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HHS to Pilot Additional Changes to Improve Exchanges

By Erin Mershon, CQ Roll Call

October 5, 2016 -- The Obama administration plans to pilot further efforts to improve the struggling public exchanges in its final three months, Health and Human Services (HHS) Secretary Sylvia Mathews Burwell signaled Wednesday at a forum with insurance industry executives.

The forum gave the administration a chance to highlight the rosiest picture of the exchange experience. 

Executives from several of the companies that have enjoyed the greatest success on the marketplaces established by the 2010 health overhaul (PL 111-148, PL 111-152) highlighted the success they had in enrolling new consumers and improving their outreach to customers through in-person meetings and phone calls.

The glowing reviews contrast with the last six months of discussion about the health care marketplaces. Absent from the stage were the many insurers who have struggled on the public exchanges. Major insurance companies like Aetna Inc. and UnitedHealth Group Inc. have announced massive withdrawals from the markets in which they were participating, citing unsustainable financial losses. Smaller insurers, too, have been abandoning or scaling back their exchange products. Others filed for double-digit rate increases in hopes of staving off their own losses.

Burwell acknowledged again that the coming open enrollment period, which begins Nov. 1, will not be easy.

"This is a transition year, and transitions always present challenges, but they also present opportunities," she said.

After listing the efforts the administration has made in recent months to improve the so-called risk pool—which combines the costs of healthier and sicker consumers among insurance customers—Burwell said the administration was "planning to pilot additional changes" in the coming months.

The administration has "heard your concerns about potential threats to the ACA risk pool," she said, referring to the acronym for the health law.

An HHS spokesman did not comment further on the potential additional changes.

Burwell said that the coming open enrollment would be the best opportunity for insurers to improve the risk pool by signing up more healthy patients. She called on insurers to listen to their competitors' advice at the Wednesday meeting.

Much of the forum focused on strategies to improve customer enrollment and retention. Pat Geraghty, chief executive officer of Blue Cross Blue Shield of Florida, highlighted his company's work in retaining consumers by offering face-to-face assistance in retail clinics across the state, some of which also offer primary care facilities. He said the company worked to improve its information and interactions with customers on a daily and weekly, not quarterly, basis.

In a second panel focused on so-called effectuation—the point at which a customer actually pays his or her premium after selecting a plan—CMS Chief Marketing Officer Josh Peck highlighted the strategies used by insurers with the best rates of completed purchases. He said the strongest strategy—and the closest thing to a "silver bullet"—was engaging potential customers with a live phone call or in-person meeting. Actually talking to customers about the plan, how to use the insurance, and how to finish the sign-up process was the best way to get people to complete enrollment and pay, he said.

Insurance executives promoted changes that they felt would improve the marketplaces. Geraghty wants the removal of remove restrictions in the law that limit the differences in the prices that insurers can charge younger adults and older adults to a ratio of 3 to 1. Insurers—and many Republican lawmakers—have called for that ratio to be expanded to 5 to 1, in part to help lower costs for younger customers. 

Democrats have balked, saying the idea would increase prices and potentially limit access to care for older Americans.

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