Tag Archive for Insurance

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.

Health Insurance Marketplaces Delay Mobile Apps for Now

In October, state health insurance exchanges (HIX) will start enrolling Americans for coverage as required by the Affordable Care Act (ACA). That’s good news for people with computers and broadband connections, who should have an easy time accessing state exchange portals to compare offerings, determine eligibility, enroll in plans and pay premiums.

But many who rely on smartphones for Internet access will have to choose a different way to apply for coverage, at least this year.

“We did have an extensive discussion around mobility and mobile access to our exchange early on,” said Curtis Kwak, CIO of the Washington Health Benefit Exchange. “Because the timeline was engraved in concrete for Oct. 1, we didn’t get a chance to build that into our version one application. But it’s definitely queued up for version two, which is planned for an August 2014 launch.”

State leaders understand that smartphones play an important role as Internet access tools, but in the scramble to get their HIXes up and running by October, most states haven’t yet tackled the question of mobile access.  

But smartphone use for Internet access is particularly high among some of the groups most likely to look to HIXes for health coverage because they aren’t getting it through employers.

Of adults who use their cellphones to access the Internet, 45 percent of 18- to 29-year-olds, 51 percent of African Americans and 42 percent of Latinos do most of their online browsing that way, according to the Pew Research Center’s Internet & American Life Project. People in households that earn less than $50,000 a year and people who haven’t graduated from college also are likelier to rely on mobile phones to get online, Pew said.

“[States] are finding themselves behind the eight ball as far as being ready for the exchanges. So they’re not as focused on the newer technology,” said Jinnifer Wattum, director of eligibility and exchange solutions for Xerox Government Healthcare Solutions.

People who lack Internet access will be able to interact with HIXes in other ways like calling customer service centers or mailing paper forms. And smartphone users won’t be entirely out of luck either.

Citizens will be able to use their mobile phones to read material on state exchange portals and perhaps to conduct some transactions. But which functions they can use, and how easily, will vary by state.
Watch video (above): Massachusetts’ Health Insurance Exchange Focuses on Reusability

“The good news is that the health benefit exchange interface is not a very heavy interface,” said Manu Tandon, secretariat CIO at the Massachusetts Executive Office of Health and Human Services. “Our idea in general is to make the amount of information we ask of citizens, especially if we’re asking the second time around, as minimal as possible.”

The Massachusetts HIX interface will contain a minimal number of data fields, Tandon said. It could become even simpler as the state’s system starts to pull more data from a hub that the federal government is building to supply data to state exchanges in real time.

If citizens don’t need to enter a lot of information, they might be able to conduct transactions through the browsers on their smartphones, he said.  

Massachusetts comes to the ACA with a strong advantage: Most of its residents already have health insurance, thanks to legislation the state enacted in 2006. When its new ACA-compliant HIX opens for business, most residents will use it to renew or change their coverage, not to enroll for the first time, Tandon said. Massachusetts will need to collect less data than typical states, so more residents will be able to use their smartphones to complete the tasks.

But in most other states, residents seeking health coverage will need to complete a lengthy form. The “streamlined application” — a single form used to apply for Medicaid, the Children’s Health Insurance Program and health insurance plans offered on state exchanges — is complex, said Bruce Caswell, president and general manager of health services at Maximus, a Reston, Va.-based company that partners with local governments to provide health services for poor communities. “That might not make it suitable to be completed on a mobile device.”

So what will Americans be able to do on their smartphones when HIXes open in October?

Smartphones aren’t the only mobile devices citizens can use to access state health insurance exchanges. Nevada is working to accommodate tablet computer users to interact with its Silver State Health Insurance Exchange.

“Tablets have a screen size that will allow for the comparison of plans side by side, and all the things that go along with the plan,” said C.J. Bawden, communications officer of the Silver State Health Insurance Exchange. The much smaller screens on smartphones don’t easily allow for that kind of activity.

Nevada is designing its exchange’s interface to display well on standard computers and tablets, Bawden said. ”We are going to move forward into development of an app or development of a mobile site, in future years, to make it easier for a person with a tablet to walk through all of the steps.”

In the exchange’s early years, Nevada will analyze how long it takes to navigate the site and where users encounter problems to improve the site across various devices.

Tablets could also become an important tool for navigators, or people who, under provisions of the Affordable Care Act, will educate individuals and small employers about health plans and help qualified individuals enroll. In Nevada, many of the navigators who guide citizens through the exchanges carry tablets, Bawden said.

Bruce Caswell, president and general manager of health services at Maximus in Reston, Va., said that navigators might become the real force driving adoption of mobile technology for health insurance exchanges.

“”I think that an iPad or tablet-based, downloadable app that individuals in the field can use in a comfortable setting to educate, communicate and then help navigate the process is going to be critical,” he said.

In states like Nevada, where vast areas of sparsely populated territory lack broadband and wireless service, navigators who visit residents during open enrollment periods might need other mobile technologies as well, said Bawden. ”We’re looking at putting together a truly mobile system, possibly with a vehicle with a satellite uplink to drive out to these remote locations.”

If consumers are using an iPhone or Android phone with a larger screen, they’ll be able to navigate the exchange Web page, said C.J. Bawden, communications officer of Nevada’s Silver State Health Insurance Exchange.

In some states, including Nevada, users of both smartphones and feature phones will be able to get text messages reminding them about premium due dates, open enrollment windows and other important deadlines.

“You’re going to have the ability through the Web portal to choose your preferred method of contact, whether that’s by SMS [short message service], email, a telephone call or regular mail,” Bawden said.

Xerox is developing Nevada’s exchange and Web portal, and the company created a function that reminds consumers when a payment is due.

“As long as the client has given their authorization and mobile number, we can put it on their account that 10 days before their premium is due, a text message will go out,” said Wattum. “They would have to go into the website to pay their premium, but it does give them a reminder via text that they need to do that.”

Rather than make smartphone users fend for themselves on their full-blown HIX portals, some states will most likely build mobile-optimized versions of those sites with simplified interfaces, said Caswell. Smartphone users probably won’t be able to complete entire applications on those mobile sites, but they’ll be able to go through the preliminary eligibility screenings.

“You might even see a relatively straightforward way to do health plan comparisons, at least at a basic level of comparing product costs and features,” he said. “But with the expectation that for a lot more detail, you’d have to go to a bigger browser version.”

While Massachusetts won’t create a separate mobile site in the first incarnation of its new portal, the state is taking mobile browsers into account, along with popular big-screen browsers, as it designs the interface.

“You always have this problem that you want to have the same content be presentable using different presentation media,” Tandon said. “This is no different.”

States could make more specific accommodations for smartphones starting in the next year or two. “I think what you’ll see in the first quarter of next year are mobile applications for paying a premium and making simple changes,” Wattum said.

Based on her conversations with officials in various states, Wattum said it seems that most users won’t be able to shop or apply for plans entirely from their smartphones until late 2014 or 2015.

Massachusetts is still confirming plans to add mobile functionality, said Tandon. “Our current thinking is to develop a mobile Web application for the state-based exchange using Oracle’s ADF Mobile product, which would support the iOS and Android OS using the same code base.”

That application probably would work best for functions like calculating insurance subsidies, managing a user account and paying premiums, Tandon said.

“Other functions, such as applying for health insurance, would be a lengthy process and may not be a good fit for mobile apps,” he said.

In Washington, Kwak envisions someday offering a mobile app that users could download for free from the Washington Health Plan Finder website or a commercial app store. But it’s not yet clear whether downloadable apps are an effective way to reach the state exchange’s target market, he said.

State officials also must remember that mobile apps carry a cost, Kwak said.  “I think there’s some perception out there that mobile applications are a dime a dozen,” he said.

That might be true for users who download the software, but it’s not the case for the organization that has to develop, test and market the app. “I want to be sensitive to the fact that there is major work in developing even the simplest mobile application and making it available to the public,” he said.  

Smartphone interfaces for health and human services already exist outside the realm of HIXes. For example, Maximus has developed a downloadable app for people receiving Temporary Assistance for Needy Families benefits in Wisconsin to demonstrate that they are seeking employment.

“You can use this mobile app to submit time sheets, to document your job search activity — literally taking pictures of the business cards from in-person interviews you’ve had,” Caswell said.

On the health-care side, this year Maximus will pilot the use of a mobile-optimized Web browser in some of the states where it provides services for the Children’s Health Insurance Program and Medicaid programs. Beneficiaries with smartphones will be able to use this browser to perform some basic activities, such as looking up health-care providers, Caswell said.

However, mobility, in general, has been making its way into the health benefit market at a glacial pace, Caswell said. HIXes provide a chance for catch-up.

While states are busy just getting their HIXes and portals up and running, they also realize that many of the citizens they’re trying to bring onto the exchanges are people under 30 who rely heavily on their smartphones, Caswell said.

“You need to have those folks in the exchanges, because from an actuarial perspective they’re critical to ensuring that the exchanges are sustainable,” he said.

It’s certainly time for a greater emphasis on mobility, agreed Wattum. In the past, organizations providing services to low-income and uninsured populations assumed that those clients lacked access to computers or weren’t technically savvy.

“That’s just not the case,” said Wattum. “And especially in the last three years, mobile devices have become the norm for every population.”

States need to figure out how to provide services through mobile devices, she said.

Like Tandon in Massachusetts, Wattum looks to the federal health-care data hub to pave the way for better smartphone access in the future.

When an applicant enters basic information, such as a name, Social Security number and current address, the federal hub will use that to verify citizenship, pull income figures from the IRS and otherwise retrieve data needed to apply for insurance and government subsidies, she explained. If the hub supplies that data, states won’t need complex on-screen forms to capture the information from applicants.

At least, that’s the theory. “States are hesitant about whether or not that’s truly going to be real time and whether it will be ready for this fall,” Wattum said. “Once that automation is proven out, I think the states and the federal government will be more open to investing in technology such as a mobile app.”

Photo of Manu Tandon by David Kidd

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What’s the Back-Up Plan for Health Insurance Exchanges?

Yet another problem has appeared that could stymie the Affordable Care Act’s successful implementation: what if we need a back-up plan to evaluate and certify the health plans that are going to be sold on the law’s online insurance marketplaces?


As it stands now, there isn’t an official one. On and off the record, officials at the U.S. Department of Health and Human Services (HHS) assured Governing that there was a secondary plan, but they declined to provide details. Industry sources say they aren’t aware of any such back-up plan—which concerns many of them—but there are a few theories out there.


Here’s the issue: Somebody has to review and certify the health insurance plans that will be sold on the online marketplaces, formerly known as exchanges, created by the federal health reform law. In the 18 state-run exchanges, the state is responsible for doing that review and certification. In the 13 states that are partnering, openly or silently, with the federal government on their exchange, the state is also responsible. In the 19 states fully defaulting to a federal-run exchange, HHS will oversee this process, known as plan management.


That’s how it’s supposed to work. But in practice, it might not be so straightforward. At least five state-run exchanges—Colorado, Idaho, Kentucky, New Mexico and Rhode Island—have yet to start accepting plan applications. If they have serious problems in the next few months–and it is a real possibility that some of them will–they could potentially have to hand plan management over to the feds. Additionally, any of the partnership states, most of which have some degree of state-level opposition to the ACA, could theoretically drop out of that partnership and leave plan management to HHS.


If that happens, nobody is sure how review and certification will be handled. Most states and HHS are allowing several months for the full application and certification process to be completed. With the marketplaces slated to open on Oct. 1, that doesn’t leave a lot of time if things go awry. The federal government is ending its application period for the federal-run exchanges in the next few weeks. If a state doesn’t figure out until a later date that they can’t do plan management and must give that responsibility to the feds, the administration has no obvious mechanism for asking health insurers to submit their plans to HHS instead.


It’s all theoretical right now. But some insurers are worried that it could become a reality very soon.


“That’s a question we’ve been asking ourselves. Nobody’s heard a word,” says one official at a top insurer, who spoke on the condition of anonymity. “At the end of the day, we’re questioning whether HHS is going to be fully ready, and we don’t know what that means if they aren’t.”


What’s the worst-case scenario? If responsibility for plan management is shifted from the state to the feds at the last minute, that could possibly delay the exchange’s opening until after Oct. 1, says Caroline Pearson, who tracks ACA implementation for Avalere Health, an independent consulting firm.


That might not have a huge practical effect for those who enroll—coverage being sold on the exchanges starts Jan. 1, 2014, so there is some lag time—but it would be a significant political blow to the Obama administration, which has steadfastly insisted that the marketplaces would launch on time. It could also complicate public outreach if people don’t know when their state’s exchange is actually opening.


“That could slow down enrollment and slow down marketing. It probably reduces overall enrollment,” Pearson says. “I think we’ve got time before you hit that point, but I’m beginning to get nervous.”


So how does this get resolved? There are a few apparent possibilities, though HHS is staying silent on what their plan is. One rumor, relayed to Governing by a knowledgeable source, is that the feds would ask any insurer planning to sell a plan on any state’s marketplace, including state-run and partnership exchanges, to submit their information to HHS before the federal application period ends in the next few weeks. That way, if the state fails to complete its plan management, the feds already have all the information they need to review and certify the plans themselves.


One insurance industry source said that sounded “plausible,” but hadn’t received any request directly from HHS. Another said they were under the impression that this is a rumor that is floating around the industry, but there were no indications that the feds would actually take that route.


The other possibility involves the two different electronic systems that states and HHS are using to solicit plan information from insurers. The state-run and partnership exchanges are using software called SERFF, which state regulators have used for years to collect information from insurers and review plans. The federal government is using HIOS, which is a separate system but performs essentially the same function.


SERFF and HIOS are capable of transmitting information to one another, one-state level source confirmed to Governing. So, in theory, a state-run or partnership exchange worried about its ability to complete plan management could ask insurers to submit their information to SERFF. Then if the state decides later that it can’t oversee plan management, the information already in the SERFF database could then be moved to HIOS, and HHS could take over.


One insurance industry source said they had heard that this would be HHS’s back-up plan if things go wrong with plan management in some states. HHS declined to confirm that on the record. So until these issues are resolved and open enrollment arrives on Oct. 1, the uncertainty will continue to linger.


Image courtesy of iStockPhoto. This story was originally published by GOVERNING.com

Health Insurance Exchanges: Benefits, Challenges, Lessons

On Thursday, Jan. 10, Government Technology hosted its first TweetChat: Innovation in Focus – States and Health Insurance Exchanges.

The chat, held on Twitter using the hashtag #GTonHIX, included industry experts John Sweeney, IBM’s senior product manager for the Curam solution, and Dan Schuyler, director for Leavitt Partners’ health insurance exchange practice, to answer questions about state health insurance exchanges (HIX).

An HIX is a government-regulated, standardized marketplace for the purchase of health insurance, and the Obama administration mandates that each state have one. States may choose to create and run their own HIX, or they can opt out and have the federal government create their exchange for them.

States had to declare whether they were running their own exchange by Dec. 14, 2012. And according to the National Conference of State Legislatures, as of Jan. 4, 2013, 19 states, including the District of Columbia, submitted blueprints for HIXs to the U.S. Department of Health and Human Services, which must approve the plans. Under the mandate, all insurance exchanges must be fully operational by Jan. 1, 2014. 

As the deadline looms, states may have pressing questions about what needs to happen by 2014. Here are some of the discussion highlights:

1.    What are the benefits for both states and their citizens in building these exchanges?

2.    Are there any lessons learned from states that have implemented or are in the process of implementing an exchange?

3.    What are the technical challenges the states face in implementing HIXs?

4.    How different will the HIXs be across states?

5.    How can states maximize the cost benefits of implementing these HIXs?

Photo from Shutterstock 

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Utah’s Health Insurance Exchange in Limbo

Since the Affordable Care Act became law in 2010, states have known they would have a choice about whether to run their own health insurance exchanges or let the federal government do it for them. But with only eight months left before those online marketplaces are expected to open to the public, Utah hasn’t made up its mind.

Utah is one of several Republican-led states weighing an eleventh-hour decision about whether to set up a state-run exchange. But it is a special case because it is one of only two states, the other being Massachusetts, that already has a functioning insurance exchange. In both states, the exchange was the brainchild of a Republican governor eager to promote free market competition.  But once the concept became integral to the success of President Obama’s federal health law, Utah and many other Republican-dominated states resisted it.

The Obama administration has a strong interest in convincing red states to establish their own, tailor-made insurance exchanges keyed to their particular needs. To that end, the U.S. Department of Health and Human Services has vowed to give states as much leeway as possible. Utah is a test of that commitment.

As soon as the federal health law was enacted, Democratic governors jumped at the opportunity to set up their own exchanges, which are expected to serve 30 million Americans. Their states have received millions in federal grants to create the online marketplaces and call centers where individuals and small businesses will be able to choose between competing insurance plans that meet federal coverage standards.  Individuals also will be able to sign up for federal insurance premium tax credits and enroll in Medicaid through the exchanges.

GOP governors put off the decision on whether to launch state-run exchanges in hopes that either the Supreme Court would strike down the health law or Republican Mitt Romney — ironically, the Massachusetts governor who championed the exchange in that state — would become president and repeal it. Once those possibilities evaporated, most Republican governors decided to let Washington run their exchanges. A handful of states, some headed by Republicans and others by Democrats, elected to create joint state-federal exchanges.

Utah’s Republican Governor Gary Herbert asked Washington right after the elections to accept his existing state exchange as compliant with the federal health law — pretty much as is.  In response, Utah received “conditional” approval from the U.S. Department of Health and Human Services last week. But the conditions include changes to Utah’s exchange that state officials say the governor may not be prepared to make.

That leaves Utah’s decision about whether to run an exchange up in the air. But even if the governor were in full agreement with Washington, he would need final approval from the state legislature, which meets January 28.

So far, Utah lawmakers have been solidly against a state-run exchange. In fact, a law was enacted in 2010 preventing the state from seeking any federal money for the project.  And despite the governor’s recent request for the flexibility to convert its existing exchange into a health law-compliant exchange, many in the legislature still oppose the idea.

One influential lawmaker, however, has an alternative. Republican Representative Jim Dunnigan, the  chair of Utah’s Health System Reform Task Force, says it’s clear the federal government isn’t going to give Utah the leeway it needs to run its own exchange. Instead, the state should maintain its existing small business exchange and let the federal government build a new site for consumers.

One thing working in Utah’s favor, at least from Herbert’s point of view, is that the state’s existing exchange has been a success. It includes 140 health insurance plans and has sold coverage to 326 small businesses employing 7,890 individuals. The site uses what it calls a “defined contribution” approach that allows employers to decide how much they want to contribute to their employees’ health insurance and then select a list of policies employees can choose from.

Of the companies served by the exchange, 67 percent had no prior coverage for their employees, and 92 percent renewed their policies after the first year. The exchange is working with 789 insurance brokers across the state to expand the number of businesses it serves, according to the governor’s office.

But the site has its critics. Unlike the one in Massachusetts, the Utah exchange — now called Avenue H — does not vet insurance policies or negotiate for the lowest prices. Built in 2009, the website was designed to let all insurance carriers offer their policies to small businesses as a way to promote competition.

As a result, critics say, many small businesses that have visited the site find the policies too expensive and look elsewhere. Utah has about 60,000 businesses with fewer than 500 employees, according to the U.S. Small Business Administration. Covering 326 businesses after two years of operation is hardly an achievement, they add.

So far, Avenue H does not offer comparison shopping for individuals, but Herbert says the state always planned to extend the service to consumers. In fact, the plan also envisioned a tool that would allow people to pull together funding from various sources —which could include federal tax credits — to purchase their policies.

Since November, Herbert and the Obama administration have been swapping letters about whether Avenue H will pass muster under the health law.  If Washington agrees to approve Avenue H in its current form, Herbert has said he would join three other Republican-led states, Idaho, Nevada and New Mexico, in creating a state-run exchange.

“I want the Utah exchange to survive and thrive as we originally envisioned it,” Herbert wrote to President Obama ;ast month. “In fact, I hope it becomes a model for other states to use as a platform for their own versions regarding health care reform.” In subsequent letters, Herbert outlined his plans for expanding Avenue H to serve individuals and larger businesses.

HHS Secretary Kathleen Sebelius promptly replied to his letter, promising that her staff would work with the state to expand its existing exchange. Herbert thanked her, but made it clear what the state would and would not do to comply with the health law. Within days, Sebelius gave the Utah exchange a conditional stamp of approval. The state is expected to give HHS more details on its plans on February 1.

The problem for Utah is that the agency’s approval came with a long to-do list. “That wasn’t what we wanted to hear,” says the governor’s exchange chief, Patty Conner. “We wanted to hear that they would approve the exchange that we have. I think we have a different definition of flexible.”

Conner says she and her staff are committed to dramatically expanding Avenue H according to their own plans, not the check lists and timelines forwarded by HHS. She says she’s confident the site will be ready to receive consumers by October 1, and will provide most of the services outlined in the federal health law. She intends to use a seamless software patch to link Avenue H to federal premium credits and Medicaid forms.

Behind the scenes, officials in the governor’s office say they’re mystified by Washington’s approval letter. “Utah’s position on our state health exchange has not changed and it will not change,” wrote deputy staff chief Ally Isom in an official response. “Of course we’ll review the HHS announcement and determine if the conditions are acceptable or reasonable for our state exchange — and that includes sitting down with legislators — but there is nothing about Utah’s path that changes as a result of today’s announcement.”

Stateline is a nonpartisan, nonprofit news service of the Pew Center on the States that provides daily reporting and analysis on trends in state policy.

Photo courtesy of Shutterstock

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