As the new public health insurance exchanges come to life, the learning curve remains a long, windy road toward smooth running. The history of health reform has been filled with surprising twists. In California, for example, the governor signed a “play or pay” employer mandate bill into law in 2003 – then employers succeeded at going to court to block the law.
At the federal level, Republican leaders have been fighting implementation of PPACA with lawsuits, repeal bills and de-funding attempts ever since the act was signed into law in 2010.
See also: PPACA: A history
Contractor representatives testified at a House hearing Sept. 10 that the federal exchanges would be ready to open Oct. 1. Republican participants struggled to keep themselves from rolling their eyes.
Exchange managers in some states were celebrating the release of what they said were great exchange plan menus as regulators in other states complained about exchange plan premiums.
Exchange backers and critics also have their own enrollment projections. The Congressional Budget Office has estimated that the public exchanges could enroll 7 million consumers in 2014. However, USA Today reported that the exchange builders are predicting that enrollment will be far higher.
The exchange critics have wondered whether the exchange managers will “fill the room.” They’ve pointed out that another PPACA program — the Pre-existing Condition Insurance Plan (PCIP) — attracted only 105,000 of the 200,000 people originally expected to enroll. Even worse, it seems much of the uninsured public is ignorant to how an exchange operates and what it will offer. The Kaiser Family Foundation found in August that 43 percent of the uninsured adults it polled had heard nothing about the exchanges.
As we were trying to plan an article that could stand up against startling twists in the PPACA story, we decided to look at what benefits professionals have been seeing out in the implementation field.
To shape the story, we considered many metaphors: The opening of a Broadway show, a ship setting sail, a game of chutes and ladders, with the players often falling into a pit of snakes. We finally went with “trail blazers” — the people who brave mud, rocks and bears to let others know what might lie ahead and, even more important, how they are coping. Here, we give you the top five strategies industry professionals have embraced as the health care exchanges open.
Many individuals, employers and even brokers are still scratching their heads when it comes to PPACA and the exchanges. Which are private? Which are federal? Do I qualify? What will the plans cover? Is it expensive?
You get the point. And as we know, the only way to combat ignorance is with education.
“Right now, it’s all about education for the parts we do know and understand,” said Robert Crisan, a senior vice president at Hylant, an insurance, risk management and consulting firm. “ACA is affecting — and going to affect — everyone differently so there is no one right answer or solution for everyone. That freedom of choice, while good for consumers, creates confusion because they have to make coverage choices based on their own personal and family situations.”
Many brokers have been preparing for the Oct. 1 open enrollment period for months — even years — with the focus for many being PPACA literacy.
“Three words sum up the preparation we have done for open enrollment in the exchange: inform, inform, inform,” said Diana Twadell, a principal at Barney & Barney. Twadell makes sure she and her staff continue to read the most up-to-date information coming out of Washington, D.C.
For small businesses, Tradwell has been educating employers about the “Renew Early” option, which will move their renewal date to Dec. 1, 2013, and allow current plan and rate structures to stay in place until Dec. 1, 2014. Additionally, her group has been working to educate small employers about SHOP, which, in some states, enables small businesses to offer their employees a choice of carriers and plan designs, along with the PPACA federal tax credit, which can provide tax credits of up to 50 percent of the employer’s premium contribution for those employers that are eligible. “Ongoing education and an understanding of the changes on a day-to-day basis is critical, both leading up to and after the open enrollment period,” said Twadell.
One of the roles of brokers during this time is to keep clients in compliance. “This starts with our legal team reading and deciphering the regulations, so we can provide tools, seminars, webinars, communication and guidance to employers, both large and small,” said Twadell.
The importance of relationships is a critical aspect to just about every business in every industry. Without them, there are no clients and, thus, no revenue. The same goes for relationships under the PPACA umbrella. The communication needed to build them — and keep them — became a critical tool as agents prepared for Oct. 1.
Twadell and her team spent countless hours interpreting and digesting PPACA legislation in an effort to turn it into a concise and easily understandable format for clients. “This allows us to advise our clients with a uniquely tailored message and action plan,” said Twadell, who advises clients on private insurance options, provides avenues for employees to use call centers, and warns about the possibility that employees may not be eligible for a premium tax credit in the exchange.
Some brokers suddenly find themselves communicating more directly with the higher ups at a company when it comes to the tricky PPACA landscape.
“We are proactively reaching out to our clients to make sure they are aware and communicating properly with their employees about upcoming changes and how those will impact coverage and costs,” said Crisan. “We are having many more meetings to help clarify each client’s approach. Many of our meetings are now with senior leadership of the individual companies because the complexity and potential cost implications of the rules are not understood and followed.”
And some are merely trying to keep up, knowing tomorrow may be a different story.
“We are educating our clients and providing information on a sometimes daily basis,” said Lori Cain, senior vice president and director of the employee benefits division at Poms & Associates. “We are all coping by staying as up to date as possible, knowing that change can happen at any moment.”
Americans are confused about PPACA and the exchanges, as illustrated by countless national surveys. A September poll by WellPoint pointed out that only one-quarter of adult Americans know that state exchanges will only offer health insurance coverage, while more than half of respondents incorrectly believed disability income insurance and life insurance will be offered. A surprising 24 percent thought auto insurance would be available while an even more disappointing 14 percent were hoping pet insurance was included. In the group markets, “most employees are thoroughly confused,” said Tim McGill, vice president at Colonial Life. “There’s a lot of fear about what the market will look like.”
These types of questions, along with the more complex issue brought about by brokers, have all warranted the need for professional advisors on the matter.
“We have been fielding many questions from consumers regarding their options both now and past Oct. 1 when they can access subsidy-eligible plans on our platform,” said Michael Mahoney, senior vice president of marketing at GoHealth.com, which opened support lines Sept. 16 so consumers could speak with a licensed benefits advisor before the open enrollment date.
Twadell, on the other hand, is focusing her efforts on employee PPACA proficiency for employers. “Our call center solution allows employers to access our resources to answer the myriad questions that employees will have and guide them through the decision process,” said Twadell.
Jay Starkman, CEO of Engage PEO, said his company has tried to help clients by adding legal resources since “the uncertainty has resulted in a great many looking for expertise and guidance, even more than solutions,” he said.
Many exchanges are integrated with the federal government’s data hub, which enables the determination of a consumer’s tax credit eligibility, along with online enrollment processes. Technology is also aiding agents in lessening the confusion. “While we do expect an increase in both the number and complexity of the questions raised by consumers regarding their options, our approach will continue to be the same — use our technology and people to plainly explain their options and help choose the right coverage for their needs,” said Mahoney.
Because PPACA is so big, the technology that the exchanges use will advance more rapidly than ever. But that doesn’t mean it will be perfect. “The undertaking is so big in a very short timeframe that I think we will experience some delays and hiccups that will be blamed on the technology,” said Crisan. “The marketplace does have a delay right now in some aspects because of technology. Some states are worried about data security. Also, the true defined contribution model for the SHOP marketplace is delayed because of the size and complexity.
Though many professionals are skeptical about the mechanics of the exchange, some are trying to remain positive in the face of the inevitable. “We are optimistic because we need to deal in the reality of health care reform as it is today,” said Crisan. Though many Republicans are staunchly opposed to PPACA, some do see the benefit of more uninsured people having access to coverage through exchanges. “My brother is 60 years old, retired with no retiree health care and a diabetic,” said Crisan. “PPACA will help many people in the same situation have access to insurance where they may have been deemed uninsurable before. That is a good thing.”
But it will take time and patience to get a complete understanding of how the laws will fully affect everyone in a day-to-day execution, and some are doubtful. Starkman feels technology gaps and a lack of carrier competition may cause problems, while McGill sees many employers adopting a wait-and-see approach. “Many employers are open to the exchanges as an option … but they don’t want to be the pilot project.”
It’s true, when changes are made to a national policy, there is going to be a learning curve and unexpected developments as policy on paper translates to real life experience and those grey areas become more evident. “Much of what unfolds in 2014 will be a learning process for everyone,” said Crisan. “Everyone is learning together, and we will get there.”
To the dismay of some political parties or to the delight of others, PPACA is here to stay. How we as an industry deal with it will be what makes the difference — now and into the future.