 13 percent, from 18 percent before the coverage access programs came to life — but 13 percent still lack health coverage.
When Gallup surveyed 976 of the Americans who are still uninsured, it found that 55 percent — about 7 percent of U.S. adults — would prefer to get health insurance rather than pay the fine to be imposed on many people who go without what the government considers to be adequate major medical coverage.
In the Medicare plan market, consumers tend to stay put, but commercial health coverage holders may be more inclined to browse. HealthPlans.com, a company that manages a health insurance shopping site, surveyed 1,150 consumers and found that even about 60 percent of the consumers who are happy with their coverage want to check out alternatives before renewing their coverage.
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2. Exchange managers have had more experience with how to reach broke people who need health coverage.
This year, exchange managers seem to be putting more emphasis on reaching consumers who have been hard to attract in 2014. In many states, for example, exchanges are doing more to court Hispanic consumers. In New Mexico, the exchange put out a request for proposals for Native American consumer enrollment help.
Covered California is organizing a statewide, bus-based exchange promotion tour.
Carriers are also trying to step up their game.
In New York, BlueCross BlueShield of Western New York hired a 27-year-old marketer, Patrick Finan, to help it appeal to Millennials. The carriers will send new enrollees a Millennial-friendly welcome package that offers two-for-one deals on healthy restaurant meals and activities.
This year, one exchange goal is to have consumers come in over time, rather than all at once.
3. The exchange managers think they have a better understanding of what they have to have in their call centers.
Many exchanges have more detailed information about call center staffing on their websites this year.
Massachusetts, for example, says it will have 315 call center agents, 20 insurer assisters and four broker assisters on hand.
4. UnitedHealth Group Inc.
The company has put QHPs from its UnitedHealthcare unit on many exchanges. In states in which UnitedHealthcare has an exchange QHP, the company’s huge size and marketing muscle could be enough to slice through many obstacles.
5. Agents and brokers may have a better idea of what they’re up against.
Last year, agents and brokers went into open enrollment thinking exchange systems would work, and that exchanges would have live humans available to help them.
This year, 40,000 remaining HHS exchange producers and the remaining state-based exchange producers know not to expect much technical excellence from the exchanges. They have armed themselves with systems from HealthSherpa, ACA Express and other organizations that are supposed to help them enter information during normal business hours, whether exchange systems are working or not, and then feed the information into the exchange systems when the systems are actually working.