100 Days Until Start of Enrollment for ACA Health Exchanges

Sunday marked 100 days until Oct. 1, when open enrollment begins for the Affordable Care Act's health insurance exchanges, the Washington Post's "Wonkblog" reports. The exchanges are expected to enroll millions of uninsured U.S. residents.

According to "Wonkblog," the Obama administration faces two big hurdles -- educating the public and technical challenges -- as it enters the "final sprint" to implement the ACA.

In response to the first challenge, the Obama administration and its allies have launched nationwide outreach campaigns to educate U.S. residents about the law's benefits and encourage uninsured individuals to enroll in the exchanges this fall. However, there are indications that effort could be an uphill climb: a Kaiser Family Foundation poll from April found that 42% of U.S. residents did not know if the ACA was law (Kliff, "Wonkblog," Washington Post, 6/23).

Technical Challenges Must Be Met Before Largest-Ever Open Enrollment

Some health policy experts say the upcoming open-enrollment season could be the largest ever in the U.S. Ceci Connolly -- managing director of PricewaterhouseCoopers' Health Research Institute -- said, "We know that this will be a real crunch period" (Galewitz/Hancock, Kaiser Health News, 6/23).

However, the federal government and states first must finish building the online marketplaces through which residents will purchase health coverage ("Wonkblog," Washington Post, 6/23).  For example, officials in Nevada -- one of the 15 states creating their own exchange -- must certify health plans, test computer systems and begin a statewide outreach campaign over the next three months. Jon Hager -- executive director of the Nevada exchange -- said, "We certainly will need every one of the days that we have left," adding, "But I am confident we will be ready to go."

In addition, government officials must complete the IT infrastructure that will allow state and federal agencies to share information and determine individuals' annual income levels, citizenship status and eligibility for federal subsidies or Medicaid in real-time. The computer system also will need to connect with those run by insurers.

Meanwhile, observers say there are still lingering questions about who will decide to enroll in the exchanges and whether they will be able to afford coverage. Of particular importance is whether young and healthy individuals -- who are needed to balance the costs of insuring sicker individuals who no longer can be denied coverage under the law -- will enroll (Kaiser Health News, 6/23).

BlueCross BlueShield All In on Exchanges

Although some of the nation's largest health insurers are taking a cautious approach to participating in the ACA's exchanges, BlueCross BlueShield is expected to offer exchange plans nearly everywhere, Kaiser Health News/Washington Post reports.

Analysts note that BCBS has the largest share of the individual market in most states and by offering exchange plans in the majority of states it is protecting that business.

Alissa Fox, a senior vice president at Blue Cross and Blue Shield Association, said, "We've been in this market for more than 80 years, and we've been providing coverage in every ZIP code to everybody," adding, "We imagine we will continue to do that."

However, the insurer is going beyond simply offering plans in places other carriers might avoid, according to the KHN/Post. Instead, BCBS is taking on an education role to explain the system to consumers and recruit them for enrollment in exchange plans, particularly in states where Republican governors oppose the law. For example, BCBS is preparing to organize community not-for-profit groups, churches, chambers of commerce and food banks to help promote the exchange offerings in Florida, Louisiana and Texas.

In contrast, other major insurers -- such as Aetna and UnitedHealth Group -- have announced they would offer plans in 14 and 12 states, respectively (Hancock, KHN/Washington Post, 6/21).

Problems in Miss. Exchange

In related news, Mississippi Insurance Commissioner Mike Chaney announced recently that just two insurers have committed to offer plans on the state's federally run exchange beginning in October, AP/Modern Healthcare reports.  The plans will serve just 46 of the state's 82 counties.

Chaney said that would leave residents in the remaining 36 counties without exchange options, making them ineligible for federal subsidies for low-income individuals to purchase coverage. According to AP/Modern Healthcare, those residents still will be able to purchase individual coverage through the traditional market, as well as rely on employer-based coverage and government plans, such as Medicare and Medicaid.  

Chaney said the department was notified that the state's two largest insurers -- Blue Cross Blue Shield and UnitedHealth Group -- would not offer plans through the exchange. The exchange will be served by Magnolia Health Plan and Humana.

Observers said they are not surprised that few new insurers would avoid the state -- which is dominated by Blue Cross -- because they would face difficulty signing up a network of doctors and hospitals and could have trouble negotiating payment rates (Amy, AP/Modern Healthcare, 6/21).

Exchange Contractor

In other news, the new call centers to help U.S. residents enroll in the federal exchanges are expected to receive 42 million calls this year, The Hill's "Healthwatch" reports (Baker, "Healthwatch," The Hill, 6/21).

Vangent has been contracted to operate both the Medicare and the federal health exchange call centers under a $530 million contract for the first year. The company will dedicate six Medicare call centers to answering ACA-related questions from the 34 states with federally run exchanges.

HHS estimates that this year the call centers will receive:

• 200,000 calls per day;
• 2,400 letters; and
• 740 emails. 

In addition, HHS expects that the call centers will host 500 daily online chats.

Consumer advocates have raised concerns that Vangent will be unable to handle the influx of calls because of its allegedly poor performance implementing changes in the Medicare call centers.

An HHS official said call center representatives would "undergo extensive training" on the ACA and basic insurance issues. The official added that HHS would evaluate Vangent's performance through a number of factors, including customer satisfaction (Jaffe, KHN/Washington Post, 6/20).