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Utah insurers try to capitalize as federal exchange sputters

Published October 23, 2013 10:36 am

Affordable Care Act • Arches Health Plan is proposing a "work-around" for troubled federal marketplace.
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A Utah insurance company is negotiating with the Obama administration to bridge an enrollment hurdle created by the troubled performance of the federal health exchange.

Like most major insurers, Arches Health Plan can enroll people directly in the plans it offers on the exchange. The nonprofit Consumer-Oriented and Operated Plan, or CO-OP, has Web-based tools that allow consumers to shop its exchange plans and drill down to see whether their doctor is covered.

But prospective customers are missing out on a key benefit of the federal site.

"Our biggest frustration ... is we can't link them with [government] subsidies," said Arches Chief Operating Officer Shaun Greene.

Arches is proposing a temporary "work-around," however, that entails enrolling shoppers, estimating their subsidy, and billing the feds for payment of those individuals' tax credit, said Greene.

The federal site was designed to calculate and award subsidies immediately, but it has been plagued with glitches.

It's uncertain whether Aches' idea will win favor with the U.S. Department of Health and Human Services.

Even as the president defends the Affordable Care Act while acknowledging the exchange's technical failings, Congress is angling for the ouster of HHS Secretary Kathleen Sebelius, who has been called to testify at a hearing Thursday.

Experts predict Sebelius has until mid-November to get the www.healthcare.gov site functioning, or the administration may have to extend the open enrollment period. People have until Dec. 16 to sign up for coverage effective in January 2014. Open enrollment ends March 31.

But steering consumers directly to individual insurers risks limiting their choices, because carriers don't market competitors' plans.

"To see the full range of options, consumers will need to be patient with healthcare.gov," acknowledged Judi Hilman, Arches vice president of strategic partnerships and consumer engagement.

In the meantime, by satisfying the curiosity of window shoppers, insurers are generating sales leads and good will.

Intermountain Healthcare's insurance arm, SelectHealth is staging forums at area hospitals and clinics on "the ABCs" of health coverage.

"The feds brought a lot of this on themselves," said Rep. Jim Dunnigan, R-Taylorsville, noting officials should have rolled out the exchange in stages on a limited basis for testing.

"They made a mistake requiring everyone to log in and create a personal identifier before seeing subsidies and comparing plans. They didn't want people to see the rates without calculating their subsidies," said Dunnigan, an insurance broker. "I understand why, but I think it was unwise."

Obama this week stressed consumers can enroll using a toll free number: 1-800-318-2596. HHS can also handle paper applications.

But if glitches aren't resolved in the coming weeks, younger, healthier shoppers could give up, leaving only unhealthy consumers to enroll and causing rates to soar, said Dunnigan. "Some insurers are getting [exchange paperwork] on three enrollments for the same person, or two enrollments and a cancellation, and they're struggling to decipher which is the true enrollment."

One sign that enrollment may be picking up: Utah's Medicaid program is receiving more referrals from the exchange.

All exchange shoppers are screened for eligibility for the low-income health program.

Utahns presumed eligible are supposed to be electronically referred to Utah's Department of Workforce Services (DWS).

The feds aren't yet able to connect to DWS, said the agency's spokesman Nic Dunn.

But they keep a head count of referrals, which grew from 501 to 2,323 during the past week, he said. Those individuals can't be fully screened for Medicaid, however, until HHS furnishes their applications, Dunn said.

Polls show Obamacare remains unpopular and that Americans are still confused by the health law, but most of the country's uninsured want insurance.

At events where Arches has showcased its exchange offerings, consumers have been pleased, said Greene, recalling the response from one woman: "A zero-dollar premium? What the hell is everyone bitching about?"


Twitter: @kirstendstewart




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