Worries Mount About Enrolling Consumers In Federally Run Insurance Exchanges
By Jenny
Gold
KHN Staff Writer
Apr 07, 2013 - Kaiser Health News
This KHN story was produced in collaboration with USA TODAY
When President Lyndon B. Johnson wanted to enroll seniors for the new
Medicare program he had just signed into law, the story goes that his
administration sent out workers on dog sleds to reach people in the remote
Alaskan tundra.
"The Forest Service even had rangers looking for hermits in the woods,"
recalled the late Robert Ball, Johnsonfs Social Security commissioner, in a documentary on Medicarefs 40th anniversary.
The plan to insure as many as 27 million Americans under the federal health
law beginning this fall will be the biggest expansion of health coverage since
that launch. Millions will be eligible to shop for insurance in the new online marketplaces, which open for enrollment Oct. 1
with the coverage taking effect Jan. 1.
But six months before the process
begins, questions are mounting about the scope and adequacy of efforts to reach
out to consumers – especially in the 33 states that defaulted to the federal
government to run their marketplaces, also called exchanges. The Obama
administration has said little about outreach plans for those states, and
neither the money nor the strategy is apparent.
"Ifm getting very worried," says Stan Dorn, a senior fellow at the
nonpartisan Urban Institute, who studies outreach and enrollment for
health programs. "Most health coverage expansions have not reached their target
populations very quickly."
'A Pittance'
Ron Pollack, executive director of the advocacy group Families USA, and an administration ally, says he is hearing
that as little as $40 million to $50 million in federal grants may be available
to hire nonprofit groups to work directly with consumers in the states with
federally-run marketplaces – a number the administration declined to
confirm.
"Thatfs a pittance compared to whatfs needed to make the application process
work," Pollack says. gIt doesnft even scratch the surfaceh -- even in tandem
with privately funded efforts.
That pot of money will cover grants to hire people to help consumers in 33
states with federally-run exchanges, including Texas and Florida, which have
some of the nationfs highest uninsured rates. Just for comparison, California
has budgeted more than $50 million for 'in person' help for consumers this year
and next, and another $200 million for outreach and education.
Officials at The Centers for Medicare & Medicaid Services declined
requests to discuss their outreach budget or strategy in the marketplaces run by
the federal government. In a written statement, the agency says it is
"coordinating with federal agencies, states and external partners to educate
consumers and motivate them to enroll."
Enrolling people under a law that few know anything about was always going to
be challenging. Three years after the lawfs passage, polls show widespread
ignorance about its provisions.
"Itfs not hard to get sick people to sign up for health insurance," says Bob
Laszewski, a Virginia-based consultant and former insurance executive. gBut
itfs really hard to get healthy people to sign up. If we donft get a healthy
cross-section, the financial structure of the [Affordable Care Act] unravels,"
and premiums will skyrocket.
'Ready, Set, Go?'
Resource disparities between states heighten the challenges. The lawfs
framers gave states broad financial assistance to set up their online
marketplaces. They also required the federal government to set up the exchanges
if states failed to do so but didnft create a separate pot of money for that
effort. The assumption was that most states would step up.
In the end, however, only 17 states and the District of Columbia did.
Resources for the federal effort may also be constrained because of the spending
cuts imposed by budget sequestration.
Private foundations, health industry groups and advocacy groups on the state
and national level say they are determined to fill the gaps in states like Texas
and Florida, but how successful theyfll be remains to be seen.
gI feel like we need a ready, set, go,h from the federal government, says Bee
Moorhead, executive director of Texas
Impact, a faith-based group, who is hoping that federal grants to pay
nonprofit groups for help will be announced soon.
"In Texas, people have been tapping their toes and drumming their fingers,"
she says. "We know we have a big uninsured population, we know we have a strong
faith-based community working hand-in-hand with the state, and we know we have
the ability to get things done. We need someone to say, 'Itfs time. Letfs do
it.'"
Blue Cross Blue Shield of Texas also recently launched "Be Covered Texas," an initiative undertaken with
community-based organizations including churches, school programs and clinics,
to educate consumers.
Enroll America,
an offshoot of Families USA staffed with tech-savvy former campaigners for
President Obama, is also hoping to step up to fill the gaps. The group has 13
staffers now, but hopes to ramp up to as many as 300 deployed in states with
high uninsured rates and scarce resources, says President Anne Filipic, a former
White House official.
The group, which is raising money from the health care industry, among other
sources, expects to begin reaching out to consumers in late spring or early
summer. It's relying on the sort of social media campaign that was key to
Obamafs 2012 reelection, Filipic says.
The campaign was about getting votes; now the trick is "how do you use [those
techniques] to compel people to sign up for health insurance," she says.
Still Time For Consumers To Plan
With six months to go, therefs also still time for the president to "use the
megaphone," says Dan Mendelson, CEO of consulting firm Avalere Health and a former Clinton administration
official.
When Mendelson worked on outreach for the Childrenfs Health Insurance Program
in the 1990s, "we had Bill and Hillary Clinton and Al and Tipper Gore all going
state to state. I attribute our success to that."
So far, however, Mendelson says the administration has not focused on
reminding the public that purchasing health insurance will soon be "an
obligation that everyone has," whether they like it or not.
That obligation takes advance planning for families with little disposable
income. "If people need to pony up $5,000, they need time to prepare for that,"
he says.
And that means telling them the time is coming soon.