Some State Health Exchanges Won’t be Finished by Deadline

Obamacare’s health insurance marketplaces go live on Oct. 1, but some of them won’t quite be finished by then.

People should be able to start shopping for health insurance on Oct. 1, the date set for the online marketplaces (also known as exchanges) to open in the Affordable Care Act. But once they find a plan they like, they might have to wait a few more weeks before making any payments. That’s because several state-based marketplaces say they’ll be busy finalizing the payment functions of the exchange after the website launches.

It shouldn’t be a problem — plans sold on the exchanges start on Jan. 1, 2014, so insurers just need to receive payments by then to begin covering people — but it’s yet another reminder that exchange implementation is happening on an incredibly tight timeline with little room for error.

Officials in Oregon and Washington say they expect to still be finalizing their exchange’s payment functions after Oct. 1. Sue Doby, a senior consultant at Oracle, which is building Oregon’s health exchange, says several exchange features might not be ready until Jan. 1, and the payment process is probably the most important.

“A lot of testing still needs to be done,” she says. “We have to prioritize what pieces of product and code can be deferred.”

Likewise, at Washington state’s health exchange, officials said in an email that they expect to have their payment functions ready during December, which is when the first round of premiums would be due for coverage starting on Jan. 1, 2014.

At least six other states are expected to facilitate premium payments through the exchange, according to StateReforum, which tracks exchange implementation. All of the 30-plus federally run exchanges will have insurers bill their new customers directly. That is one less thing for the U.S. Department of Health and Human Services to worry about, after a recent Government Accountability Office report questioned the Obama administration’s readiness to open the exchanges on time.

But even in states like Rhode Island that plan to have their exchange’s payment features ready for the Oct. 1 launch, there is an acknowledgement that it could be delayed, and officials say the state has done some contingency planning in case that becomes necessary. For example, when the consumer purchases a health plan, they could receive a message notifying them that their coverage will be contingent on the insurer receiving payment and a bill will be sent at a later date.

“Our intent here in Rhode Island is to have the functionality for Oct. 1,” says Brian Keane, who is overseeing the exchange’s technical implementation for Deloitte Consulting. “But we do have a contingency plan, and we may go to one of those other options.”

A state’s inability to process payments on Oct. 1 might delay HHS’s decision to officially approve the exchange, but that doesn’t mean they won’t be allowed to open. All 18 state-based exchanges are currently conditionally approved and must receive final approval from HHS, but can be launched with only conditional approval, according to HHS.

“The secretary can allow states to operate their exchanges under conditional approval while they finalize components of their exchange,” an HHS aide said in an email.

This story was originally published by GOVERNING.com.

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LA County Environmental Health Launches $5.7M Tech Project

Thanks to the Los Angeles Public Health Department’s Environmental Health Division’s newest technology project, field employees from 16 county district offices can now record inspection data on a tablet and provide a printed inspection report in the field, according to a press release. And in the next three months, the remaining 15 district offices will come aboard this mobile system.

Using the EnvisionConnect Software Suite, which includes a mobile inspection app, the Environmental Health Division manages environmental health services such as inspections and permits for retail, food, swimming pools and housing programs, as well as smaller programs that deal with theaters, pet stores and self-service laundry facilities.

One phase of the project involved migrating more than 107,000 facility records and 117,000 permit records into the EnvisionConnect database, and another part of the migration process includes the county’s deployment of 300 tablets to meet its automation goals.

In the near future, the county is set to implement an EnvisionConnect portal to allow the public to submit online complaint forms and other applications. Through the portal, the public will have access to inspection results and closures.

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Several Agencies Linked in ACA ‘Hub’

Characterized as “one of the most complex computer projects in the government’s history” by Bloomberg, the technical aspects of Obamacare are far from settled. Some say that the success or failure of a $267 million computer system called the Hub, central to Obamacare, will likewise determine the success or failure of the Affordable Care Act (ACA) as a whole.

According to a Bloomberg report, the system links databases from seven federal agencies, including the Internal Revenue Service and the Peace Corps, to establish who is eligible to purchase health insurance and who can have their coverage subsidized.

Medicare administrator Marilyn Tavenner will oversee the hub, and expects system construction and testing to be complete by September 1 — one month before government-run health insurance exchanges open for business. Officials have indicated that all parties using the hub must adhere to strict rules and standards to ensure proper security.

“We have been engaged in a great deal of discussions to make sure these standards are incredibly strong,” said Chiquita Brooks-Lasure, deputy director of the Center for Consumer Information and Insurance Oversight.

But not everyone is convinced. Some lawmakers feel the system’s size and contents will make it a target for hackers. Others warn that the government may misuse the information.

In prepared comments before a congressional hearing on July 16, Tavenner defended the system, citing a “robust security monitoring system that reviews all security events, tools, requirements, and network device logs to identify, assess, and manage vulnerabilities and threats.”

The Congressional Budget Office expects roughly seven million Americans to seek coverage through the exchanges.

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Texas Groups Promote Health Exchange Without Help From State

Texas officials have declined to establish a state-based health insurance marketplace, a major provision of the federal Affordable Care Act. So private organizations are working to educate Texans about coverage options through the federal health insurance exchange, which opens on Oct. 1.

Of the more than 6.3 million uninsured Texans — the state has the country’s highest rate of uninsured residents — almost half will be eligible to buy insurance through the federal exchange, an online tool for coverage shopping.

But Texans suffer from a “general lack of knowledge” about the law, said Allison Brim, a director at the Texas Organizing Project, one of several groups working to reach uninsured families before the federal exchange’s rollout.

“Folks just don’t have a lot of information about the exchanges and what their options will be,” she said.

The Texas Department of Insurance has made no extra effort to publicize the federal exchange, said John Greeley, an agency spokesman. In 2010, it conducted a federally financed campaign about health insurance options but has done nothing comparable since, he said, adding that those with questions could use the department’s website or telephone service.

Brim criticized the state for not promoting the exchange, saying its help would make it possible to reach all eligible Texans by October.

“The state has, as far as we know, done nothing to spread the word to uninsured Texans about the exchanges or the Affordable Care Act,” she said. “It leaves a mountain of work for us.”

In response to questions about publicizing the exchange, Lucy Nashed, a spokeswoman for Gov. Rick Perry, wrote in an email that the state was “not interested in implementing Obamacare, including the exchange.”

On July 10, a division of the U.S. Department of Health and Human Services awarded about $9.9 million to Texas community health centers to make people aware of their options.

The department will also finance at least two “navigators” — organizations intended to guide people through the exchange — per state. Texas’ navigators will receive about $8 million.

But Jacob Cortes, the lead organizer of the group Austin Interfaith, said that might not be enough. “The private sector would have to step up,” he said.

Julie Bataille, a spokeswoman for the Centers for Medicare and Medicaid Services, said navigators were just one federal resource. The agency also dispatches officials from its Dallas office and Washington headquarters to speak with health workers and organizers in Texas.

And it collaborates with local initiatives, Bataille said, including groups like Blue Cross Blue Shield, which started a Be Covered campaign; the Texas Organizing Project; and Enroll America, which promotes the health care act.

Be Covered has joined with churches, museums and other organizations in every Texas county to distribute literature on obtaining insurance, said Michelle Riddell, a Blue Cross Blue Shield of Texas spokeswoman. 

The Texas Organizing Project and Enroll America are canvassing and organizing community meetings where Texans can get more information.

Reaching exchange-eligible people will not be easy, said Mimi Garcia, Enroll America’s Texas director. She added that groups like hers will have to work beyond January 2014, the deadline for Americans to obtain coverage.

“I would love it if we could get everybody enrolled in the first year and that would be it and we would be done,” she said. “But that’s not going to be the case.”

Cortes said ambiguity about the federal exchange — including yet-undetermined providers and premiums — make it difficult to spread a clear message.

Texas’ size poses another challenge, Brim said, because in rural areas “we just can’t reach as many people as fast.”

“There will be some folks,” she added, “who just don’t get the word.”

This story was originally published by The Texas Tribune, and was produced in partnership with Kaiser Health News.

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Can Sports Teams Help Inform the Public About Health Exchanges?

It’s a Wednesday night in Boston, and Amy O’Leary is out at Fenway enjoying a Red Sox game and hoping for another year like 2007. That’s when the team won the World Series, sweeping the Colorado Rockies in four games.

It’s also the year that Massachusetts started requiring nearly all residents to have health insurance — and the Red Sox helped to get the word out about it. They let the state set up booths at games to explain the new law to fans, and the Massachusetts Health Connector ran ads on Red Sox broadcast networks.

O’Leary remembers it well. “I think it made sense. People feel like they know the players,” she says. “I think that sports teams in general can be messengers of good information to a wide variety of people.”

Now that other states are opening health insurance marketplaces, they’re trying the same strategy. Myung Kim is outreach director for Colorado’s new health insurance marketplace, Connect for Health Colorado.

“People who care about being healthy, our young adult population, are big watchers of the sports shows, and we know are going to be an important population for us to reach,” Kim says.

Colorado is targeting young people — many of whom are uninsured — to help balance the insurance pool under the Affordable Care Act. Young people generally use fewer health services so their premiums will help the insurance companies cover the medical needs of older, sicker beneficiaries.

So the state is running television ads during Rockies baseball games that show people buying a health policy and then celebrating as if they’d just won sporting event. The voiceover in the ads says, “Connect for Health Colorado, because when health insurance companies compete, there’s only one winner: You.”

But while Colorado follows Massachusetts’ lead on advertising its new insurance marketplace, it is one of only 15 states independently setting up its own exchange. The federal government is fully or partially at the helm of the insurance exchanges in all the other states.

Mandy Cohen, with the federal Department of Health and Human Services, says it can be tough to reach young people who may not currently value having health insurance.

“We also know that they’re most heavily marketed to, so it’s really hard to break through to this group,” Cohen says. “We know we had to put an extra emphasis on the 18-to-35 year old cohort.”

But when the White House reached out to pro baseball, NASCAR and other sports organizations to discuss marketing partnerships, some Republicans called a foul. Senate Minority Leader Mitch McConnell sent the leagues a letter saying they, “risk damaging (their) inclusive and apolitical brand(s)” by promoting the federal health care law.

That didn’t happen in Boston, says Red Sox Vice President Charles Steinberg.

“We didn’t have negative feedback,” says Steinberg. “In American democracy we debate issues and we come to resolution and we pass laws. And those laws are designed to benefit the people. So when you can be a communicator of the laws of the land, you believe that you’re helping people.”

Still, the White House as of now has cancelled at least some of its meetings with sports leagues about potential partnerships.

In Colorado, the ads running during Rockies TV broadcasts haven’t stirred up any controversy. But they might not be home runs either.

The same night O’Leary was in Boston, Joan Ringel was at the Rockies game. She’s seen the ads on TV and says it’s kind of hard to even tell what they are selling.

“You wouldn’t know that that is Colorado’s exchange for the Affordable [Care] Act,” Ringel says. “I didn’t think they explained clearly that people need to pay attention to the exchange when it’s time to sign up.”

Open enrollment for Obamacare insurance starts in October — World Series time. The White House is hoping sports fans will also think of it as a chance to benefit from the Affordable Care Act.

This story was originally published by Kaiser Health News.

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