ACA Federal Marketplace updates

[Gatordoc50]

In theory, this is fine if (a) the employer passed on all the saved health care costs to the employee to buy their own insurance, and (b) if the inequity in tax treatment between employer-provided insurance benefits and cash payments used to buy your own policy were eliminated.

If someone's coverage costs the employer $10,000 a year, I don't trust employers to give employees $10,000 a year to buy their own policy, or less than that net of the subsidy so it's a wash for the employee. Then again, that subsidy is another wrinkle. Do you give the same $10,000 (or whatever) to someone with $100K in household income as someone earning $40K in household income, knowing that the latter would also get a pretty hefty subsidy and would pay a lot less than $10K per year out of pocket for health insurance?

I don't believe that the money could be dispersed to the employees for them to buy insurance. Some may take the money and pay the penalty which doesn't help the overall picture. As far as the tax inequity, that is another problem. If you tax employer benefits then you are characterizing the benefit as income. The employer can not then withhold your income to buy insurance. That would be unconstitutional.. Or at least would be challenged. I believe that battle has been saved for a future day.

 

[timo2]

The more things get OT politically, the more the scent of bacon begins to fill the air
I still think it's useful to have a thread for updates related to the Exchanges/Marketplace as Oct 1 approaches.

OK. sorry.

 

[Brat]

Still incomplete details, but indications from Indiana's Dept of Insurance of significant rate increases in that state (which will be using Federal Marketplace).

http://www.indystar.com/article/201...cent-increase-individual-insurance-plan-rates

The Indystar article did report that many in their state could not obtain health insurance because of pre-existing conditions and that the health care law has mandated coverage in excess of that required by the State of Indiana. Health insurance can be inexpensive if the insurer predicts that you won't use it.

 

[killingme]

Michael, only know what my friend in Albany who works for the State has told me "off the record"

 

[MichaelB]

Michael, only know what my friend in Albany who works for the State has told me "off the record"

Then you are fortunate that New York State publishes the rate tables for individual coverage by insurer and region. It is quite easy to simply compare those rate sheets and see that premiums are declining by similar amounts across all regions.

 

[ERhoosier]

The Indystar article did report that many in their state could not obtain health insurance because of pre-existing conditions and that the health care law has mandated coverage in excess of that required by the State of Indiana. Health insurance can be inexpensive if the insurer predicts that you won't use it.

For some years IN has had a high-risk pool (ICHIA- IN Comp Health Assn). Basically it is open to those non-Medicare/Medicaid-eligible established IN residents with pre-existing conditions who cannot get or keep other HI at 'reasonable cost'. The various plans' benefits are roughly comparable to offerings of current (pre-ACA) private HI and range from HDHP to near "Cadillac" coverage. The max annual out-of-pocket for all plans is $5k or less (which is less than the ACA's $6250 for 2014)

https://www.onlinehealthplan.com/index.cfm?xnode=1007000
Indiana Comprehensive Health Insurance Association (ICHIA) | Indiana

Premium costs of ICHIA plans are capped at 150% of "what a healthy person would pay" for given plan adjusted for age, sex, and geographic area within the state. Only eligibility exclusions I know of are coverage for pre-existing conditions (for 3mo) in folks who are not HIPAA-eligible &/or who did not apply to pool within 6mo of losing other coverage. Unfortunately, those ICHIA premiums can be well beyond what many (non-Medicaid eligible) folks can afford to pay. So indeed some fall through the cracks, particularly if they are unaware of the need to apply promptly after losing other coverage or they simply cannot afford the premiums for >6mo. But realistically those current 7500 uninsured not ICHIA-eligible who will be covered by ACA should have fairly minor 2014 market premium impact in light of the 200,000 IN residents currently with individual HI (IN DOI stats as quoted in Indystar article). IMHO- There will be other factors mainly responsible for the large HI premium increases IN DOI predicts (assuming they have seen figures not yet made public).

Bottom line is- Even for states with functioning 'high-risk pools', ACA will expand individual HI eligibility but we still await some important details (inc actual premiums) on the various metal tiers (Marketplace plans).

 

[killingme]

There is always a difference when the rubber meets the road isn't there.

 

[samclem]

An article from the AP on the scaled-back user interfaces being planned for the ACA rollout. It looks like there will be fewer online tools to help with the decisionmaking and application processes than initially planned, and more reliance on telephone calls (to call centers) and email exchanges. The story.

Snippets:

Struggling with a deadline crunch, some states are delaying online tools that could make it easier for consumers to find the right plan when the markets go live on Oct. 1.
Ahead of open enrollment for millions of uninsured Americans, the feds and the states are investing in massive call centers.
. . . .

‘‘A lot of the more sophisticated functionalities that might have been offered through the Web are being deferred to later phases.’’ When the markets first open, Hencoski said, ‘‘there will be a significant amount of manual processing of things that will later be automated.’’ Translation: emails, phone calls, faxes.
The Obama administration, which will be running the markets or taking the lead in 35 states, has yet to demonstrate the technology platform that will help consumers get financial help with their premiums and pick a plan. . .

‘‘Consumers see this as a serious product, and something that requires a serious amount of research,’’ said Julie Bataille, overseeing the outreach effort at the federal Health and Human Services department. ‘‘It’s something they see in a more serious way than (buying) an airline ticket.’’

I think Ms Bataille's comment misses the point. People do see this as a serious choice that requires serious research, and that's why they want to have the information available to do that research. Phone calls and emails to a call center can be good for answering pinpoint questions, but not for a detailed analysis of alternatives.

 

[Mulligan]

An article from the AP on the scaled-back user interfaces being planned for the ACA rollout. It looks like there will be fewer online tools to help with the decisionmaking and application processes than initially planned, and more reliance on telephone calls (to call centers) and email exchanges. The story.

Snippets:

I think Ms Bataille's comment misses the point. People do see this as a serious choice that requires serious research, and that's why they want to have the information available to do that research. Phone calls and emails to a call center can be good for answering pinpoint questions, but not for a detailed analysis of alternatives.

Sam, you are the problem. You are way too intelligent and analytical. In other words you want to be an informed consumer. I would imagine 90% of all other people are not so. If you can't get all the necessary info compacted into one paragraph that is very short, they won't read it, or even understand it. I just read an article that the rates in Nevada are nearing fruition. The article shows basic cost for a 40 yr. old while showing significant differences in premium costs between Las Vegas area (cheaper) and Reno area (more expensive).

http://www.lasvegassun.com/news/2013/jul/26/health-exchange-insurance-plans-cost-less-las-vega/

 

[Htown Harry]

An article from the AP on the scaled-back user interfaces being planned for the ACA rollout. It looks like there will be fewer online tools to help with the decisionmaking and application processes than initially planned, and more reliance on telephone calls (to call centers) and email exchanges.

Multi-feature comparison tools will certainly be valuable for shopping policies, but I personally wouldn't rely on web tools exclusively in making a final policy decision. Nor would calling a help line be my next level of investigation.

However, quality screening tools are the most important feature, IMHO. They can save users at all sophistication levels time and aggravation.

I recall shopping for a 6-month "bridge" policy on ehealthinsurance.com a few years ago. It wasn't particularly deep on it's ability to compare and contrast individual plans. Addition digging with data acquired from each provider was necessary for a fully-informed decision. It was slow going...

Nevada has posted a video walk-through of how their exchange interface will work for browsing, comparing and selecting individual and family plans. The blog post that pointed me to their site said they are one of the leaders, both in readiness and the features offered.

My expectations are exceeded.

Small Group Shop & Compare Walk Through - YouTube

 

[ERhoosier]

An article from the AP on the scaled-back user interfaces being planned for the ACA rollout. It looks like there will be fewer online tools to help with the decisionmaking and application processes than initially planned, and more reliance on telephone calls (to call centers) and email exchanges. The story.

IMHO- This story provides little new info for consumers. Just a reminder that after 3+ yrs of ongoing bureaucratic incompetence and spending $$$$ to develop the Exchanges, folks still won't have the promised support for their HI needs. To me, the facts are rather shameful. Consider the 3 states this article used as examples of Exchanges with delayed/missing functionalities-

MN alone got >$122M in Fed grants to develop their state Exchange.
State Exchange Profiles: Minnesota | The Henry J. Kaiser Family Foundation
Washington got >$150M
State Exchange Profiles: Washington | The Henry J. Kaiser Family Foundation
Rhode Island got >$64M, PLUS another ~$10M in its share of another $44M grant for New England states
State Exchange Profiles: Rhode Island | The Henry J. Kaiser Family Foundation

That's well over $300M in Fed funding (not inc other technical assistance) for Exchanges in just 3 smallish states alone. It's no wonder Republicans (and some prominent Democrats, BTW) are demanding some consumer-focused Exchange accountability before blindly dumping more huge sums of $$.
I truly hope the Federal Exchange my state will use turns out better, although I'm not holding my breath.

 

[samclem]

Nevada has posted a video walk-through of how their exchange interface will work for browsing, comparing and selecting individual and family plans. The blog post that pointed me to their site said they are one of the leaders, both in readiness and the features offered.

My expectations are exceeded.

That video reflects a system that would be a good start. I guess the household income/subsidy calculator is somewhere else, and that info would need to get imported into the calculator shown in order to show real costs for each policy and the anticipated use that the shopper can input.

Eventually, I'd want some way to compare the quality of the various plans, too. It seems sometimes people are discussing health insurance as an end in itself. The tool shown in the video wouldn't allow a consumer to know that patients in some plans may wait months to see a primary caregiver or specialist, etc. That's a bridge too far for the roll-out, but it needs to get done eventually. A (pseudo-) market-based system will work best when consumers have solid info on both quality and price.

 

[Htown Harry]

Just a reminder that after 3+ yrs of ongoing bureaucratic incompetence and spending $$$$ to develop the Exchanges, folks still won't have the promised support for their HI needs. To me, the facts are rather shameful. Consider the 3 states this article used as examples of Exchanges with delayed/missing functionalities-

I have to disagree with your connection between "promised support" and features such individual doctor sorting, mobile support or updates for post-purchase life events entered via the exchange instead of the carrier. I believe these are all "nice to haves", not necessities or promised features. They certainly weren't spelled out in the PPACA.

I truly hope the Federal Exchange my state will use turns out better, although I'm not holding my breath.

Better than what? I ask not to be provocative, but to better understand what you or others consider essential or promised features of the exchange portal.

For example, I believe this is a feature set for sign-ups that lists some items that meet minimum requirements (eligibility determination) and includes some additional items that exceed the "promised support" (Paypal payments):

• Determine their eligibility to Medicaid, CHIP, Basic health plan, Exchange plans and Federal subsidies
• Determine their eligibility to exemption from individual mandate
• Save eligibility information
• Enroll self and family through filing an electronic application with the health insurer or state agency
• Submit applicants' verification documents online
• E-sign the application
• Track application status
• Print semi-filled application& fill it in by hand to submit it offline
• Submit paper application via e-mail or fax
• Pay via credit card, bank transfer, PayPal, check, or Health Reimbursement Accounts (HRAs)
• File for life status changes
• Manage renewals

 

[samclem]

There was a little humorous mixup regarding the comparison between buying a health care plan and buying a plane ticket: Somebody didn't get the approved talking points memo.

From President Obama's 24 Jul speech in Galesburg, IL (emphasis added).

If you don’t have health insurance, then starting on October 1st, private plans will actually compete for your business, and you'll be able to comparison-shop online. There will be a marketplace online, just like you’d buy a flat-screen TV or plane tickets or anything else you're doing online, and you'll be able to buy an insurance package that fits your budget and is right for you.

And from MS Baitelle, responsible for the "outreach effort" at HHS:

"Consumers see this as a serious product, and something that requires a serious amount of research . . . It's something they see in a more serious way than (buying) an airline ticket."

​

 

[Htown Harry]

That video reflects a system that would be a good start. I guess the household income/subsidy calculator is somewhere else, and that info would need to get imported into the calculator shown in order to show real costs for each policy.

Yes, the policy comparison features are separated from the enrollment / eligibility determination features.

Here is their video on the latter, which would be step one for a user ready to make a purchase:

Individual & Family Walk-Through - YouTube

 

[Htown Harry]

There was a little humorous mixup regarding the comparison between buying a health care plan and buying a plane ticket: Somebody didn't get the approved talking points memo.

As a general rule, software developers prefer to not answer the phone when the marketing or PR staff calls.

 

[MichaelB]

Nice links, Harry.

The fact that we have exchanges and minimum coverage requirements (essential health benefits) makes it so much simpler to shop for and compare plans. It will still be easy to criticize the exchange efforts, especially when the comparison is against a theoretical "what could have been" or something someone said and the core functionality is unimportant to the critic. We will probably be seeing more of this as October nears.

Once the portal and cost functions are complete, one essential component I think imprtant would be comprehensive information on the provider network. This is very difficult to do today but I see it as one of the primary drivers of price differences among different policies. The number of participating doctors is a start but still a crude approximation.

 

[samclem]

It will still be easy to criticize the exchange efforts, especially when the comparison is against a theoretical "what could have been" or something someone said and the core functionality is unimportant to the critic. We will probably be seeing more of this as October nears.

Yes, just as we'll continue to have cheerleaders who gloss over the shortcomings of the system enshrined in the ACA itself as well as this thing we'll experience beginning in October (which are not quite the same anymore). The best we can do is to help each other through the thicket while keeping the pressure on for needed improvements. Your suggested addition of info on provider networks is a step in that direction, and I'm hoping we can include even more information on availability and health outcomes. "Shopping" using price alone is a recipe for decreasing the quality and availability of health care.

 

[ziggy29]

Yes, just as we'll continue to have cheerleaders who gloss over the shortcomings of the system enshrined in the ACA itself as well as this thing we'll experience beginning in October (which are not quite the same anymore). The best we can do is to help each other through the thicket while keeping the pressure on for needed improvements. Your suggested addition of info on provider networks is a step in that direction, and I'm hoping we can include even more information on availability and health outcomes. "Shopping" using price alone is a recipe for decreasing the quality and availability of health care.

Like it or not, I think right now we are speculating on what we expect the outcomes will be, both those for and against the ACA in general. Some of those fears will surely materialize, and I'm pretty sure some won't. In reality I think it will have to operate for a year or two before it's evident what aspects of it are working well and what are fairly broken.

 

[Mulligan]

Like it or not, I think right now we are speculating on what we expect the outcomes will be, both those for and against the ACA in general. Some of those fears will surely materialize, and I'm pretty sure some won't. In reality I think it will have to operate for a year or two before it's evident what aspects of it are working well and what are fairly broken.

I know this is a long shot, but here is what I hope ultimately comes from this. MAYBE the government will take a more active role in controlling healthcare costs since "they" will bear the initial expense of escalating costs due to so many people with lower incomes benefiting from subsidized plans. Yes I know it is more likely that more taxes will come from this than increased healthcare efficiency, but I will try to be optimistic.

 

[ERhoosier]

While I agree that things like mobile app support are just "nice to haves", there are important support issues consumer won't get for 2013-4 roll-out. We're all familiar with the repetitive statements from Admin (inc Obama) that under ACA you can "keep your own doctor". How do you know if you cannot check on your Exchange? Prompt updates for life-changing events (like baby's birth) are rather critical to obtaining care under your HI as many providers & facilities require such documentation prior to providing (even scheduling) non-emergency care. Specific details regarding costs associated with specific plans are obviously important in making informed decisions. Boston.com article indicates that these Exchange features which I (& IMHO many other folks) would consider key are not going to be there for initial Open Enrollment period--at least in the states cited.
And re Federal Exchange- "For the federally run exchanges, officials said the calculator will automatically subtract the consumer’s tax credit from plan premiums — a help. But it won’t provide an estimate of likely out-of-pocket costs that the plan doesn’t cover, a feature consumer advocates say is closer to the true bottom line."
IMHO- Knowing my potential out-of-pocket costs is absolutely essential in deciding on ANY insurance product, whether HI, auto, homeowners, or whatever. I get that info with my current employer-sponsored HI so I have no idea why it cannot be provided by Fed Exchange.

Agree 100% with Ziggy that it will likely take a yr or two to work out the bugs with the Exchanges. But some of the shortcomings being discussed in the media would be more than mere bugs. I truly hope that Dem Senator Baucus is wrong is his fear that ACA OE could be a "train wreck".
Max Baucus worried about health law 'train wreck' - Jennifer Haberkorn - POLITICO.com

 

[bUU]

Some of those fears will surely materialize, and I'm pretty sure some won't.

Just like some of the fears about what would have happened without ACA would have materialize and others wouldn't have. Discussion of fears is pretty meaningless. It just serves fear, and curmudgeony, not people.

 

[ERhoosier]

Discussion of fears is not meaningless in that it may adversely drive human behavior. Most pundits, and the Administration itself, believe the Exchanges must deliver enough functionality to attract a critical mass of participation by currently uninsured young adults. If fears about inadequacy/complexity of ACA Exchanges cause most of them to not participate, most all agree it will be a major fiscal problem for the new HI system.

Reliable info on what features will not be in the Exchanges during '13 OE is not fear mongering, but useful (even necessary) information for those needing individual HI under the program. It appears the Exchanges will NOT be "one-stop shopping" for HI as gov't (e.g. Cong Res Svc) has repeatedly claimed.
http://www.fas.org/sgp/crs/misc/R42663.pdf
Somehow I am not reassured that HHS will be providing phone service back-up for support, since it appears these newly hired folks will be mainly ex-telemarketers reading from prepared scripts-
Employment ads for the call centers' "temporary customer service representatives" seek applicants who have a high school diploma or equivalent and six months of telemarketing or secretarial experience.
"An HHS spokeswoman said that customer service representatives will answer questions by reading from HHS-approved scripts and provide state-specific information. However, she would not provide examples of the scripts or say whether they were tested with consumers."
http://www.healthcareitnews.com/news/insurance-exchange-poses-new-challenge?single-page=true
Bottom line: Folks need to prepare to do their own research BEYOND the Exchanges regarding Plans they are considering, inc. specific docs/facilities participating, anticipated out-of-pocket costs, how to PROMPTLY register important life events (birth, marriage, etc.), etc. Since IRS works much the same way, not sure we should be all that surprised by this The more folks understand the reality of the Exchanges, the better the system will function.

 

[bUU]

I agree with your Bottom line, though not with your premise for how you got there. We'll have to settle for that.

 

[ShokWaveRider]

Why do folk worry about who their doctor is and wanting to keep them? Unless of course they are a close family member. When you change your home state you have to get a new doctor.

Methinks it is kind of like the Blue Pill Syndrome. "I have been taking a blue pill now you give me a pink one, I want my blue one". Habit over practicality. If we have to change a doctor because of coverage, (E.G. Current Doc does not accept Medicare Patients) So be it.

Personally I do not really care, doctors are like car mechanics, you get one you like, you stick to it. You get a bad one, you find a new one, you move you find a new one.

We have moved so many times and had so many doctors it is not funny, but we always find one we like in the new place.