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State Health Exchanges Emphasize Individual Help in Year Two

By John Reichard, CQ HealthBeat Editor

November 12, 2014 -- Directors of leading state insurance exchanges painted an upbeat picture of their upcoming open enrollment periods, saying Wednesday they’ve hired more customer service representatives, added storefront sites to provide personal assistance, tweaked websites to more easily connect visitors to insurance agents, and made it easier for uninsured people to window shop for a plan.

Peter Lee, executive director of Covered California, drew a sharp contrast to the gloomy atmosphere surrounding the health law’s coverage expansion emanating from Washington.

“I see huge interest in communities,” said Lee, formerly the head of the Pacific Business Group on Health, a health care purchasing group.

Lee made his comments on a press call sponsored by the advocacy group, Families USA, a strong supporter of the law. The lineup of exchange officials represented some of the most successful state marketplaces, among them New York, Kentucky, and Washington.

A Supreme Court challenge to the legality of subsidies in states using the federal exchange would not affect such states, which set up their own marketplaces and whose authority to offer subsidy assistance isn’t in dispute.

“Do we see headwinds because of the fracases in Washington?,” Lee asked “Zero. Winds are in our sails.”

“There will be over 200 storefronts open across California and more ways to link people to individual insurance agents and certified counselors,” said Lee. “We have more than 25,000 certified and trained either insurance agents, county eligibility workers, or certified counselors.”

The marketing aims to drive people to the Covered California website to click on a green button to “find health care near me,” Lee said. “You can find local people, insurance agents, etc. to help you enroll.”

But the executives acknowledged that enrollment will be harder this year. They’re having to renew customers for the first time, face a shorter open enrollment period heavy with holiday distractions and must reach people they either missed with their messages last year or who skipped enrolling.

“It will be harder this year” Lee said. “We think it’s going to require more in person assistance and we’re going to be doing that.”

Kentucky surprised the nation last year by taking full advantage of coverage expansion provisions under law despite significant opposition to the statute in the state. Kentucky saw the second largest drop in the uninsured rate in the country as a result. Exchange director Carrie Banahan said she’s excited by a new mobile app her exchange developed with the hard-to-enroll “young invincibles” in mind. It’s designed to help users easily connect to individual enrollment help from insurance agents or other assisters.

New York got its renewal efforts off to an early start with letters to 300,000 families or households in mid-October. The letters told them the premiums they’d have to pay if they stick with their current plans in 2015, taking fresh calculations of their subsidies into account, said Donna Frescatore of the New York Health Benefit Exchange.

Richard Onizuka, head of the Washington Health Benefit Exchange, admitted that the state had to adjust its enrollment projections for next year because it had a higher than expected dropout rate from 2014 coverage. The state currently has about 140,000 exchange enrollees, a lower starting point than it expected for building enrollment next year. It expects to add 85,000 new enrollees next year, he said.

Onizuka said that coverage expansion lowered uncompensated care costs 30 percent this year in the state. But he noted that universities in the state are dropping health plans as coverage becomes available under the health law and state officials are focusing outreach efforts on students as a result.

Plan designs are part of the marketing strategy of the exchanges. Kentucky is keeping the plans and networks of existing enrollees the same to ease the reenrollment process. To respond to concerns about high out-of-pocket costs, Washington is emphasizing cost-sharing subsidies in silver plans and has cut front-end deductibles for one of its silver tier plans.

California stumbled in outreach to Latinos last year but hopes to bring in more Latino young invincibles by reassuring them that enrollment information they give on citizenship status won’t be used to deport family members who are undocumented, said Lee.

“About a third of Latinos that are citizens or have legal status are worried about signing up because a family member might be undocumented,” he said.

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