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Life Health > Health Insurance

On the Third Hand: Carolinas

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The Robert Wood Johnson Foundation has released a paper by analysts at the Urban Institute that seems to have nothing at all to do with exchange plan enrollee counting problems at the U.S. Department of Health and Human Services (HHS) but has plenty to do with those problems.

Analysts looked at the HHS-run exchanges in North Carolina and South Carolina.

The states are right next to each other, and similar in many ways, but enrollment activity was much stronger at the North Carolina exchange than at the South Carolina exchange. One possible reason proposed: the nonprofit exchange program outreach people in North Carolina had a much better relationship with agents and brokers than the outreach people in South Carolina had. The brokers in South Carolina felt as if they were frozen out of the exchange program, and the nonprofit outreach people in South Carolina weren’t quite sure whether they were allowed to refer tough cases to brokers.

One reason brokers may be so helpful to an exchange is simply that they know they’re doing.

Another reason may be that, because they know what they’re doing, because they have a degree of financial security as a result of their ability to get out there and close sales, and because they, by nature, tend to have a stubborn, independent streak, brokers can be honest.

This week, higher-profile PPACA news came out: HHS Secretary Sylvia Burwell made headlines by announcing that HHS inflated exchange plan totals a few weeks ago by adding dental plan enrollees to the exchange qualified health plan (QHP) enrollment total.

On the one hand: It seems reasonable to think that HHS could have messed up the enrollment statistics. HHS and its giant daughter, the Centers for Medicare & Medicaid Services (CMS), have messed up other aspects of public exchange program administration over the past two years. Why not tracking of statistics?

On the other hand: The Republicans have rolled their eyes at the announcement and hinted, broadly, that it also seems possible that HHS tried to dress up its enrollment figures to show that it still had 7 million exchange public enrollees on Election Day.

Of course, on the third hand, the whole fuss over the 7 million public exchange QHP enrollment statistic seems a little bizarre. The 7 million figure came from Congressional Budget Office analysts who were trying to think what the Patient Protection and Affordable Care Act (PPACA) might actually be like years in the future, at a time when it seemed as if Democrats would control both the House and the Senate, voters were enthusiastic about health reform, and the CBO analysts may have had only a vague understanding how hard it might be to keep broke consumers to keep making monthly premium payments.

But HHS has fed into paranoia by releasing far less information about its planning process, its staff deliberations, and its actual performance than many of the state-based exchanges. HHS has justified its refusal to release rough estimates of indicators such as the number of people enrolled in Small Business Health Options Program (SHOP) QHPs by saying it wants to make sure it has complete, accurate data. Now, we find the individual QHP update information HHS hoarded over the summer for the noble sake of completeness and accuracy is inaccurate, anyway.

Brokers simply seem open and honest. HHS and many of its outreach people seem to be trying a little too hard to accentuate the positive. Maybe health insurance is an area in which many consumers would prefer honesty over positivity.


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