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Agents Keep Health Rates Down: California Exchange Chief to Congress

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An Affordable Care Act (ACA) universe celebrity told members of Congress Wednesday that health insurance agents help keep commercial health insurance affordable.

Peter Lee, the executive director of Covered California — California’s ACA public health insurance exchange program, or web-based health insurance supermarket — testified at a House hearing that advertising, operating local storefronts, sponsoring nonprofit navigators, and working with 10,000 agents are all ways to stabilize health insurance markets, by persuading low-risk people to pay for coverage before they feel sick.

“People know we’re there,” Lee said. “It’s because we support navigators and agents.”


  • Links to hearing resources, including a video recording of the hearing, are available here.
  • An article about an earlier House Energy health subcommittee hearing is available here.

All successful organizations need to market themselves, Lee said.

“Beyond that, health care is different,”  Lee said. “People don’t want health insurance, because they don’t think they’re to get sick.”

Someone has to cajole people into getting covered, Lee said.

A Matter of Life and Death

Covered California’s marketing and outreach programs, including efforts to work with agents, have probably saved some California residents from dying of COVID-19, Lee said.

When people get COVID-19, “early diagnosis and treatment are critical to getting good care,” Lee said.

Having Medicaid, commercial health insurance or some other source of coverage may increase the odds that people will get good care quickly, and that shows why managers of — the arm of the the U.S. Department of Health and Human Services (HHS) that handles ACA exchange plan enrollment and account administration duties for states without their own locally run ACA exchange programs — need to do a better job of marketing, Lee said. has helped about 11 million people sign up and pay for commercial health coverage this year.

Lee estimated that, based on Covered California’s 2020 enrollment experience, would have helped 500,000 more people get covered if it were marketing as aggressively as Covered California is marketing its services.

Lee said Covered California gets about half of its business through agents and navigators.

EHealth, a commercial web broker, has estimated that it may earn about $258 per ACA exchange plan enrollee over the lifetime of eHealth’s relationship with that enrollee. That implies that marketing support weakness may have cost agents and brokers more than $60 million in commission and fee revenue.

Lee talked at the hearing about the human cost of weak marketing support for

“This failure to act is a matter of life and death,” Lee said.

Aside from the fact that good care helps the patient, “the public benefits by having potentially infectious individuals tested and treated,” Lee said.

The Hearing

Lee appeared at a hearing with the title “Health Care Lifeline: The Affordable Care Act and the COVID-19 Pandemic” that was organized by the House Energy and Commerce health subcommittee.

The subcommittee held the hearing online, with a “virtual” format.

Democrats warned about the possibility that the U.S. Supreme Court could use the Texas v. California case to strike down all of the ACA, and, possibly, eliminate programs that now provide coverage for hundreds of thousands of people.

Eliminating the ACA could also wipe out health insurance benefits and pricing standards that help tens of millions of Americans with health problems, including high blood pressure and obesity, get access to coverage at the same price everyone else pays, Democrats on the panel said.

Republicans countered that they, too, have said over and over again that they support maintaining protections for people with pre-existing conditions.

But subcommittee members also tried to reach across party lines, and through the virtual conference system, to try to support each other.

The son of one subcommittee member, Rep. Markwayne Mullin, R-Okla., suffered severe injuries in March while riding a utility terrain vehicle on the Mullin family’s ranch.

Rep. Anna Eshoo, D-California, the subcommittee chair, took time to mention that.

“You know, Markwayne, that our prayers follow your son,” Eshoo told Mullin.

Mullin said his son is on track to come home from the hospital Oct. 8.

The hearing might be the last the health subcommittee will hold before the Nov. 3 general elections, and Eshoo also made a point of talking about the subcommittee members who will be leaving, either because they have retired or because they have lost primaries.

Eshoo gave an especially warm farewell for Rep. Susan Brooks, R-Ind., who is retiring.

“It’s a pleasure to recognize, really, just a superb member of our subcommittee,” Eshoo said. “We are going to miss her, miss her, miss her.”

Brooks acknowledged that the subcommittee’s ACA lifeline hearing was highly partisan, but she said that members of the House and their aides had worked well together, in a genuinely bipartisan way, and succeeded at getting many important bills, including the 21st Century Cures Act, signed into law.

Going to forward, “we all have to do better to find the common ground,” Brooks said.

It now appears that everyone who recovers from COVID-19 will have what insurers will see as a pre-existing condition, Brooks said.

Both Democrats and Republicans want to protect people with pre-existing conditions, Brooks said.

Now that having had COVID-19 will be pre-existing condition, “we’ve got to make sure we get this right,” Brooks said.

ACA Exchange Program

Dean Cameron, the Republican director of the Idaho Department of Insurance, talked about how Idaho is the only Republican-dominated state with a locally run individual ACA exchange program, and that it is built a successful exchange program by relying on collaboration and creativity.

In Idaho, for example, the five major health insurers in the market agreed on their own to waive cost-sharing for COVID-19 testing, Cameron said.

Idaho has also developed a short-term health insurance policy that meets many of the same standards as policies that meet the ACA individual major medical insurance standards and cost half as much, Cameron said.

Douglas Holtz-Eakin, president of the American Action Forum, said working through the ACA public exchange program is a logical way to help people who face covered problems as a result of the COVID-19 pandemic.

Holtz-Eakin, who served as a senior staff economist on President George H.W. Bush’s Council of Economic Advisers, and as director of the Congressional Budget Office from 2003 through 2005, told Rep. Michael Burgess, R-Texas, who is the highest ranking Republican on the House Energy health subcommittee, that Medicaid, the ACA exchange program and COBRA employer coverage continuation subsidy programs could all play a role in getting people through the turmoil.

“To date, I think that the safety net has help up pretty well,” Holtz-Eakin said.

Economists worry that the turmoil will leave many people without health coverage, but, so far, Census Bureau figures suggest that number of people with health coverage may have increased slightly, Holtz-Eakin said.

For a look at more of what hearing participants said at the hearing, see the slideshow above.

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