3 state-based PPACA exchange snapshots

Managers of some state-based Patient Protection and Affordable Care Act (PPACA) public exchanges are still trying to forge ahead, on their own, without running into the arms of HealthCare.gov.

As storm clouds gather outside the exchange system, at the U.S. Supreme Court, and at the federal offices in charge of the PPACA health insurance company lifeboat programs, the managers are trying to pay producers, resolve squabbles between producers, deal with legislative interference, and get consumers covered.

For a look at some of what exchange boards have been talking about this month, read on.

1. Covered California

Peter Lee, who has hung on as Covered California's executive director since the beginning, says in a board meeting report that the exchange had 13,414 certified insurance agents and 5,148 certified enrollment counselors on June 11.

The number of agents has increased 8.4 percent since June 2014. The number of certified enrollment counselors has dropped 13 percent.

Covered California has made some progress with resolving problems with paying agent commissions, Lee says.

He says the exchange has paid commissions on policies sold from January 2014 through September 2014, and has submitted the commission payment requests for October 2014 through December 2014 to the state controller's office.

The exchange is now processing or is about to process agent commissions for January 2015 through April 2015, Lee says.

Over the past few years, agents in California and other states have complained about a sense that nonprofit enrollers have been trying to crowd them out, or that exchange managers have favored the nonprofit enrollers over the licensed agents.

This month, Peter Manzo, president of United Ways of California, is saying that agents have caused problems for the nonprofit enrollers.

United Ways, an organization that has received some of the Navigator grant money flowing to nonprofit organizations, has more responsibilities than agents necessarily have, because it is legally required to help consumers with post-enrollment problems, use of coverage and technical problems, Manzo writes.

But the nonprofit enrollers get paid only when consumers actually pay for their Covered California coverage, Manzo says.

"Agents generally receive more compensation per enrollment due to commissions, and yet we often assist consumers with errors or changes needed after being supported by an agent," Manzo writes. "We continue to assist consumers who completed online enrollment themselves or sought help from an enrollment agent and subsequently need help due to system errors and application mistakes."

Moreover, the "find a certified enroller" directory on the Covered California site does not work nearly as well as the "find a certified agent" directory, Manzo says.

Doreena Wong, project director at the Health Access Project at Asian Americans Advancing Justice-Los Angeles, wrote to say that nonprofit enrollers at her group and allied group found that they helped many consumers who got help from agents during the 2014 PPACA exchange open enrollment period, but found that the agents were unwilling to help with 2015 open enrollment applications.

"While we understand the need for, and respect the role of, the insurance agent community in enrollment consumers, many grantees encountered consumers who needed assistance and help troubleshooting their applications due to problems with insurance agents," Wong says. "Some consumers had enrolled with agents but when returning to the agents for follow-up assistance, the insurance agents were unwilling or unable to provide help and/or provide the consumer their account log-in credentials."

Lack of agent help with retrieving log-in credentials slowed the work of the nonprofit enrollers, Wong says.

2. MNsure

Exchange managers in some states have talked about the possibility of improving service for customers and generating extra fee revenue by working with other organizations to offer consumers products such as disability insurance or life insurance.

In Minnesota, Gov. Mark Dayton, D, has signed a health and human services finance bill, Senate File 1458, that prohibits MNsure from "certifying, selecting, or offering products and policies of coverage that do not meet the definition of health plans or dental plan" given in the legislation.

The new statute also requires MNsure to work with federal regulators to try to make the PPACA Small Business Health Options Program (SHOP) small-group tax credit available to employers that buy group coverage outside of the SHOP exchange system.

3. Access Health CT

Managers of Connecticut's state-based exchange have attracted 26,612 enrollees who are paying the full, unsubsidized price for exchange coverage, meaning that the exchange system lured them away from the off-exchange market.

The total number of qualified health plan (QHP) enrollees has increased to about 100,000, from about 80,000 a year ago. The number of subsidized enrollees is up about 30 percent, and the number of market-rate enrollees is up about 50 percent.

One concern is that the state will be booting about 1,350 adult Medicaid enrollees out of Medicaid because of budget constraints.

Exchange managers say most of the adults coming out of Medicaid will probably qualify for exchange coverage subsidies. The exchange is trying to come up with a strategy to encourage those people to sign up for exchange QHPs.

Rhode Island went through a similar process, and only 11 percent of the adults leaving that state's Medicaid program ended up getting coverage, exchange managers say in a board meeting presentation.

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