Lessons Learned from State Exchanges Can Help Build Long-Term National Success
SACRAMENTO, Calif. — Covered California Executive Director
Peter V. Lee urged U.S. Secretary of Health and Human Services (HHS) Sylvia Mathews
Burwell on Monday to consider specific strategies to build on the Patient
Protection and Affordable Care Act’s success. Covered California shared some
key insights and lessons learned with Burwell so that health exchanges
nationwide can continue their success in 2017 and beyond.
In written comments submitted Monday in response to
proposed federal regulations, Covered California weighed in on three key elements
of the proposed regulations, related to standard benefit design, ensuring federal
and state exchanges have resources to do effective marketing and the role of Web-based
entities in enrollment. As Covered California, the federal marketplace and
exchanges in other states enter the third historic year of operations, lessons
learned in 2014 and 2015 can be applied to future years.
Standard Benefit Design — Proposed
regulations related to the federal marketplace in 2017 contemplate the standardization
of benefits under the Affordable Care Act. Covered California currently offers
standardized benefits so that consumers can easily compare health insurance plans
knowing that every plan within the same metal tier has the same cost-sharing amounts
and benefits. With standardized benefits, consumers can also rest assured
knowing that some services will always be affordable and accessible. For
example, every health plan available through Covered California has primary
care visits that are not subject to the deductible, which means primary care is
affordable and accessible.
“Covered California developed the standard benefit designs
with input from consumers and health care advocates, health plans and policy
experts,” said Lee. “Our goal is always to promote consumer understanding and
access to needed care as well as encourage consumers to get the right care at
the right time.”
Lee applauded the secretary for taking important steps in
the right direction to build on the Affordable Care Act’s essential health
benefits by promoting standard benefit designs created for consumers. Encouraging
health insurance companies to offer health plans with standardized benefits in the
federally facilitated exchange could allow consumers to compare plans more
easily, decrease the complexity of buying insurance and encourage the use of
appropriate medical services.
Federal Assessment on Plans to Ensure
Ongoing Enrollment — Recent reports from HHS, California and other
states’ exchanges show that enrollment for the upcoming third coverage year of
the Affordable Care Act is strong, which bodes well for continued improvement
of the “risk mix” and for ensuring long-term affordability.
The proposed federal regulations, which would not take
effect until 2017, present the assessment on health plans to support all
marketplace functions, including a small portion for marketing and outreach costs.
While California has no plans to use the federal enrollment platform, Covered
California believes making investments in marketing and outreach is vital to
promoting larger enrollment and retention, which have direct correlation to
fostering a better risk mix that keeps premiums low for the entire market by
encouraging healthier consumers to buy health insurance.
“Covered California believes strongly that strategic and
adequate investments in marketing, outreach and sales are critical factors to
ensuring that the marketplace grows and, more importantly, maintains a good
risk mix,” Lee said.
Covered California believes robust marketing has been
essential to attracting members who are healthy, young and cost less to serve,
as well as patients who are sicker, higher-cost and often older, as demonstrated
by California having the best risk mix in the nation as of the end of 2014. Lee
said ongoing marketing in the years ahead will be essential to the long-term success
of the health reform law.
“The importance of sales and marketing efforts will only
increase in the coming years as the free, earned media garnered by the historic
nature of the Affordable Care Act subsides and the efforts of
foundation-supported enrollment and marketing efforts decrease,” he said. “While
both the federal exchange and state exchange have been doing an effective job
attracting members, success over the long haul will require continued, robust
marketing.”
Web-Based Entities — Lee affirmed the important role that
licensed insurance
agents have and continue to play in promoting enrollment, while he commented on
proposed standards for the federal marketplace related to the role of those
agents who sell online — referred to as “Web-based entities.” Covered
California believes that having clear standards and expectations of Web-based
entities’ “choice architecture” is of critical importance to making outreach
work for consumers.
“In the absence of clear standards, consumers may
experience confusing displays of health plan options, make less optimal plan
and product choices, be routed to off-exchange products, or not get appropriate
in-person support when it is needed,” Lee wrote. “Having poor or confusing plan
choice display runs the risk of resulting in smaller enrollment and a worse
risk pool.”
While it is unclear from the rules whether they would apply
to state-based marketplaces, Covered California voiced specific concerns about
the inappropriate nature of applying such rules to state-based marketplaces,
and provided specific suggestions for how the federal marketplace could ensure Web-based
entities serve consumers, and about the need for federally established
standards for Web-based entities regarding how consumers choose plans and get
support from these agents. Covered California strongly believes that Web-based
entities and other direct enrollment vendors should have to support consumers
in all aspects of the application, display available health plans with
additional consumer tools such as filtering and sorting options, and meet other
requirements.
About Covered California
Covered California is the
state’s marketplace for the federal Patient Protection and Affordable Care Act.
Covered California, in partnership with the California Department of Health
Care Services, was charged with creating a new health insurance marketplace in
which individuals and small businesses can get access to affordable health
insurance plans. Covered California helps individuals determine whether they
are eligible for premium assistance that is available on a sliding-scale basis
to reduce insurance costs or whether they are eligible for low-cost or no-cost
Medi-Cal. Consumers can then compare health insurance plans and choose the plan
that works best for their health needs and budget. Small businesses can
purchase competitively priced health insurance plans and offer their employees
the ability to choose from an array of plans and may qualify for federal tax
credits.
Covered California is an independent part of the state
government whose job is to make the new market work for California’s consumers.
It is overseen by a five-member board appointed by the governor and the
Legislature. For more information about Covered California, please visit www.CoveredCA.com.
