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New Flexibility Could Ease 2018 Pain: Exec

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Executives at Softheon Inc. are hoping’s new, flexible approach to web brokers will make the individual major medical market work smoothly this fall.

The company is doing everything it can to get a direct enrollment proxy connection with running up Nov. 1, the scheduled start date for the Affordable Care Act individual major medical open enrollment period for 2018

Mike Baker, director of broker solutions at Softheon, a Stony Brook, New York-based insurance enrollment and relationship management systems company, talked about the company’s direct enrollment proxy effort Monday, in a telephone interview.

(Related: This Uber-Like Marketplace May Revolutionize Private Exchanges)

The Centers for Medicare and Medicaid Services (CMS), the agency in charge of, intends to move the end date of the open enrollment period to Dec. 15, from Jan. 31 in the past few years. Given how short the open enrollment period will be, “brokers are going to have to make sure they’re super efficient,” Baker said. “The window is going to be so tight.”

Access to a smoothly running, web-based enrollment system could make that level of efficiency possible, Baker said.

“Web broker entities” (WBEs), or web-based organizations that meet CMS business and data security standards, have been able to pass customers on to the enrollment system through an indirect process. In May, officials in President Donald Trump’s CMS said they would take off the web broker entities’ digital mittens and let WBEs that agree to go through auditing programs connect directly to

CMS began holding Direct Enrollment Proxy technical support sessions for the WBEs on Aug. 3. The agency has also been releasing proxy program technical specifications.


Softheon, the parent of Welltheos, a private exchange platform that also serves as a web broker entity, has sent executives directly to Washington, to talk to members of the staff of the Center for Consumer Information and Insurance Oversight, the CMS division that actually runs

The CCIIO representatives seem to be eager to work with private-sector organizations, Baker said

“They’ve got an appreciation of the role of the broker community,” Baker said.

Softheon needs direct enrollment program specifications “as soon as possible” to get systems ready for Nov. 1, but, if CCIIO sticks to its current specification release schedule, meeting the Nov. 1 deadline should be doable, Baker said. (Image: CMS)

(Image: CMS)

Baker also expressed cautious optimism about the 2018 issuer population.

Some carriers with roots in the Medicaid market seem to be pretty successful in the individual major medical market under the ACA rules, Baker said.

The drafters of the Affordable Care Act created the ACA public exchange system in an effort to give consumers an efficient, web-based system for shopping health coverage the way consumers were already using the web to shop for books and airplane tickets.

Officials in former President Barack Obama’s U.S. Department of Health and Human Services, the parent of CMS, had CMS set up to provide ACA exchange enrollment and relationship administration services for states that were unable or unwilling to handle the job themselves.

WBEs, or web-based agencies, brokers and broker support organizations that meet CMS business and data security standards, have been able to pass customers on to the enrollment system through an indirect process.

The list of registered WBEs started to shrink last year, but it has included Softheon’s Welltheos arm and companies like HealthSherpa, ACA Express, and eHealth Inc.

The ACA exchange system came to life in late 2013. The first exchange plans sold began to take effect in January 2014.

Some insurers backed away from the exchange system in 2015, because of concerns about sales and profitability, and more pulled out in 2016.

Sluggish 2017 coverage sales, unpredictable ACA health claim risk allocation programs, and uncertainty about the fate of the ACA, and ACA subsidy program payments have chased many national insurers away from the 2018 individual market.

For now, however, a CMS coverage map shows that most counties in the country could have at least one individual exchange plan coverage issuer on Nov. 1. If the federal government keeps making ACA program subsidy program payments, the subsidies could hold down average increases in the amounts consumers actually pay for coverage to a modest level.

For 2017, for example, average announced individual health increases were well over 15% in most of the country, but the average amounts consumers actually paid for coverage were only a little higher than in 2016.

Many insurers cut or eliminated individual health agent and broker commission payments for 2017, but tens of thousands of producers continued to help consumers buy exchange coverage. In Colorado, for example, the number of brokers working with that state’s state-based exchange fell 17% in 2017, to 961, but the number of people the brokers enrolled in coverage increased 61%, to 97,377.

The average number of exchange plan enrollments per Colorado exchange broker increased to 101 for 2017, from 52 for 2016.

Although Republicans in Congress and officials in the administration of President Donald Trump have been critical of the Affordable Care Act in general, they have mostly kept quiet about the ACA public exchange system.

None of the Republican ACA change bills that has gotten through a House or Senate committee since January would eliminate the ACA exchange system.

—-Read CCIIO Posts Web Broker Entity List on ThinkAdvisor.


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