October traditionally marks the beginning of open-enrollment season—your annual opportunity to choose healthcare coverage from the options provided by your employer. But selecting the right health insurance can be confusing—even frustrating. This year may be even more challenging because many of the most sweeping changes brought about by the Affordable Care Act (ACA), President Barack Obama’s signature healthcare reform legislation, are about to go into effect, and no one knows for sure how it will all work out.
Based on what we know about the law, however, we can make short-term projectionsabout some of the changes people will encounter. In this article, we’ll focus on workers who have insurance through their employers and those who do not.Workers Who Do Not Have Health Insurance Through Their Employers
In the past, folks who worked for employers that did not offer insurance coverage often had difficulty finding or affording an individual policy. The ACA attempts to change that with several new provisions:
First, as of January 1, 2014, health insurance companies must accept all applicants. That means insurance companies can no longer deny or charge you more for coverage if you have a pre-existing condition.
Second, many people will qualify for help to pay for their insurance coverage. If your household income is less than 400% of the poverty level ($94,000 for a family of four) you may be eligible for a tax credit to help you pay for your health insurance premiums.
To receive the credit, you must purchase a policy from your state’s insurance exchange. An exchange is simply an online marketplace where you can compare plans and prices. You can select from four levels of coverage: bronze, silver, gold and platinum. Platinum is the most comprehensive and expensive and bronze is the least.Workers Who Have Health Insurance Through Their Employers
In 2015, employers with more than 50 employees will be required to offer health insurance to their employees. However, many employers are preparing for this mandate by updating their policies now.The new policies must cover at least 60% of an employee’s healthcare expenses including copays, co-insurance, deductibles and out-of-pocket caps. And the employee’s share of the premiums for the lowest-cost individual plan cannot exceed 9.5% of the employee’s pay.
If your employer doesn’t offer a plan that meets these requirements, you and your family may then be eligible for a tax credit to purchase a policy on your state’s health insurance exchange.
But if your employer-sponsored coverage does meet the requirements, you and your dependents are not eligible for the credit. Keep in mind that the affordability factor is based on the cost of individual coverage through your employer, not what you’d pay to cover a family.How Can You Be Sure to Make the Right Choice?
Another requirement of the ACA is that all Americans (with few exceptions) must have health insurance coverage in 2014 or face a penalty. So this isn’t an issue you can avoid, no matter how complicated it seems.
And, since this is a new and complicated law, any part of it could change at any time.
Oct. 9, 2013, 8:07 a.m. EDT10 things Obamacare won’t tell you The health exchanges, central to the law, are also its biggest mystery By Jen Wieczner, WSJ Marketwatch
1. “You might want to avoid signing up on Day One.”
In the offices of certain government officials and health insurance companies, a ticking countdown to a specific date has been posted on the walls for months: Oct. 1. That’s the day of the official ribbon-cutting for the exchanges created by the Affordable Care Act (commonly called Obamacare), when Americans can begin lining up for 2014 health insurance. But because the law’s future was uncertain until the Supreme Court upheld it in mid-2012, the exchanges have been scrambling to get ready for opening day. Thirty-six states declined to set up their own exchanges for 2014 (each state has just one), so federal health officials had to do it instead — cramming years of work into a tight time frame. “Some people we’ve talked to will count it as a victory if the lights come on Oct. 1,” says Eric Johnson, a Columbia business professor and co-director of the university’s Center for the Decision Sciences. (On Thursday, the administration acknowledged that the small-business section of the exchanges in those 36 states wouldn’t be able to accept online applications until November, and some of the states running their own exchanges may also be running behind, having not yet announced when they will open to small employers.)
Indeed, anticipated grand-opening snafus range from jammed telephone lines and websites to technological glitches and security failures. “As much of a big deal as is made about that date, it is still a soft opening,” says Bill Melville, a market analyst for HealthLeaders-InterStudy, a research firm covering the exchanges. Exchange officials have acknowledged that the beginning may feel more like the previews of a Broadway play, but say there’s no rush because people will still have three months to get coverage before the Jan. 1 deadline to have insurance.Five Things Health Exchanges Won’t Tell You
Health insurance marketplaces are the centerpiece of the Affordable Care Act. They are also its most misunderstood aspect. MarketWatch’s Thomas Bemis discusses five things health exchanges won’t tell you. (Photo: Getty Images)
But the exchanges will actually be open for a full six months before closingMarch 31, so stragglers — and those whose insurance policies cover them into 2014 — can still avoid paying the penalty that the ACA imposes on those who don’t buy insurance, because people are allowed a “short coverage gap” of less than three months, according to the IRS. “Unless you are desperate for health insurance, our advice is wait till November or December,” says Bryce Williams, a managing director of exchange solutions for professional services firm Towers Watson. “It’s kind of like not buying the first model of a car when it comes out: Wait until the kinks get worked out.”
2. “Yes, some workers are being required to use exchanges — but not these exchanges.”
Three of the country’s biggest companies — IBM, Time Warner and Walgreen — announced in recent weeks that instead of offering traditional health benefits, they would send some of their current or retired workers to purchase coverage on insurance exchanges. That caused a panic among some Americans who believed major corporations were ending job benefits and turning them over to the government. But health-care experts say it was all a big misunderstanding: The corporate exchanges are completely separate from the exchanges created by the Affordable Care Act.What Americans don’t know about health-care rollout
Uncertainty plagues Tuesday’s roll out of President Obama’s healthcare reform act as millions of Americans become eligible for coverage. Shelby George, a benefits marketing strategist at Manning & Napier Partners, joins MoneyBeat.
The new ACA exchanges, also known as health-insurance marketplaces, are run either by states or the federal government and cater to individuals. Employers, in contrast, are using private exchanges operated by benefits firms like Towers Watson and Aon Hewitt, which serve employee groups. The private exchanges are not “a result of Obamacare—that’s false,” says Williams, who runs Extend Health, an exchange that has been selling Medigap plans for seven years and will host IBM’s retirees. Sears Holdings and Darden Restaurants already moved active employees to Aon Hewitt’s health exchange in 2013, long before the rollout of the public exchanges.
Still, the trend is spreading, and some analysts worry it’s a sign of deteriorating employer health benefits. In the next three to five years, 44% of employers plan to offer health insurance through a corporate exchange, giving workers a fixed dollar amount to spend on coverage, up from 4% today, according to Aon Hewitt.
3. “Expect to be confused.”
While the exchanges are the centerpiece of the health care law — the mechanism for bringing health insurance to the uninsured — they have long remained an abstract concept. Health officials and advocates have compared the exchanges to brick-and-mortar institutions such as shopping malls, farmers markets and a stock exchanges, leaving many Americans with the wrong picture of what the marketplaces will actually be. Indeed, a survey by insurance-rate site InsuranceQuotes.com found that 90% of Americans didn’t know when the insurance exchanges would open, and 22% thought they were already open — six months before they actually were.Obama on how to sign up for new health insurance
In a speech to promote the benefits of his health care law before new insurance exchanges open for business next week, President Obama explained to an audience at a Maryland community college how to sign up for the new health insurance.
In reality, each exchange will essentially be a website, where people can log on to compare insurance plans similarly to the way they compare airline flights on websites like Orbitz.com or Priceline, say experts. If consumers need help shopping, special government “navigators,” as well as customer service agents, will be available by phone and in community health centers. Other businesses, including pharmacies and H&R Block, may also provide in-person assistance. Americans can choose to submit insurance applications by mail, but their information will ultimately be processed through an electronic portal known as the federal “data hub.” Some online insurance brokers, such as eHealthInsurance.com, will function as a private version of the exchanges, selling the same subsidized plans and directing people through the same process. If a consumer is not eligible for subsidies, however, these brokers are not required to mirror the government exchanges and may only present plans on which they receive commissions.
But many details surrounding the exchanges, including the prices of specific health plans, will likely remain a mystery till they go live, says Jennifer Tolbert, director of state health reform for Kaiser Family Foundation. People can get the latest information atHealthCare.gov, which will directly serve the federal exchanges in 36 states and also refer Americans to the other states’ exchanges.
4. “Don’t bother asking our staff for recommendations.”
Cardon Outreach, a Texas-based organization that helps lower-income Americans enroll in health insurance, planned to use an $833,000 federal grant to provide similar services as a navigator in the new health insurance exchanges, the organizations and staff charged with guiding consumers. But just a few weeks later, Cardon declined the money. Helping consumers would be a “huge risk” under current regulations, says Chuck Kable, Cardon’s chief legal officer. The insurance commissioner in Oklahoma, one state where Cardon planned to work, had warned that navigators were forbidden to discuss with consumers how specific health plans might affect them. Kable worried other states would also enforce these restrictions.
Under Affordable Care Act rules, finalized in July by the U.S. Department of Health and Human Services, navigators are not allowed to receive money from the insurance industry — that’s supposed to keep them “neutral and impartial,” according to an HHS spokesperson. But the regulations also bar navigators from recommending and choosing a specific health plan on a consumer’s behalf. Those services have traditionally been the purview of insurance brokers, who must be licensed to sell health plans under existing state regulations (and who usually receive commissions from insurance companies). Indeed, agents and brokers lobbied heavily for restrictions on navigators, who they say are unqualified to recommend plans — and also threaten brokers’ livelihood. The ACA rules adopted several of those suggestions, say legal experts, and limit navigators to “facilitating enrollment,” which includes helping consumers set up their online account at the exchange and apply for a subsidy, the HHS spokesperson says.
While some states have said they’ll allow navigators more leeway, others have imposed further regulations, often as a result of political opposition to the ACA or lobbying by insurance agents. These range from requiring them to pay fees or obtain surety bonds to banning them in certain places; some states require navigators to hand consumers off to brokers for enrollment advice. “It’s difficult, where do you cut yourself off in that conversation?” Kable says, adding that he believes the line between Navigator and broker is gray.
To be sure, there are benefits to using brokers, which don’t cost any extra, says Laura Adams, an analyst for InsuranceQuotes.com: “You may get a lot more service upfront.” But brokers’ recommendations could also be biased toward the insurance companies that pay them commissions, Tolbert says. navigators are required to show consumers all their options for health insurance, but brokers don’t have to, the health department spokesperson says.
5. “Blue states do it better.”
In a recent speech, Georgia Insurance Commissioner Ralph Hudgens said that to “solve” the “problem” of Obamacare, officials in his state are doing everything in their power “to be an obstructionist.” The first part of that strategy? Refusing to run Georgia’s exchange altogether. It’s a tactic adopted by 34 states — most of them led by Republicans — often to express their opposition to the ACA. Instead, federal health officials took over in those states (plus in two others that asked for extra help their first year), hurrying to set up exchanges in hostile territory. As a result, those exchanges generally have fewer resources supporting enrollment and have encountered more setbacks than exchanges run by their own state, exchange analysts say. Politicians opposed to the health law have also created “new roadblocks to enrollment,” says Melville of HealthLeaders-InterStudy, which published a report card for the state exchanges, assigning lower marks to states that have enacted anti-exchange regulations. In a recent survey by the Pew Research Center, 23% of Americans said elected officials “should do what they can to make the law fail.”State health care ad: For Vermonters, By Vermonters
With health plans under the Affordable Care Act set to start Oct. 1, states have launched ads touting the benefits of health insurance. This Vermont spot appeals to “the thrill-seekers and the caretakers.” (Photo: Vermont Health Connect)
By contrast, Democratic states running their own exchanges have invested more in marketing and supporting them, Tolbert says. Connecticut, for example, sent enrollment representatives to the state’s public beaches over the summer, while Maryland partnered with the Baltimore Ravens to promote its marketplace. “That’s a kind of readiness you can’t get necessarily if the federal government is running the exchange,” Melville says.
6. “Abuse our honor system at your peril.”
A key component of the Affordable Care Act is the ability for lower-income people to receive subsidies on health insurance they buy through the exchanges. People up to 400% of the federal poverty level are eligible. But after the Obama administration announced that it would delay till 2015 certain verification processes to determine whether people are eligible for the health insurance subsidies, analysts speculated that exchanges would rely on the honor system to calculate the subsidies for 2014. And of course, if people lie to receive money they don’t deserve, experts say, that could make the ACA much more costly to implement.
But legal experts say that dishonesty is risky on the exchanges because the actual checks in place may be far more rigorous than an honor system. And besides the federal penalty for perjury, which is up to three years in prison, the ACA outlines additional consequences for falsifying income, with fines ranging from $25,000 for negligent misrepresentation to $250,000 for intentional misrepresentation, says Timothy Jost, a professor at Washington and Lee University School of Law who is studying the marketplaces and calls the idea of an honor system “nonsense.” Even without the fines, people will owe the money back after they file tax returns.
Of course, a few fraudsters may still get away unscathed, especially in 2014 before all verification mechanisms are in place, Jost says. After all, the IRS loses hundreds of billions of dollars every year to tax cheats. But the ACA may have even more safeguards than the IRS — requiring verification of tax forms, Social Security data, and electronic wage information, according to the Centers for Medicare and Medicaid Services. “It’s more likely someone is going to get caught cheating on this than on their small business taxes,” Jost says.
7. “You’ll still pay for this, even if you don’t use it.”
Americans who receive affordable health benefits through their employer aren’t eligible for health insurance subsidies on the exchanges, so the company plan is almost always going to be a better deal than individual policies, just as it is today. But that doesn’t mean people won’t pay for the plans sold on the marketplace — at least indirectly. A lesser-known ACA provision requires employers to pay fees that will go toward the cost of covering Americans who were previously uninsured — often people who have chronic health conditions that will be very expensive to insure. “The assumption is, people who will be taking the coverage first are going to be the ones who are the sickest,” says Helen Darling, CEO of the National Business Group on Health, which represents large employers.With health plans under the Affordable Care Act set to start Oct. 1, states have launched ads touting the benefits of health insurance. In this ad from Nevada, a resident describes why insurance matters to him. (Photo: Nevada Health Link)
That tax is known as the Transitional Reinsurance Program, and will charge health insurers and self-insured employers (that is, companies that provide their own insurance) $63 per person covered on their plans, with payments eventually tapering off as the exchange plans collect enough premiums to be self-sufficient. Employers and insurers, already saddled with their own rising health care costs, are likely to pass those fees on to consumers in the form of rate increases, Darling says.
8. “We’re a magnet for hackers and con artists.”
Government officials are cautioning consumers to beware of threats when attempting to buy insurance in the marketplace: Con artists attempting to swindle their money or steal their identity. “At the FTC, we know all too well how scammers invariably try to take advantage of developments in the marketplace and new government programs,” Federal Trade Commission chairwoman Edith Ramirez said in a statement. While officials say they are not yet seeing large-scale fraud surrounding Affordable Care Act programs, previous federal benefits initiatives, including Medicare, have attracted criminals.
The concerns range from the security of the exchange websites to unscrupulous staff who may come into contact with consumers’ information, to potential scams asking people to pay, say, $200 in order to sign up for health insurance. Scammers have already targeted the elderly with false Obamacare pitches by email or telephone.
Administration officials, however, say that the federal exchange website has advanced security systems to prevent breaches and punish unacceptable behavior. Officials are also telling consumers to know the rules, so criminals can’t manipulate them: “If you have Medicare, you don’t need to sign up for one of the marketplaces. You should not be asked to pay any advance fees in order to enroll in the marketplace.”
9. “You might not be able to keep your doctor.”
When the health law was being debated in Congress in 2009 and 2010, President Obama said that people buying insurance through exchanges would be able to keep their doctor. It turns out, though, that many plans strictly limit the network of doctors they pay for. Consumers can try to stay on their same plan or look for one that covers their doctor, but this might not be possible in some marketplaces, especially if their current insurer is not participating there. (Many uninsured people, of course, will be able to see a doctor for the first time as they gain health coverage.)Six things boomers need to know about Obamacare
Open enrollment for the health-insurance exchanges under the Affordable Care Act is set to begin on Oct. 1. MarketWatch’s Thomas Bemis discusses six things about the law that people over 50 should know. (Photo: Getty Images)
“The narrow-network plans are kind of the name of the game in health exchanges,” Melville says. An analysis of exchange plans in 13 states by McKinsey & Co. found that nearly half of them had limited networks. Some people who currently have individual insurance and stick with their current policy may find that it becomes more restrictive after the insurer enters the exchange. Wellpoint’s Anthem Blue Cross and Blue Shield has been criticized by state senators and consumers in New Hampshire, Indiana and Maine for excluding major hospitals from coverage, but a spokesman says the “narrower network” products, available on exchanges in 14 states, meet or exceed the ACA’s standards for “convenient access,” while also being affordable. Centers for Medicare and Medicaid Services official Gary Cohen says that many insurers are taking this tack because the limited-network plans can lower costs — and are a “positive development” for health care.
10. “Competition is for the greater good — except when there aren’t any competitors.”
Government officials have said that the exchanges will keep insurers’ prices down by making them compete with each other. Prices on the exchanges have been lower than government forecasts, partially a sign of “healthy competition,” Cohen says, and are generally lower in more competitive markets. So far, though, the marketplaces seem to be having another effect on major insurance companies, too: Scaring them away.Should doctors weigh costs when making decisions?
University of Pennsylvania’s Ezekiel Emanuel argues that doctors should consider price when considering treatment options, where the outcomes are the same. Steward Health Care System’s Ralph De La Torre says that’s unethical. They joined a WSJ panel on the cost of health care in America. Photo: Getty
Large insurers like Cigna and UnitedHealth have abstained from many states’ exchanges this year; Aetna has backed out of seven exchanges it originally applied to, instead “focusing on the markets where we can be most competitive and deliver the greatest value to our customers,” a spokesperson says. In Mississippi, 36 counties would not have had any plan options if Humana had not joined at the 11th hour, Melville says. “There were concerns there would be coverage deserts, there would be places that you wouldn’t be able to get a policy.” This hasn’t happened, but some states have so few carriers offering plans in the marketplaces that the lack of competition has kept rates high. West Virginia and New Hampshire, for example, currently have only one carrier for their entire states, respectively. Wyoming only has two, after most of the state’s insurers skipped the exchange, and has the highest rates in the country. Analysts, however, say that there is likely to be more competition in future years: Insurers will wait and see how 2014 plays out and re-evaluate their strategies. Aetna, for one, says it is “taking a measured, multiyear approach to exchanges.”
Through methods like Medicaid expansion and subsidies for the online exchanges, reform is expected to add 14 million people to the insurance rolls in the first year alone.
However, nearly 30 million people will still remain uninsured for one reason or another by 2022, according to Congressional Budget Office estimates. For this reason, free clinics will remain an essential community fixture, according to Nicole Lamoureux Busby, executive director of the National Association of Free and Charitable Clinics. “There’s a misconception that [healthcare reform] is universal coverage. It’s not,” Busby told the State Journal. “The Affordable Care Act is just a first step. It was never meant to cover everyone.”
For example, Busby cited undocumented immigrants, who are specifically excluded from the law. Others will earn too little for the individual mandate to apply, but too much to qualify for Medicaid coverage. In addition, others won’t know they are eligible for Medicaid, will be uninsured during a change of jobs or will voluntarily go without insurance.
More patients are likely to fall through the cracks in states like Wisconsin, where Gov. Scott Walker declined to expand BadgerCare, the state’s Medicaid program, and last year raised the program’s income eligibility requirement, FierceHealthFinance previously reported.
Some clinics will offer services specifically targeted at the gaps in the law, such as offering services to undocumented immigrants or providing dental care, according to the Boston Globe. Others, such as the Community Connections Free Clinic in Dodgeville, Wis., also will hold seminars this fall to help explain the law, the State Journal reports.
“We want to do everything we can to get any person who wants to and can to sign up for the new coverage,” Clinic Manager Molly Zuehlke told the State Journal. “But I think people who work in healthcare don’t see this as solving the problem of unaffordable insurance and issues with access.”
Confusion among patients might not be what clinics should be most concerned about–some worry that private donors, the primary source of funding for free clinics, may assume there’s no need for clinics in the wake of the law, according to the article.
ACA cloud site costs three times initial estimateSeptember 12, 2013 | By Ashley Gold, FierceHealthIT The cost of running a data site related to the Obama administration’s Affordable Care Act has tripled to more than $35 million since 2011, according to an article fromNextgov, citing documents from the Federal Business Opportunities government website.
This ACA site–a cloud that stores cost, coverage and performance data for insurance plans–powers Healthcare.gov’s Plan Finder application, made for small businesses and consumers to compare health plans in their areas. It will also be used by state health insurance exchanges.
The Centers for Medicare & Medicaid Services’ Center for Consumer Information and Exchange runs the site, and awarded a $10.8 million contract to Verizon to design the site, Nextgov pointed out. Seven modifications later, the three-year base contract has grown to $35.5 million. The FBO documents posted Wednesday stated that CMS needs to purchase another $110,000 in products from Terremark, Verizon’s cloud computing division, in order to make the site run correctly.
“This effort has experienced a significant degree of change after award,” CMS said in its notice. “At the time of the contract award, the scope of cloud computing needs to support the implementation of insurance exchanges was unknown.”
Progress is finally being made in other places for the ACA’s technology tools: the long-awaited,controversial data hub that stands as the most important piece of technology in the Obama Administration’s Affordable Care Act is finally ready as of last Friday, according to federal health officials. The hub will be used to help determine who will qualify for government subsidies when purchasing individual health insurance plans.
This news came just over a month after a report published by the U.S. Department of Health & Human Services Office of Inspector General stated that security testing for the data hub was behind schedule.
States can expect a big spike in Medicaid enrollment and spending, even in those states that have refused toexpand the state-federal health insurance program under the healthcare reform law, according to a newreport by the Kaiser Commission on Medicaid and the Uninsured.
The report projects enrollment in Medicaid will rise on average by almost 9 percent in fiscal year 2014. The number of people signing up for Medicaid will increase by nearly 12 percent in the 25 states expanding the eligibility requirements to income threshold for adults with children to 138 percent of the federal poverty level.
But even those states that have refused or haven’t yet committed to expanding eligibility will see a jump in enrollment of 5 percent as more people learn about the program through outreach campaigns designed to increase awareness about online health insurance exchanges and participation.
Spending also will increase by about 10 percent across all states, according to the report, which is based on the 13th annual budget survey of Medicaid officials in all 50 states and the District of Columbia conducted by Kaiser and Health Management Associates.
The report also found:
- State spending growth will average 13 percent among the states that have expanded eligibility and 6.8 percent among those that will not;
- Only three states (Louisiana, Maine and Wisconsin) project a decrease in Medicaid enrollment in FY 2014 because they intend to reduce eligibility levels; and
- Nearly all states report they are developing and implementing payment and delivery system reforms to improve quality and manage costs.
“At least initially, physician practices are taking a cautious approach with ACA exchanges,” says Susan Turney, M.D., president and CEO of the association. “Because it’s unclear how many patients will sign up for exchanges in their area, or if practices will even contract to provide care under new exchange insurance products, at this time they can only speculate about their future business needs in relation to the ACA.”
To start, when asked of the expected impact on a practice of the exchanges, 40.5 percent of more than 1,000 surveyed practices said “unfavorable” and another 15 percent picked “very unfavorable.” Only 16 percent thought the exchanges would be favorable or very favorable to practices and about 28 percent thought the affect will be neutral. MGMA conducted the online survey in September 2013 with responding practices representing more than 47,500 physicians.
Only 29 percent of responding practices plan to participate in exchanges; another 40 percent are evaluating participation. Those looking to participate cite remaining competitive in the local market, replacing some of the charity care as uninsured patients get coverage and providing care to underserved populations as the primary reasons.
Those practices not participating are significantly worried about five issues arising from insurance exchanges: administrative and regulatory burdens (64 percent), collecting payments because of patient financial burdens such as high deductibles (62 percent), low reimbursement rates that pose a financial risk to the practice (59 percent), concerns of assuming financial liability during a 90-day grace period for enrollees (59 percent), and uncertainty and confusion about exchange products (53 percent).
That worry extends to practices evaluating exchanges as well, with more than 80 percent citing low reimbursement rates, liability during a grace period and patient financial burdens as major barriers to participation.
Most surveyed practices that received patient rate information from exchange insurers found the reimbursement rates of commercial insurers to be somewhat to much lower than they currently receive, with traditional Medicare and Medicaid reimbursement through exchanges also considerably lower.
Oklahoma uses federal suit to fight ACAOctober 7, 2013 | By Ron Shinkman, FierceHealthFinance
Oklahoma, perhaps the most conservative state in the union, is taking extra steps to avoid implementing the Affordable Care Act, the Los Angeles Times reported.
Oklahoma Attorney General Scott Pruitt is leading the last state challenge against the ACA in federal court. The action claims the wording of the law should preclude residents of states not running their own exchanges from obtaining tax subsidies to purchase coverage.
“Folks want something to be done because they are fearful,” Pruitt told theTimes. He added that his lawsuit might be the “last best hope” to topple the ACA.
Should Pruitt prevail in federal court, it could affect other states that are not operating their own health insurance exchanges, but an adjudication of the lawsuit could be years away.
Media Matters observed that Pruitt’s legal argument “is making is an extremely strained reading of what is, at worst, an unintended ambiguity in the ACA.”
Many anti-ACA states are disseminating information intended to discourage participation in the ACA.
Meanwhile, the Sooner State’s steadfast refusal to disseminate any information about the healthcare law has left its residents confused, according to the Times. Some have said money to pay from insurance coverage would be taken out of their Social Security or disability checks.
“No two people comprehend it the same way. You’re hearing one thing. I’m hearing another. He’s hearing another,” Dave Minyard told the Times, convinced the ACA will force him to shut down his livestock auction business.
5 design flaws of HealthCare.govOctober 7, 2013 | By Ashley Gold, FierceHealthIT Amid the government shutdown and partisan games plaguing Washington, D.C., and the rest of the country, something is actually happening–online signups for the Affordable Care Act. HealthCare.gov is finally open for business, but how well is it designed?
The site has more than a few technical issues and was down for maintenance over the weekend. Glitches and technical issues in the health insurance exchange ran rampant on the opening day of the health insurance marketplaces with delays and server crashes as consumers overwhelmed computer systems.
The Washington Post’s Joey Marburger, the Post’s director of digital products and design, and Sarah Sampsel, the paper’s digital strategy director, offered some thoughts on what went wrong, and how the site could be improved in an article published Sunday.
Here are five of their complaints.
- No clear description of the ACA: The Post webmasters argue that when you get to healthcare.gov, there’s no clear description of the ACA or why you should enroll. D.C. residents are sent to a different site than other state enrollees, and the messaging doesn’t match up. If having trouble with the site, you were directed to a phone hotline that had 30-minute-plus wait times.
- Confusing prompts: Wording throughout the site is “inconsistent” or “redundant,” the article authors note. There are too many links with similar language.
- The sitemap isn’t functional: “The vast and complex sitemap looks like a test in information architecture,” the Post authors write. There is a glossary of terms, but it’s an overwhelming amount of information provided out of context.
- Forms take too long to load: The Post authors wanted to go through the process of making a “marketplace account,” but getting the form took them 30 minutes. After filling it out, they were told their security information was invalid.
- Messaging on tech issues isn’t clear: The authors suggest the site be more upfront about tech issues before users hop in and get started so they can avoid frustration later.
“We know there were several hurdles for the design and development teams to overcome, but the first impression shouldn’t highlight those complexities and internal debates and compromises,” the Post staffers wrote of Healthcare.gov. “It should be focused on the user coming to the site to enroll. The rest really doesn’t matter.”
It’s not just the website that’s a problem. The 13 states–Arkansas, Florida, Georgia, Iowa, Illinois, Indiana, Maine, Missouri, Montana, Ohio, Tennessee, Texas and Wisconsin–that have passed laws or regulations that prevent navigators from guiding consumers in exchange-related matters make it even harder for people to get clear information on the ACA.
Practices taking ‘cautious approach’ to ACA exchanges October 8, 2013 | By Debra Beaulieu, FiercePracticeManagement
Last week, we reported on an announcement from Summit Medical Group, one of New Jersey’s largest physician practices, that the organization had not yet decided whether it was going to accept insurance provided by its state’s new Affordable Care Act–mandated exchanges.
As it turns out, Summit is far from alone in its approach. According to research announced during a press briefing at the Medical Group Management Association’s annual conference in San Diego, 40 percent of more than 1,000 practices surveyed are awaiting more detailed information about exchange reimbursement and administration before agreeing to contracts. In addition, 16 percent of practices said they don’t know if they’ll be participating and 14 percent responded that they would definitely not.
“At least initially, physician practices are taking a cautious approach with ACA exchanges,” Susan L. Turney, M.D., MGMA president and CEO, told reporters. “Because it’s unclear how many patients will sign up for exchanges in their area, or if practices will even contract to provide care under new exchange insurance products, at this time they can only speculate about their future business needs in relation to the ACA.”
The most commonly cited “major barrier” to exchange participation cited by respondents was low reimbursement rates (85 percent), followed by the 90-day nonpayment grace period for ACA exchange enrollees (83 percent) and concerns about the burden of greater patient collections due to high deductibles (82 percent).
Among practices that said they had evaluated reimbursement rates offered by exchanges in their markets, most identified the reimbursements as being “somewhat lower” than for other commercial payers with whom they contract or other commercial products offered by the same payers offering exchanges.
And despite industry predictions that physician practices will see a large influx of patients once ACA is fully implemented, most respondents (39 percent) said they expected their patient rolls to increase only slightly. Furthermore, more than half of respondents (52 percent) said they have planned no business changes related to the ACA and only 4.5 said they intend to hire additional physicians.
According to Anders Gilberg, MGMA’s senior vice president of government affairs, who analyzed and presented the research at the meeting, practices’ hesitancy to participate in exchanges isn’t necessarily all about reimbursement–as most are eager to help provide care to their underserved populations–but with the uncertainty that surrounds the structure and administration of the plans.
“Practices are not able to have full negotiations [about exchange products] as they do with other payer contracts,” he said. For example, practices are currently facing many unanswered questions about certification, prior authorizations, deductibles, the number of patients they’ll have covered by exchanges and more.
“I’ve been hearing some of the exchanges are working OK and some are having glitches, but it definitely seems like there was a good response,” says Julie Stich, director of research at the International Foundation of Employee Benefit Plans.
LeAnn Tobin, senior vice president and director of the employee benefits division at the Bethesda, Md.-based consulting firm RCM&D, says that, while annoying, the technical failure “says there’s a lot of interest,” not a lack of preparation. “Maryland has spent a lot of money trying to get people aware of this opportunity to enroll in coverage,” Tobin says; the state thinks it can halve its uninsured population of 800,000 in the next six years.
“As happened in many other states, there was a logjam. Many more people went online than they expected … and the system just basically stopped,” Tobin says. “There were many, many people looking for information on the plans, and I think that’s a good thing. As every employer knows, when you roll out anything that has an online opportunity, there can be a chance of just too many people hitting the system at the same time, and clearly that’s what happened. All around the country, people just couldn’t get through.”
Speaking of getting through, Tobin says it would be “pure conjecture” at this point to speculate as to whether the young and healthy will actually sign up – a crucial development if the Affordable Care Act is to survive. She speculates, however, that the penalty alone won’t be enough to drive them into a plan.
“They’ve made strides to communicate to everybody,” she says. “The state of Maryland had even the Ravens’ (football team) help to make communications on this. Whether young people will reach out – I just don’t know. If we look at the law in totality, the overall first-year penalty is not a lot of money.”
Employers would do well to take advantage of the public spending and communication efforts, as such a push may not come again, says Alan Cohen, co-founder and chief strategy officer of Liazon, which runs the Bright Choices private exchange. “The government is spending a lot of money on teaching people about exchanges,” Cohen says, “a lot more money than we can spend” and dovetailing on their efforts would be wise.
“So now all of a sudden, you can imagine us five years ago going to companies and trying to explain, ‘Yeah, let your employees shop in a store and they can have all these options,’” Cohen says. “Companies were looking at us and going, ‘I’ve never heard of that before.’ Now companies don’t say that anymore. It’s becoming part of what’s the accepted way to do business.”
Of course, the vast majority of employers aren’t discontinuing their health care coverage; most of those now going to state and federal exchanges are presently uninsured, not hunting for a different deal.
IFEBP’s Stich says that, even if employers aren’t planning on shifting populations to exchanges, their due diligence doesn’t end with notification that Obamacare exists.
“We’re suggesting that the employers or plan sponsors do communication proactively about ACA – what it does and doesn’t do, talk to them concisely about the law, just give them a little background information and explain how this may be affected and what plan design changes employees may be seeing in their own plans,” Stich says.
Tobin says, moreover, that now is the perfect educational opportunity for employers to begin investigating private exchanges “that may become more of an option going forward.” ACA’s ultimate goal is more and cheaper health insurance coverage, and one hopes that private and public exchanges can become two fronts of the same battle. But don’t jump to a private exchange just because they’re out there, Tobin says.
“There are some that exist now; they are still very obviously infancy-stage,” she says. “Several of our clients have begun asking us questions about private exchanges and whether it’s an option for them to offer coverage to their employees. We are certainly going to help them to consider that, but more than anything at this point, we are typically saying go slow on the decision.
“These things are just starting. … Give it a chance to roll out for a couple of years. Let’s let it play out; let’s see how this is working. But is it something that should be considered in the future? Absolutely. It gives an opportunity for employers to manage the cost of care differently. It provides an administrative platform that is streamlined. It allows employers to get out of the day-to-day business of running a health care plan.”
Cohen says that “as the public exchanges become reality, as opposed to potential reality,” companies should consider the general trend toward consumer-driven health and observe how the process works in ACA marketplaces.
“Even if they have private exchanges, they need to think about this idea,” Cohen says. “Do they believe in this idea that people should make decisions instead of companies, that a person is better able to figure out what their needs are and the needs of their family are than a company is able to figure out the average needs?”