Uninsured Find More Success via Health Exchanges Run by States

WASHINGTON — Robyn J. Skrebes of Minneapolis said she was able to sign up for health insurance in about two hours on Monday using the Web site of the state-run insurance exchange in Minnesota, known as MNsure. Ms. Skrebes, who is 32 and uninsured, said she had selected a policy costing $179 a month, before tax credit subsidies, and also had obtained Medicaid coverage for her 2-year-old daughter, Emma.

“I am thrilled,” Ms. Skrebes said, referring to her policy. “It’s affordable, good coverage. And the Web site of the Minnesota exchange was pretty simple to use, pretty straightforward. The language was really clear.”

The experience described by Ms. Skrebes is in stark contrast to reports of widespread technical problems that have hampered enrollment in the online health insurance marketplace run by the federal government since it opened on Oct. 1. While many people have been frustrated in their efforts to obtain coverage through the federal exchange, which is used by more than 30 states, consumers have had more success signing up for health insurance through many of the state-run exchanges, federal and state officials and outside experts say.

Alan R. Weil, the executive director of the National Academy for State Health Policy, an independent nonpartisan group, credited the relative early success of some state exchanges to the fact that they could leap on problems more quickly than the sprawling, complex federal marketplace.

“Individual state operations are more adaptable,” Mr. Weil said. “That does not mean that states get everything right. But they can respond more quickly to solve problems as they arise.”

In addition, some states allow consumers to shop for insurance, comparing costs and benefits of different policies, without first creating an online account — a barrier for many people trying to use the federal exchange.

The state-run exchange in New York announced Tuesday that it had signed up more than 40,000 people who applied for insurance and were found eligible.

“This fast pace of sign-ups shows that New York State’s exchange is working smoothly with an overwhelming response from New Yorkers eager to get access to low-cost health insurance,” said Donna Frescatore, the executive director of the state exchange.

In Washington State, the state-run exchange had a rocky start on Oct. 1, but managed to turn things around quickly by adjusting certain parameters on its Web site to alleviate bottlenecks. By Monday, more than 9,400 people had signed up for coverage. TheWashington Health Benefit Exchange does not require users to create an account before browsing plans.

“The site is up and running smoothly,” said Michael Marchand, a spokesman for the Washington exchange. “We’re seeing a lot of use, a lot of people coming to the Web site. If anything, I think it’s increasing.”

Other states reporting a steady stream of enrollments in recent days include California, Connecticut, Kentucky and Rhode Island.

In Connecticut, a spokesman for the state-run exchange, Access Health CT, said users have generally had a smooth experience with the Web site other than “a couple of bumps and hiccups on the first day.”

By Monday afternoon, the Connecticut exchange had processed 1,175 applications, said the spokesman, Jason Madrak.

Daniel N. Mendelson, the chief executive of Avalere Health, a research and consulting company, said: “On balance, the state exchanges are doing better than the federal exchange. The federal exchange has, for all practical purposes, been impenetrable. Systems problems are preventing any sort of meaningful engagement.”

“By contrast,” said Mr. Mendelson, who was a White House budget official under President Bill Clinton, “in most states, we can get information about what is being offered and the prices, and some states are allowing full enrollment. All the state exchanges that we have visited are doing better than the federal exchange at this point.”

In California, Peter V. Lee, the executive director of the state-run exchange, said that more than 16,000 applications had been completed in the first five days of open enrollment. Mr. Lee said that while the consumer experience “hasn’t been perfect,” it has been “pretty darn good.”

Some state-run exchanges have run into difficulties because they rely on the federal marketplace for parts of the application process, like verifying an applicant’s identity. Minnesota, Nevada and Rhode Island are among the states that have reported problems with the “identity-proofing” process, which requires state-run exchanges to communicate with the federal data hub.

Brandon Hardy, 31, of Louisville, Ky., was one of the first to sign up for health insurance through Kentucky’s state-run exchange, working with an application counselor who guided him through the process last Wednesday. Mr. Hardy, who is uninsured and has epileptic seizures that land him in the hospital every few months, spent about 45 minutes filling out the online application, and learned that he would be eligible for Medicaid under the health care law.

“It was pretty easy,” Mr. Hardy said of the process. “What I really need is a neurologist, and now hopefully that will happen. This is like a huge relief.”

Attempts to sign up for coverage through the federal marketplace have often proved more frustrating.

Bruce A. Charette, 60, of Tulsa, Okla., said he had been trying to log onto the Web site for the federal exchange since last Wednesday, but had not been able to see the available plans or their rates.

Mr. Charette said he was asked verification questions that did not appear to match his identity. One question, he said, asked about the name of a pet for which he had purchased health insurance two years ago. “I don’t have any pets,” he said.

“It’s obvious that the site is overloaded,” said Mr. Charette, an electrician who works in the aviation industry and said he did not have health insurance. “I am not going to stare at a computer screen for 45 minutes, waiting for a response. It looks as if the Web site is freezing up.”

Still, some groups helping people sign up for insurance through the federal marketplace said they were finally able to complete applications on Tuesday, a week into open enrollment.

“This was the first day that I have been able to get onto the Web site and sign people up,” said Laura Line, corporate assistant director for Resources for Human Development in Philadelphia, which has a contract to help people in Southeastern Pennsylvania enroll in health plans through the federal exchange. “We have been setting appointments and answering a ton of phone calls now that we are able to do something.”

Katie Thomas and Jennifer Preston contributed reporting from New York.

Covered California delays offering 'embedded' dental plans

Board members of the California Health Benefit Exchange voted Thursday to delay soliciting bids for medical plans that include pediatric dental care until next year.

Covered California, the state's health insurance exchange, has said it will offer five stand-alone pediatric dental plans for 2014 as well as what's called a "bundled" plan in which insurers pair a stand-alone dental plan with a medical plan.

Critics have argued that Covered California should also offer so-called "embedded" pediatric dental plans that are included in medical plans.

But Leesa Tori, senior adviser for plan management, told the board at its special meeting that too many questions remain for the exchange to offer embedded pediatric dental plans before 2015.

The exchange still must decide whether to make purchasing dental insurance mandatory, and for whom it would be necessary. Until Covered California makes this decision, Tori said, staff members will not know which types of plans to include in the exchange.

"There is no silver bullet for 2014," said Tori, as board members considered final recommendations on pediatric dental plans. "What we are suggesting here is that we go back, we do the proper policy analysis, look at the various products and then put it into a portfolio for 2015."

Tori also said that six of the eight health insurance firms with the ability to provide embedded dental plans said they could not develop a bid for next year.

"If we thought we could, we would," said Susan Kennedy, one of the board members. "We don't believe it's technically feasible or in the best interests of consumers to do so right now."

The board's plan to solicit multiple options for children's dental plans in 2015 comes in response to concern from children's advocates and families about the affordability of pediatric dental care. Monthly premiums for the pediatric dental plans to be offered in 2014 start at $10 per child, depending on the plan. The plans cover children up to age 19.

A coalition of children's health advocates sent a letter on Monday to the health exchange's board members urging them to request bids for embedded pediatric dental plans in addition to the stand-alone and bundled plans the exchange has already solicited.

The coalition -- which includes Children Now, United Ways of California, California Coverage and Health Initiatives, The Children's Partnership and Children's Defense Fund California-- called for the board to give the public the opportunity to choose their dental coverage.

"Consumer choice is important, and we recognize that for some families the option to select a stand-alone plan will be attractive," the letter read. "But stand-alone plans must not be the only choice."

PHOTO: Tribal dentist Gurminderajit Sufi works on Jonathan Jesus Lomeli, 10, of Arbuckle at the Colusa Casino's Wellness Center on April 23, 2013. The clinic offers subsidized medical care for low-income families. The Sacramento Bee/ Randy Pench.

Read more here: http://blogs.sacbee.com/capitolalertlatest/2013/08/covered-california-delays-offering-embedded-pediatric-dental-plans.html#storylink=cpy

'Wal-Mart' bill fails in Assembly as Democratic caucus splits

The California Assembly rejected hotly contested legislation Thursday to penalize large employers that provide workers with wages and hours low enough to qualify them for Medi-Cal rolls.

Assemblyman Jimmy Gomez, D-Los Angeles, was granted reconsideration after hisAssembly Bill 880 failed on three roll call votes.

Gomez conceivably could take the bill up again, but Democrats will lose their supermajority Sunday, clouding prospects for a future vote.

The final tally Thursday was 46-27, eight votes shy of passage.

The vote on AB 880 was closely watched statewide as a test of Democrats' supermajority because it forced moderate lawmakers in the party to stand with or to buck their more liberal colleagues in the lower house.

Three Assembly Democrats voted against it: Cheryl Brown of San Bernardino, Tom Daly of Anaheim, and Adam Gray of Merced. Five party colleagues did not vote: Henry T. Perea of Fresno, Raul Bocanegra of Pacoima, Steve Fox of Lancaster, Rudy Salas of Bakersfield, and Al Muratsuchi of Torrance.

Lobbying was intense, pitting organized labor against business groups on a top-priority issue for both.

The Assembly was running out of time to act on the bill because it required a two-thirds vote for passage and Democrats will lose their supermajority when Assemblyman Bob Blumenfield resigns Sunday to join the Los Angeles City Council.

The California Labor Federation and the United Food and Commercial Workers, sponsors of AB 880, claim that it would close a loophole that allows the state's largest businesses -- 500 employees or more -- to avoid subsidizing employee medical insurance under next year's federal health care overhaul.

Federal law will penalize businesses if employees who work 30 hours a week are forced to buy health insurance from a new state exchange next year because they are not covered by an employer plan.

No penalty is provided under current law if compensation is low enough to push employees onto Medi-Cal rolls, meaning income of about $15,900 for an individual or $32,500 for a family of four. AB 880 would close that gap by penalizing firms about $4,400 for each employee on Medi-Cal who works at least 12 hours per week.

The California Chamber of Commerce has labeled AB 880 a "job killer" bill. Business groups contend it would be a drag on the economy, discourage the hiring of part-time workers, and that it is premature because the federal health care overhaul has not yet been implemented.

Organized labor has accused Wal-Mart of practices targeted by AB 880. The giant retailer, in a written statement, counters that its wages and benefits "meet or exceed those offered by most competitors and our health care offerings go beyond the eligibility and affordability requirements of the Affordable Care Act."

PHOTO: First-term Assemblyman Jimmy Gomez, D- Los Angeles listens during the first day of the legislative session at the state Capitol in Sacramento on Monday, Dec. 3, 2012. The Sacramento Bee/ Hector Amezcua

Read more here: http://blogs.sacbee.com/capitolalertlatest/2013/06/walmart-wal-mart-bill-fails-in-california-assembly.html#storylink=cpy

California Tries to Guide the Way on Health Law

Members of the audience lined up to speak at a meeting of the California Health Benefit Exchange last month in Sacramento. 

By ABBY GOODNOUGH

SACRAMENTO — The meeting came to order, the five members of the California Health Benefit Exchange seated onstage with dozens of consumer advocates and others looking on. On the agenda: what to name the online marketplace where millions of residents will be able to shop for medical coverage under President Obama’s health care law.

 An adviser presented the options, meant to be memorable, appealing and clear. What about CaliHealth? Or Healthifornia?

Or Avocado?

“I am kind of drawn to Avocado,” declared Kim Belshé, a member of the exchange’s board of directors, which is hustling to make dozens of decisions as the clock ticks toward deadlines set by the law.

Delay and outright resistance to the health care overhaul might be the norm in much of the country, but not here. California — home to seven million uninsured people, more than any other state — is at the forefront of preparations for January 2014, when a controversial requirement that most Americans have medical coverage or pay a penalty takes effect.

So far, only 13 states and the District of Columbia have told the Obama administration they intend to set up the insurance exchanges that are supposed to provide a marketplace for people to buy health plans. None are being watched as closely as California, whose singular challenges, from the size, diversity and geographic spread of its uninsured population to its vast budget problems, make it stand out. Many feel a successful rollout here could convince other states with high numbers of uninsured residents that the law can be made to work for them.

“We are the example,” said Anthony Wright, executive director of Health Access California, an advocacy group. “If it can be done here, it can be done anywhere.”

The California Health Benefit Exchange has already hired 50 employees and is poised to hire 50 more. Construction of the Web portal through which some three million people are expected to buy insurance by 2019, and through which many others will likely enroll in Medicaid, is under way.

This fall, the board will seek bids from insurers to sell plans through the exchange, and it intends to have the portal up and running by next summer, several months before enrollment starts in October 2013.

Realizing that much of the battle will be in the public relations realm, the exchange has poured significant resources into a detailed marketing plan — developed not by state health bureaucrats but by the global marketing powerhouse Ogilvy Public Relations Worldwide, which has an initial $900,000 contract with the exchange. The Ogilvy plan includes ideas for reaching an uninsured population that speaks dozens of languages and is scattered through 11 media markets: advertising on coffee cup sleeves at community colleges to reach adult students, for example, and at professional soccer matches to reach young Hispanic men.

And Hollywood, an industry whose major players have been supportive of President Obama and his agenda, will be tapped. Plans are being discussed to pitch a reality television show about “the trials and tribulations of families living without medical coverage,” according to the Ogilvy plan. The exchange will also seek to have prime-time television shows, like “Modern Family,” “Grey’s Anatomy” and Univision telenovelas, weave the health care law into their plots.

“I’d like to see 10 of the major TV shows, or telenovelas, have people talking about ‘that health insurance thing,’ ” said Peter V. Lee, the exchange’s executive director. “There are good story lines here.”

Although the exchange will not start advertising until next year, the California Endowment, a foundation that has spent $15 million promoting the law, is running newspaper and television ads, including one in which the television personality Dr. Mehmet Oz exhorts viewers to “get educated, get engaged, get enrolled.” That campaign has targeted Hispanics, who make up more than half of the state’s uninsured population.

But for all the progress, California’s intractable budget woes loom as a threat to implementation here. Even with the federal government financing most of the insurance expansion, the state’s contribution could exceed $2 billion a year, according to an estimate that was made by the administration of Gov. Arnold Schwarzenegger, a Republican, who signed the legislation creating an insurance exchange here in September 2010, earlier than any other state. Diana S. Dooley, the state’s Health and Human Services secretary, said the administration of Gov. Jerry Brown, a Democrat, was working on a new estimate.

Mr. Brown, while supportive of the law, has not spent much time talking it up publicly, in part, Ms. Dooley said, because he is “absolutely laser-focused on getting the budget balanced.”

To help close a $16 billion deficit, Mr. Brown made more than $1 billion in cuts from Medicaid and other health programs even though about a million of the Californians expected to gain coverage through the health care law by 2019 would get it through a prescribed expansion of Medicaid. (Those who buy private insurance through the exchange will be able to get federal subsidies to help cover the cost if they earn up to four times the federal poverty level, or currently $92,200 for a family of four.)

Mr. Brown is hoping voters will approve a package of temporary tax increases in November to avoid $6 billion more in cuts. Ms. Dooley said that without the tax package, carrying out the health law might be at risk, including the expansion of Medicaid.

“I wouldn’t characterize it as all bets are off,” she said. “I’m just saying nothing is protected.”

The exchange itself has so far been financed by three grants, worth $237 million, from the federal government. Most of the money is committed to consultants, including Accenture, which has a $327 million contract to build and support the initial operation of the enrollment portal.

Ms. Dooley said getting the enrollment system up and running in such a tight time frame was one of her biggest worries. The other, she said, was making sure the health plans sold through the exchange were affordable. The federal law lists 10 categories of “essential health benefits” that plans sold through exchanges must provide, but Ms. Dooley said those categories “go beyond what I would call essential.”

“It’s all good for consumers,” she said. “But somebody’s got to pay for it, and that’s going to go into the premium.”

Despite the full-throttle approach here, another uncertainty is the outcome of the presidential race. Mitt Romney, the Republican nominee, has vowed to repeal the health care law and restructure Medicaid, not only scrapping the planned expansion but making the program much leaner. Even without a repeal, Republicans could undo the federal subsidies and other financing for the law if they won the presidency and even a narrow majority in the Senate.

“If the federal funding stopped,” Mr. Lee said, “we would be at a ‘press reset’ button.”

In a Field Poll released on Aug. 20, 54 percent of California voters said they supported the health care law, compared with 37 percent who said they were opposed. Support was strongest among blacks (88 percent) and Hispanics (67 percent), who together make up more than 44 percent of the state’s population. Voters of Vietnamese and Korean descent also firmly supported the law, but white and Chinese voters were more divided. The poll of 1,579 voters, conducted in July, has a sampling error of plus or minus 3 percentage points.

Only 17 percent of respondents said they had seen, heard or read anything about the insurance exchange though. Still, 75 percent of those who are not insured through their employer or Medicare said they would be interested in using the exchange to shop for health insurance.

Mr. Lee said the fact that few people had heard of the exchange was “totally unsurprising.” A catchy new name might help spread the word, he said; a decision on Avocado and the other finalists should come next month.

“The fact that very few people have heard about us isn’t an issue,” Mr. Lee said. “Come back in a year.”