Tag Archive for Health

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.

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.

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.

View the original article here

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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