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Insurance Lobbyist Predicts Smoother Health Law Sign-Ups, Battle Over Networks

By Rebecca Adams and John Reichard

October 24, 2014 -- The top lobbyist for health insurers expressed optimism that the next open enrollment period under the health law will proceed more smoothly but warned that a lobbying battle looms over networks that could lead to higher premiums.

Visitors to federal and state health insurance exchanges will have a much easier time enrolling when the marketplaces reopen Nov. 15 to start selling coverage for the 2015 plan year, America's Health Insurance Plans President Karen Ignagni predicted in an hour-long interview with CQ HealthBeat last week.

Ignagni was unconcerned about the lack of a major outreach effort earlier this year to make the uninsured aware of the upcoming enrollment period and the availability of federal subsidies to help some pay their premiums.

Ignagni described insurance companies as well-prepared to retain existing exchange enrollees and to keep plan renewal rates high. "This is what they do," she said.
She was careful not to project enrollment for the second year of plan sales under the law. Such predictions could be cited as evidence of failure if things don't go well. "Our job isn't to worry about prognostications but to do the best job on the ground for each individual customer," she said.

But Ignagni elaborated at length on a major area of concern to the industry: that powerful providers will exercise lobbying clout to muscle their way into the narrower networks insurers use to keep low-cost plan options available in insurance exchanges. A big battle is brewing and costs could "explode" if providers get their way, she said.

Ignagni said the debacle surrounding last fall's launch of the federal insurance website that served 36 states is a thing of the past.

The government has spiffed up the "front door" of exchanges covering the shopping and sign-up process. And health plan officials have provided guidance about how to facilitate enrollment, she said.

"We've marshaled the best and the brightest people on the operations side in the plans to work collaboratively with the federal officials that are running the exchange," she said. "The technical people with the plans have been working for a very long time now, for more than a year, with exchange officials."

"What consumers will see this year in the front door is definitely an improved experience from last year," she said.

Ignagni said consumers who are new to the exchange will see a considerably shortened application and will be able to go through the process fairly quickly. Federal officials say that about 70 percent of first-time marketplace customers will use an application that uses 16 computer screens, down from 76.

Less far along is the "back door" –the administrative processes associated with the exchange and its interactions with insurers.

For all the improvements, health plans are uncertain whether the reenrollment process for existing customers will run smoothly. 

"We're in uncharted waters because we've never gone through a reenrollment process," she said.

Among the challenges are ensuring that existing enrollees update any changes to their marital status, incomes, and other changes affecting the size of subsidies for 2015 coverage. It will be important for customers to know what their 2015 subsidies are when they are evaluating coverage choices, Ignagni said.

Health plans are doing a great deal of outreach to make sure people know they need to update their information at the exchange, Ignagni said, adding that AHIP was "very pleased" to see that the Obama administration launched a similar effort last week.

Industry outreach efforts include setting up storefronts in local communities to assist with the enrollment process and maintaining 24-hour consumer call centers, AHIP officials say. One example are storefronts in Harlem and Queens, N.Y., operated by New York-based insurer EmblemHealth.

Consumers will get a letter before the Nov. 15 start of open enrollment telling them about any premium or other changes in their plan for next year. Consumers can consider coverage alternatives if they want to stretch their dollars, Ignagni said.

Ignagni said insurer outreach draws on health plans' experience in other markets, such as Medicare Advantage and Medicare Part D prescription drug plans.

Asked how confident she is plans will be able to get good renewal rates, Ignagni said "they know how to do this work."

She shrugged off questions about whether a more aggressive government or private outreach effort should have been launched by now to bring in new customers by targeting the uninsured.

A poll released this week by the Kaiser Family Foundation found 89 percent of the uninsured surveyed in early October didn't know that the next open enrollment period starts in November. Slightly more than half weren't aware that in many cases, subsidies are available to help pay premiums.

"It wouldn't have made sense in September to start this outreach effort because you want to do it close to open enrollment," Ignagni said.

Ignagni also addressed consumer concerns that some networks are too narrow and leave out some of the most important hospitals in a service area. 

The National Association of Insurance Commissioners is working on revising its model state law on the adequacy of networks. Health and Human Services Secretary Sylvia Burwell has said that federal officials will monitor those efforts before deciding whether they will take added steps to ensure that the number and types of providers in a network are adequate.

Ignagni said that one major difference between tight networks in the HMOs in the 1990s and the current environment is that consumers in exchanges have a choice of plans. Back then, it was the employers not the consumers making the choices, she said.

"They make those decisions themselves and they are getting lower premiums as a result" if they choose tighter networks, she said.

Ignagni said that providers are beginning to lobby "to see whether or not they can be written into specific networks and to have regulations and legislation which forces them in."

The risk for consumers "is that would not only be bad for affordability, that will make costs explode," she said, adding the NAIC has an important job balancing these issues.

"Without a doubt, there are provider groups that don't want to reduce their prices and are looking to regulation and ultimately legislation to protect them," Ignagni said.

The health plan lobbyist said it's "going to be important this time for regulators and legislators to understand that this is a whole different situation because consumers are choosing for themselves and they're balancing all this information at their kitchen table."

"Now the public is much more interested in this question of what are the prices being charged, as opposed to simply what are the premium prices," she said, noting that the costs for medical procedures in the United States are far higher than in other nations.

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