Archive for August 31, 2013

Will States Sell Ads Like Nevada to Break Even on Health Exchanges?

By law, the online health insurance marketplaces created under the Affordable Care Act (ACA) must be financially self-sustaining by 2015. Most states are planning to pay for their operation by charging a user fee to insurers that sell their plans on the marketplaces, also known as exchanges. But those costs will likely be passed onto the customer, making health coverage under the ACA a little less affordable.


That gave one state, Nevada, an idea: sell advertising space on the exchange’s website to generate some extra revenue.


The state doesn’t yet know exactly how much money banner or pop-up ads could yield for the exchange, but every advertising dollar means a lower price for the people purchasing coverage. Officials are in the process of drafting a request for proposals and hope to have ads on the exchange site by the middle of 2014. Nevada’s marketplace — like others across the country — launches Oct. 1, 2013.


“If we broaden our revenue base, we will have a viably funded exchange. We want to be sure that we don’t just burden the insurance buyer,” says C.J. Bawden, a spokesperson for Nevada’s marketplace, the Silver State Health Insurance Exchange. “The more we can broaden our base, the more we can hopefully lower those charges and lower the price of insurance.”


For now, Nevada is the only state with definite plans to sell ads on its website. Governing surveyed 16 of the 17 state-based exchanges (Idaho was excluded because of its late start) and only three—Colorado, Hawaii and Vermont—said they were considering selling ads in the future.


As for the federal exchange that will sell insurance plans for the 30-plus states that decided not to set up their own marketplace, officials at the U.S. Department of Health and Human Services (HHS) say it won’t sell ads as a revenue source — but there’s nothing stopping the state-based exchanges from doing so.


So why aren’t more of them following Nevada’s footsteps?


Most likely because of the administrative and publicity headaches that might come with selling ads on a political lightning rod like the ACA’s exchange, says Jennifer Tolbert, director of state health reform at the Kaiser Family Foundation.


“States will want to be really careful about the ads that they allow on the exchanges. I suspect that’s why many states have chosen not to allow ads to be sold,” she says. “But as long as the state is really careful, it could be a good vehicle for revenue.”


That’s an issue already weighing on the minds of Nevada officials. Bawden gives the admittedly outlandish example of one of the state’s legal brothels trying to purchase ad space on the exchange.


“Obviously, that’s something we don’t think taxpayers would appreciate,” he says. “It’s easy to imagine the accompanying headlines.”


To avoid such a scandal, Nevada’s exchange is hoping to attract advertising partners who would further its mission of extending health coverage to uninsured Americans. Dental and vision insurance plans, which could supplement the more traditional medical coverage that will be sold on the marketplace, could be obvious targets. The details will be ironed out after the request for proposals is finalized and responses are received.


The relative smoothness (or bumpiness) of Nevada’s experience could inform other states’ decisions, Tolbert says, but there’s another to-be-determined factor: how much it actually costs to operate an exchange. Right now, with the federal government footing the bill, it’s mostly guesswork, but estimates of exchange operating costs range from $25 million to $60 million or more, according to the Kaiser Family Foundation.


If the exchanges end up being more expensive than states expected or if fewer people enroll in the exchanges than anticipated, that could cause officials to return to the idea of advertisements as a revenue stream.


“If it comes down to a choice between significantly increasing the assessments and looking toward other ways to generate revenue, states could be open to trying something new,” Tolbert says.


The Year Ahead in Health Reform: Dylan Scott’s educated guesses about what to expect from the Affordable Care Act in its first year of full implementation.

Exchange enrollment will be (a little) lower than expected. The almost exclusive focus on outreach in the six months or so leading to the exchange openings on Oct. 1 should tell you that even supporters of the law are worried about whether they can get enough people to sign up for coverage. When four in 10 Americans say they don’t know the ACA is still law — and those proportions rise among the low-income people the law is intended to benefit — I think the White House might struggle to reach its goal of 7 million enrollees in the first year. At least five more states will expand Medicaid by 2015. I’m looking to historical precedents on this one. ACA supporters will often point out that nearly half the states didn’t join Medicaid when the program was created in 1965, but almost all of them had within the next few years. I think the prospect of losing another year of 100 percent federal funding for expansion will be too much for at least a handful of states to pass up. The 2014 midterm election complicates this a bit, but there are enough states that were close to expanding this year — Florida, Ohio and Tennessee, to name a few — that it’s easy to see them finishing the job next year. Obamacare will become a little more popular once it’s fully implemented. I’m not expecting conservatives to have a sudden change of heart and embrace the law, but the ACA’s approval and disapproval ratings have hovered in the low 40’s since it was passed, which means that close to 20 percent of people are undecided. That’s a lot of people who could be won over, and 2014 finally brings the most visible parts of the law: the exchanges and the Medicaid expansion. People will actually know other people who are getting health coverage because of Obamacare. I think that starts to turn the tide in the law’s favor.

Whatever Happened To … White Space Network Products, L.A.’s Gmail Contract, Fingerprint ID Program?

The Original Story: In 2010, Wilmington became the first city in the nation to begin testing TV “white spaces” and applications. White space networks take advantage of unused bands of wireless spectrum that were left over when television broadcasters switched from analog to digital. Wilmington was a natural choice to be a guinea pig for applications based on white space networks. The city was the first major market in the U.S. to switch to digital TV in 2008.


In spring 2010, Government Technology reported that Wilmington planned to use wireless traffic cameras at intersections to monitor traffic, travel time and fuel consumption, and to support local law enforcement. In addition, water-level sensors would be used to monitor and manage wetland areas in the coastal city without a boat trip.


Project Update: As planned, Wilmington became a valuable test bed for white space devices and it has put the technology to work on several “smart city” initiatives.


In 2011, the FCC officially approved the use of white space for wireless broadband networks. The ruling was significant because wireless broadband requires the use of spectrum, which is a limited resource. Using white space to provide broadband service is now part of the FCC’s overall plan to find more wireless spectrum and expand broadband availability across the country.


Today, Wilmington uses white space spectrum to monitor real-time water quality and traffic conditions on roads that previously lacked access to a broadband connection. In addition, the city helped with the development of new white space devices that are just now reaching the market.


“Over the past couple of years, Wilmington has done a lot of work with original equipment manufacturers and radio vendors to test and evaluate their products,” said Rodney Dir, president and CEO of Spectrum Bridge Inc., a company involved in the early testing efforts.


In 2012, the FCC approved the first white space device. There are several additional devices pending approval. Estimates are that by the end of 2013 there could be six FCC-certified devices available, many of which were tested in Wilmington. — Justine Brown


The original story: Los Angeles stepped way out on a limb in 2009, becoming the biggest city in the nation to move its entire email system — used by 30,000 municipal employees — to Google’s Gmail service. The city’s massive shift to the cloud would become one of the most closely watched IT deployments in local government over the next several years. Los Angeles CTO Randi Levin told Government Technology in 2010 that using Gmail to replace the city’s in-house GroupWise email system would let her eliminate 92 servers and reassign nine employees responsible for maintaining that equipment. In addition, city workers would get more reliable email and a suite of new features.


Project Update: Four years later, the project never exactly delivered on its promises and never was completely finished. Although the city moved email for 17,000 employees into the cloud, it could never transition police and other public safety personnel to the hosted system, leaving about 13,000 employees on the GroupWise platform. The city formally abandoned plans to move cops into the cloud in 2011, citing security concerns.


Now Steve Reneker, who replaced Levin as city CTO last year, is prepared to rebid the contract. Los Angeles’ five-year contract with Google ends in a year, and Reneker said he has no preconceptions about what the city will do next.


“We are at a juncture right now,” he said.


Reneker said the next contract will be 10 years long and split into three parts: email, applications and security. That will give Los Angeles flexibility. His sense is that city employees are comfortable with Gmail and don’t want to switch away from it, but he says “conversion issues” between Google Docs and Microsoft Office have made life difficult. Most city departments still prefer Office.


The Los Angeles Police Department will continue to use an on-premises email system, Reneker added, to ensure compliance with California Department of Justice requirements.


Reneker credits his predecessors in the Los Angeles Information Technology Agency for making a bold move, even though there were unforeseen obstacles and some erroneous assumptions. He said Gmail “significantly” reduced total cost of ownership for the city’s email, even though the extent of the savings hasn’t been what was forecast in 2009. — Matt Williams


The original story: In 2010, Bergen County, N.J., began scanning the fingerprints of people coming to its food banks. The new technology was meant to solve a dilemma the county had dealt with for years: Its Department of Human Services (DHS) could not accurately estimate how many homeless individuals received services like food, medicine and shelter. Because many people served by the department did not have accurate forms of identification, DHS staff had no way to track who was receiving services or how often.


“It’s not like you can do a head count,” said Susan Nottingham, the department’s Homeless Management Information System administrator. “We could sit down and say, ‘Can we talk to you for 45 minutes?’ But we didn’t want them to turn around and say, ‘We’re not that hungry.’”


Project Update: Bergen County’s fingerprint technology appears to be working as intended, and use of biometric identification is spreading to the state level. County officials say the technology improved both the accuracy of records and the speed in which people receive food. The Bergen County DHS now has a more accurate account of the number of people in the system and the real demand for services. With this information, officials have been more effective in getting state and federal funding for homelessness programs.


The county system also inspired state officials to phase in a similar tracking system for homeless services. In April 2013, New Jersey began using a new biometrics data management system that includes a Web-based fingerprinting component to track and manage food, shelter, medicinal services and other necessities the state provides to its homeless population. The system will help state officials track who is receiving homeless services and the types of services rendered.  — Justine Brown

Demystifying Health Insurance Exchanges

Obamacare’s new health insurance exchanges are scheduled to open for business Oct. 1. But a recent survey shows that nearly 80 percent of those who stand to benefit have no idea what an exchange is or how to get the health insurance subsidies they will offer.


That’s where the private nonprofit Enroll America comes in. The group, which has strong ties to the Obama administration, has been using more than 100 staff and about 3,000 volunteers to go door-to-door and to stage community events this summer to inform people about the opportunities for health care coverage on the exchanges.


Its president, Anne Filipic, announced Monday that the group would focus most of its effort on 10 states with the largest number of uninsured and the lowest level of state-funded outreach: Arizona, Florida, Georgia, Illinois, Michigan, New Jersey, North Carolina, Ohio, Pennsylvania and Texas. All but Illinois have Republican governors.


California was left off of the list even though it has the most uninsured residents and among the highest percentage of uninsured population in the country at 20 percent. But with more than $600 million expected in state and nonprofit funding to support outreach efforts locally, Filipic said her group chose to support California’s efforts rather than launch its own.


“Our focus,” she said, “is on states that do not have a robust infusion of resources.” In the remaining 40 states, the group’s regional directors will be working without staff to support state-led and other local efforts.


When the exchanges open, anyone who does not already have employer-sponsored insurance will be able to comparison shop for coverage and find out whether they qualify for federal subsidies to help pay for their policies. Visitors to federally funded websites and call centers will also find out whether they qualify for Medicaid or the Children’s Health Insurance Program, and they’ll be able to sign up for that coverage immediately. Policies purchased on the exchange will take effect Jan. 1, 2014.


Enroll America stressed that it is not helping people sign up for insurance but informing them of their options. In the 10 target states, Filipic said the goal is to recruit and train volunteers and work with existing organizations, such as schools, churches, community health centers and other groups to build an infrastructure that will spread the word on Obamacare starting now.


The Obama administration is scheduled to announce Thursday how it will dole out $54 million in federal money to hire so-called “navigators” who will help people actually sign up.


This article was originally published by Stateline. Stateline is a nonpartisan, nonprofit news service of the Pew Charitable Trusts that provides daily reporting and analysis on trends in state policy.

App Helps Victims Report Sexual Assault Anonymously in D.C.

A new app launched last week in Washington, D.C., assists victims of sexual assault, domestic and dating violence. Users can report incidents anonymously and find other helpful resources.


The free app, called ASK DC (short for Assault. Services. Knowledge.) is a joint effort between Mayor Vincent Gray’s Office of Victim Services and nonprofit organization Men Can Stop Rape. Once downloaded, users can access 33 assault-response resources including medical, law enforcement, 24-hour support hotlines and more in the D.C. area.


The app is part of a larger, districtwide initiative that includes a website and training materials intended to help raise community awareness about sexual assault and dating violence.


“The ASK DC app is not just for assault victims,” according to a statement from Men Can Stop Rape. “The bystander tools and resources provided can be used by anyone to direct a friend, family member or a colleague who may have experienced sexual assault to the help they need.”


Melissa Hook, director of the Office of Victim Services, said men are also encouraged to download the app in the event they are a bystander in a crime like sexual assault.


Since the app allows victims direct access to medical attention, they can get properly examined before reporting the assault to the police, Hook said. Providing multiple resources through the app connects victims to numerous response and support options, even if they don’t report the assault right away.


“The practical details are sometimes the biggest barriers in the middle of the night when someone’s traumatized,” Hook said.


To reach beyond English speakers, the app offers services in English, Spanish, French, Amharic, American Sign Language, and more than 20 different Asian languages. Legal assistance is available for immigrant victims, and the app connects those visiting from abroad to their home country’s embassy or consulate in the U.S.


But before the app was available across the District of Columbia, a similar app was launched on a smaller scale.


ASK DC was modeled after U ASK DC, which was released last year across Washington D.C.’s college and university campuses, mainly to help women report sexual assault and violence. Hook said D.C.-area colleges were seeing a spike in the number of assaults and needed a more coordinated response.


The mayor’s office reported that prior to the launch of U ASK DC, sexual assaults on campuses had been greatly under-reported. The success of U ASK DC later incentivized the mayor’s office to expand the project districtwide with the launch of ASK DC.


ASK DC can be downloaded for BlackBerry, iOS and Android devices.

Virtual 3-D Desktop Targets Medicine, Education

Some organizations are looking to a new form of virtual reality to conduct research, educate students and accomplish medical tasks.

Take the Bullis Charter School, a kindergarten through junior-high school in Los Altos, Calif., which is building a fabrication lab (FabLab) that will use technology complete with  a pair of 3-D glasses, a stylus and software integration — along with 3-D printers —  to allow students to create things in the 3-D space, and then materialize their creations once they’re complete.

Developed by a company called zSpace, the new product allows its users greater immersion in their work, while facilitating a work environment more in tune with the 3-D world people are used to. The leap from 2-D to high-resolution 3-D on a person’s desktop is so dramatic and beneficial, said Chief Technology Officer David Chavez, that this technology will eventually become a standard part of a computing work environment.

Bullis Charter’s Superintendent and Principal Wanny Hersey said via email that such technology supports the school’s mission of individualized learning. The school provides a wide variety classes and programs, from things like Lego robotics to guitar, and this FabLab, she said, was a natural extension of the school’s mission to provide opportunities for their students to pursue their passions and discover new areas of interest.

At a cost of about $60,000 for equipment — which includes the zSpace system — the FabLab will give students a head start toward a career in IT or engineering, if that’s what they want, Hersey said.

“Students will now have the opportunity to use the latest technologies to create and test a prototype for their solution, in a process that mirrors what takes place here in the Silicon Valley,” she said, adding that traditional education models have not provided students with such opportunities, and the Bullis FabLab is an opportunity to provide their students an opportunity to learn by doing, while providing a model for other educational institutions to see what’s possible.

And across the country in New  York, the Touro College of Osteopathic Medicine also is deploying a virtual lab using the system — which costs  about $4,000 —  that will allow students to perform autopsies on virtual cadavers.

“It’s going to make a lot of people a lot more productive. There’s no question about it,” Chavez said. “Our vision is to give this to everybody. And there’s no doubt in my mind it’s going to happen. It’s that significant.”

Any applications that involve imaging, he said, such as CT scans or MRI, would benefit tremendously by entering a 3-D interface.

As seen in the video below, the system works in a fashion somewhat similar to what Tony Stark uses in Iron Man to virtually build and perfect his suits — but perhaps a very, very early iteration. People use a stylus to pull objects out of screens into the air in front of them, rotate objects and perform various other spatial tasks, and sometimes share the vision with another user wearing their own pair of 3-D glasses, as the system is designed for collaboration both locally and remotely.

What using the technology is like is difficult to explain, Chavez said. “I tell people, ‘You’re not going to believe this.’ It’s the coolest thing I’ve ever worked on. I’ve been making things in Silicon Valley for almost 30 years now, and this is the most exciting. I’ve never seen anything elicit such reaction from people. … It’s almost impossible to set people’s expectations too high.”

And the benefits in the educational and medical field are tremendous, Chavez said.

“They think students will be more immersed,” he said, noting that students will spend more time because, in the case of the Touro College of Osteopathic Medicine,  virtual cadavers have many advantages over a real cadaver.  “If you make make a mistake,” Chavez said, “you just put it back.”

Just as with any virtual system, the zSpace 3-D system allows for functions like adding or removing layers to an image, turning it or undoing a mistake — only everything is in 3-D.

Additionally, the zSpace system provides users with 1920 x 1080 resolution as they sit at a desk and use a stylus, whereas traditional virtual reality uses a “cave” that the user must physically walk into while wearing a headset and pointing a device at the walls, he said. The ability to sit at a desk provides comfort and precision, while making collaboration much easier, he added.

“It’s just the beginning,” he said. “It’s our first product. Some people say, ‘Wow! That’s really cheap for what you get’ and other people say it needs to be a lot lower [in price] for mass penetration.”

And, Chavez says, both of those things are true.

View the original article here

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