Obamacare: Are All Bets Off For 2018 Open Enrollment?

By D. Kenton Henry, Editor, Broker, Agent

Last evening I began to receive texts and messages inquiring how President Trump’s executive order (EO) on Thursday, October 12th, would impact both the near and long-term future of Obamacare. Before retiring for the evening, I responded – “In the long run, dramatically. But in the short run, not so much because it will take quite awhile for the insurance industry to respond appropriately.” At that time, all I had learned was, the President ordered regulators to allow consumers to shop across state lines for health insurance along with the ability individuals of like professions, careers, and risk profiles, to band together in associations for the purpose of acquiring individual and family health insurance. Theoretically, the first would allow the consumer to shop for their best value among a far greater number of companies and plans, thus restoring competition to the market. The second would allow pooling a large number of people, and the resulting volume would lower risk to the insurance companies, thus allowing them to charge lower premiums to the members. The same principle and effect currently available to employer groups. And that was all I was aware of regarding the EO. Additionally, the EO loosens the restrictions on “Short-Term” health insurance, allowing it to serve as a viable alternative to long-term coverage for the young and/or healthy.

Today, I awakened to learn the Department of Health and Human Services announced late last night that the EO includes the cessation of federal payments for Cost-Sharing Reductions (CSRs) to insurance companies. “Immediately.” This, according to Secretary Eric Hargan and Medicare administrator, Seema Verma. And―with that―all bets are off! The Administration claims this can be done because Congress never appropriated funds for the CSRs. These funds were used to reimburse insurers for the CSRs which result in reductions in deductibles, copays, and out-of-pocket maximums for eligible individuals. However, while the insurers will lose these subsidies (amounting to $7 billion this year), they remain obligated to continue offering them to eligible customers! Eligible customers mostly include those qualifying for subsidies and electing “Silver” plans through the Marketplace, Healthcare.gov. At the very least, halting the payments could trigger a spike in premiums, at some point, for the coming year, unless Congress authorizes the money. The next payments are due around October 20th. The Congressional Budget Office estimates, without the subsidies, premiums could go up by as much as 20%. That is on top of the 15-20% average increase anticipated with the subsidies in place! Nearly 3 in 5 Healthcare.gov customers qualify for help. If you qualify for a premium subsidy, the increase will simply be paid for by your fellow taxpayers as it has the last four years. The person or family who does not qualify will have to pay for it entirely out of their own pocket. As always, it is the hard working middle class who could be hurt the most. Those who make just enough to get by, but a little too much to qualify for government assistance.

Will this break Obamacare altogether and, if so, when? What impact will it have on 2018 individual and family health insurance premiums? Rates had to be (and were) submitted to state health insurance commissioners, as required, on September 30th. Can insurance companies pull out of the market at this point? Will they? Apparently, Premium Subsidies (separate from CSRs), designed to lower premiums, per se, for qualified individuals – as well as though qualifying for tax credits upon filing – will not be affected. However, here is what the Washington Post (article below) had to say about the cessation of CSR subsidies, alone: “Ending the payments is grounds for any insurer to back out of its federal contract to sell health plans for 2018. Some state’ regulators directed ACA insurers to add a surcharge in case the payments were not made, but insurers elsewhere could be left in a position in which they still must give consumers the discounts but will not be reimbursed.” In my opinion, it is too late to submit new rates for approval in time for Open Enrollment, just around the corner. But it is not too late for an insurance company to pull out of the market altogether. What options will that leave the consumer, including my clients, for coverage in 2018 and beyond?

I agree with the administration; this is their move to force the hand of Congress to reverse the policies of Obamacare, restore competition and consumer choice, to the market. It will allow elements of a free market to regulate the variables, most important of which are, benefits, choice of provider, and premium. How long it will take for this action on the part of the Trump to accomplish this, I can’t say. The Executive Order is almost certain to be challenged by state Attorney Generals and litigated in federal courts. This could take months, or more, to play out, and probably will.

I apologize that, at this point, I have more questions than answers. In the meantime, I, and, my clients have yet to learn what our 2018 health options and premiums would be (or would have been) without the ramifications of the Executive Order. Rest assured, I will be watching in earnest for the details as this situation evolves.

As always, please feel free to phone me at 281.367.6565; text me at 713.907.7984 or email me at allplanhealthinsurance.com@gmail.com. The closer we get to November 1, the more I will know. And whatever is available to you, I will have. Along with your best option. Bear in mind, “best” is a relative term.

http://TheWoodlandsTXHealthInsurance.com https://HealthandMedicareInsurance.com

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Featured article:

WASHINGTON POST
By Amy Goldstein and Juliet Eilperin By Amy Goldstein and Juliet Eilperin
Health & Science
October 13 at 9:42 AM

President Trump is throwing a bomb into the insurance marketplaces created under the Affordable Care Act, choosing to end critical payments to health insurers that help millions of lower-income Americans afford coverage. The decision coincides with an executive order on Thursday to allow alternative health plans that skirt the law’s requirements.
The White House confirmed late Thursday that it would halt federal payments for cost-sharing reductions, although a statement did not specify when. Another statement a short time later by top officials at the Health and Human Services Department said the cutoff would be immediate. The subsidies total about $7 billion this year.
Trump has threatened for months to stop the payments, which go to insurers that are required by the law to help eligible consumers afford their deductibles and other out-of-pocket expenses. But he held off while other administration officials warned him such a move would cause an implosion of the ACA marketplaces that could be blamed on Republicans, according to two individuals briefed on the decision.
Health insurers and state regulators have been in a state of high anxiety over the prospect of the marketplaces cratering because of such White House action. The fifth year’s open-enrollment season for consumers to buy coverage through ACA exchanges will start in less than three weeks, and insurers have said that stopping the cost-sharing payments would be the single greatest step the Trump administration could take to damage the marketplaces — and the law.
Ending the payments is grounds for any insurer to back out of its federal contract to sell health plans for 2018. Some states’ regulators directed ACA insurers to add a surcharge in case the payments were not made, but insurers elsewhere could be left in a position in which they still must give consumers the discounts but will not be reimbursed.
A spokeswoman for America’s Health Insurance Plans, an industry trade group that has been warning for months of adverse effects if the payments ended, immediately denounced the president’s decision. “Millions of Americans rely on these benefits to afford their coverage and care,” Kristine Grow said.
And California Attorney General Xavier Becerra (D), who has been trying to preserve the payments through litigation, said the president’s action “would be sabotage.” Becerra said late Thursday that he was prepared to fight the White House. “We’ve taken the Trump Administration to court before and won, and we’re ready to do it again if necessary,” he said in a statement.
Trump’s move comes even as bipartisan negotiations continue on one Senate committee over ways to prop up the ACA marketplaces. Both Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) have publicly said the payments should not end immediately, though they differ over how long these subsidies should be guaranteed.
The cost-sharing reductions — or CSRs, as they are known — have long been the subject of a political and legal seesaw. Congressional Republicans argued that the sprawling 2010 health-care law that established them does not include specific language providing appropriations to cover the government’s cost. House Republicans sued HHS over the payments during President Barack Obama’s second term. A federal court agreed that they were illegal, and the case has been pending before the U.S. Court of Appeals for the D.C. Circuit.
President Trump signed an executive order on the Affordable Care Act on Oct. 12. With the order, he directed federal agencies to rewrite regulations on selling a certain type of health insurance across state lines. President Trump signed an executive order on the Affordable Care Act on Oct. 12. (Photo: Jabin Botsford/The Washington Post)
President Trump signed an executive order on the Affordable Care Act on Oct. 12. With the order, he directed federal agencies to rewrite regulations on selling a certain type of health insurance across state lines. (The Washington Post)
“The bailout of insurance companies through these unlawful payments is yet another example of how the previous administration abused taxpayer dollars and skirted the law to prop up a broken system,” a statement from the White House said. “Congress needs to repeal and replace the disastrous Obamacare law and provide real relief to the American people.”
In a filing Friday morning, the administration informed the court that HHS had “directed that cost-sharing reduction payments be stopped because it has determined that those payments are not funded by the permanent appropriation.”
House Speaker Paul D. Ryan (R-Wis.) said in a statement that the administration was dropping its appeal of the lawsuit — something the White House did not mention in its announcement. Ryan called the move to end to the court case “a monumental affirmation of Congress’s authority and the separation of powers.”
Meanwhile, the top two congressional Democrats, House Minority Leader Nancy Pelosi (Calif.) and Senate Minority Leader Charles E. Schumer (N.Y.), excoriated the president’s decision. “It is a spiteful act of vast, pointless sabotage leveled at working families and the middle class in every corner of America,” they said in a joint statement. “Make no mistake about it, Trump will try to blame the Affordable Care Act, but this will fall on his back and he will pay the price for it.”
For months, administration officials have debated privately about what to do. The president has consistently pushed to stop the payments, according to officials and advisers who spoke on the condition of anonymity to discuss private conversations. Some top health officials within the administration, including former HHS secretary Tom Price, cautioned that this could exacerbate already escalating ACA plan premiums, these Republicans said. But some government lawyers argued that the payments were not authorized under the existing law, according to one administration official, and would be difficult to keep defending in court.
Acting HHS secretary Eric Hargan and Seema Verma, administrator of the department’s Centers for Medicare and Medicaid Services, said they were stopping the payments based on a legal opinion by Attorney General Jeff Sessions. “It has been clear for many years that Obamacare is bad policy. It is also bad law,” their statement says. “The Obama Administration unfortunately went ahead and made CSR payments to insurance companies after requesting — but never ultimately receiving — an appropriation from Congress as required by law.”
While the administration will now argue that Congress should appropriate the funds if it wants them to continue, such a proposal will face a serious hurdle on Capitol Hill. In a recent interview, Rep. Tom Cole (R-Okla.), who chairs the House Appropriations Subcommittee overseeing HHS, said it would be difficult to muster support for such a move among House conservatives.
One person familiar with the president’s decision said HHS officials and Trump’s domestic policy advisers had urged him to continue the payments at least through the end of the year.
The cost-sharing payments are separate from a different subsidy that provides federal assistance with premiums to more than four-fifths of the 10 million Americans with ACA coverage.
Word of the president’s decision came just hours after he signed the executive order intended to circumvent the ACA by making it easier for individuals and small businesses to buy alternative types of health insurance with lower prices, fewer benefits and weaker government protections.
The White House and allies portrayed the president’s move as wielding administrative powers to accomplish what congressional Republicans have failed to achieve: fostering more coverage choices while tearing down the law’s insurance marketplaces. Until the White House’s announcement late Thursday, the executive order represented Trump’s biggest step to date to reverse the health-care policies of the Obama administration, a central promise since last year’s presidential campaign.
Critics, who include state insurance commissioners, most of the health-insurance industry and mainstream policy specialists, predict that a proliferation of these other kinds of coverage will have damaging ripple effects, driving up costs for consumers with serious medical conditions and prompting more insurers to flee the law’s marketplaces. Part of Trump’s action, they say, will spark court challenges over its legality.
The most far-reaching element of the order instructs a trio of Cabinet departments to rewrite federal rules for “association health plans” — a form of insurance in which small businesses of a similar type band together through an association to negotiate health benefits. These plans have had to meet coverage requirements and consumer protections under the 2010 health-care law, but the administration is likely to exempt them from those rules and let such plans be sold from state to state without insurance licenses in each one.
In addition, the order is designed to expand the availability of short-term insurance policies, which offer limited benefits as a bridge for people between jobs or young adults no longer eligible for their parents’ health plans. The Obama administration ruled that short-term insurance may not last for more than three months; Trump wants to extend that to nearly a year.
Trump’s action also is intended to widen employers’ ability to use pretax dollars in “health re-imbursement arrangements” to help workers pay for any medical expenses, not just for health policies that meet ACA rules — another reversal of Obama policy.
In a late-morning signing ceremony in the White House’s Roosevelt Room, surrounded by supportive small-business owners, Cabinet members and a few Republicans from Capitol Hill, the president spoke in his characteristic superlatives about the effects of his action and what he called “the Obamacare nightmare.”
Trump said that Thursday’s move, which will trigger months of regulatory work by federal agencies, “is only the beginning.” He promised “even more relief and more freedom” from ACA rules. And although leading GOP lawmakers are eager to move on from their unsuccessful attempts this year to abolish central facets of the 2010 law, Trump said that “we are going to pressure Congress very strongly to finish the repeal and replace of Obamacare.”
But in an early morning tweet Friday, Trump reached out to Democrats with an appeal to somehow work together on a health-care “fix.”
“The Democrats ObamaCare is imploding,” Trump wrote. “Massive subsidy payments to their pet insurance companies has stopped. Dems should call me to fix!”
The executive order will fulfill a quest by conservative Republican lawmakers, especially in the House, who have tried for more than two decades to expand the availability of association health plans by allowing them to be sold, unregulated, across state lines. On the other hand, Trump’s approach conflicts with what he and GOP leaders in Congress have held out as a main health-policy goal — giving each state more discretion over matters of insurance.
Health policy experts in think tanks, academia and the health-care industry pointed out that the order’s language is fairly broad, so the ensuing fine print in agencies’ rules will determine whether the impact will be as sweeping or quick as Trump boasted — his directive will provide “millions of people with Obamacare relief,” he said.
Significant questions that remain include whether individuals will be able to join associations, a point that could raise legal issues; whether the administration will start to let association health plans count toward the ACA’s requirement that most Americans carry insurance; and whether such plans can charge higher prices to small businesses with sicker workers — or refuse to insure them.
A senior administration official, speaking to reporters on the condition of anonymity shortly before Trump signed the order, said that the policy changes it sets in motion will require agencies to follow customary procedures to write new rules and solicit public comment. That means new insurance options will not be available in time for coverage beginning in January, he said.
Among policy experts, critics warned that young and healthy people who use relatively little insurance will gravitate to association health plans because of their lower price tags. That would concentrate older and sicker customers in ACA marketplaces with spiking rates.

Selling health plans from state to state without separate licenses — the idea underlying much of the president’s order — has long been a Republican mantra. It has gained little traction in practice, however.
Half a dozen states — before the ACA was passed in 2010 as well as since then — have passed laws permitting insurers to sell health policies approved by other states. And since last year, the ACA has allowed “compacts” in which groups of states can agree that health plans licensed in any of them could be sold in the others. Under such compacts, federal health officials must make sure the plans offer at least the same benefits and are as affordable as those sold in the ACA marketplaces.
As of this summer, “no state was known to actually offer or sell such policies,” according to a report by the National Conference of State Legislatures. A main reason, experts say, is insurers’ difficulty in arranging networks of doctors and other providers of care far from their home states.

ALL PLAN MED QUOTE AND CLIENTS TO BE REPRESENTED IN WASHINGTON, D.C. NEXT WEEK

ALL PLAN MED AND LIFE LOGO (2)

Not content to sit passively on the side lines while Washington dictates to him, his clients and fellow citizens – Kenton Henry, agent, owner of Allplanhealthinsurance.com in The Woodlands, will voices his–and your–concerns  in our nation’s Capitol.

KENTONSBUSINESSWEBPHOTO

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Trusted friends and clients:

It is my privilege to soon be attending the annual legislative conference for my professional association, the National Association of Health Underwriters, from February 24-26 in Washington, D.C. Representing influential professionals in my industry, I will take this opportunity to present meaningful solutions to our national policymakers to improve the cost and quality of health insurance while reducing the burdens the Patient Protection and Affordable Care Act has placed on businesses and individuals across the United States.

As the regulations and requirements of the health reform law continue to evolve, it is extremely important that our representatives in Washington, D.C., hear what is going on with you; your families; employers and employees. Our representatives on Capitol Hill need to hear a common-sense perspective from the average citizen’s point of view along with consumer inspired solutions. I will attend meetings on Capitol Hill with Senators, Representatives and their staff and would be happy to pass along any thoughts about health reform you, my valued friends and clients, may have. I have requested an appointment with Texas District 8 Congressman Kevin Brady, among others.  Please contact me at Quote@Allplaninsurance.com to share your message with them. Share with me your greatest problems and concerns with health care and health insurance and what solutions you may have in mind. I promise your story will be told and commit to being your voice among those who represent us.

In addition to talking to our elected representatives, I will be attending educational sessions about benefit and policy trends that will include:

• Key briefings from the national policy staff and association leadership.
• Panel discussions on health cost transparency, innovations in coverage and delivery systems, and policy trends relative to cost containment.
• Updates on the latest developments regarding the new health insurance marketplaces (exchanges).
• Presentations from congressional and Administration health policy leaders including updates about potential changes to the law and new evolving regulatory guidance.
• A session about using the political dynamics of healthcare to transform business.
• Breakout meetings that will cover innovative solutions to address the employer reporting requirements, shared responsibility requirements, self-funding options in a reformed health system, private and public exchanges, small group market trends and much more!

The future of healthcare reform is ever changing and the impact of this law will affect us all in many different ways across the country. I believe that my voice and your voice truly do make a difference. I look forward to sharing our stories as I lobby on Capitol Hill. Upon my return, I will share with you what I hope will be encouraging news of coming improvements to the present state of healthcare and health insurance in Texas and the rest of America.

Sincerely,
D. Kenton Henry

Navigator Vs. Insurance Broker: Who To Go To For Your New Affordable Care Act Health Insurance?

By Kenton Henry, Administrator

 
Let me preface this article with an admission. I am a health insurance broker and have been for 27 years. So consider that as you weigh the comparison suggested in the title of this piece.

 
Very shortly (October 1 to be exact) you are going to be able to enroll in a new Affordable Care Act (ACA) compliant health insurance plan to be effective January 1. Having health insurance at that time is no longer an option – it is a mandate. You probably know this by now and there is no need to review the details and I will not be addressing the penalties for not having coverage next year and beyond. Rather, I will be addressing your options for enrolling and factors you might want to weigh before electing the path you take to enrollment. I will strive to be as objective as possible in light of my preface.

 
First, let’s consider going through an insurance agent or broker like myself. Before I could consider selling my first health insurance policy back in 1986, I had to study for and pass my state’s insurance exam in order to obtain my license. I did this initially in Indiana and again in 1991 when I moved to Texas. While not the Bar Exam or Medical Board Exams – on both occasions they were comprehensive tests and I recall spending weeks of self-study in the quiet of the local library for the first and–after 5 years of experience–another week and a 40 hour prep course to boot for the second. They covered my knowledge of things not the benefit of common sense–and they were certainly not IQ tests–but measured my grasp of esoteric insurance laws, regulations, the principles and components of insurance and ethics among other topics. Next, I had to be appointed with an insurance company before I could represent their products. In addition to an application, an appointment entailed a thorough background and credit check. Approximately twenty years ago, every company with whom I applied to for an appointment made it mandatory I purchase errors and omissions coverage just as required of your attorney or doctor. Every person is fallible and the insurance makes certain an agent’s clients can be compensated for any negligence or unintentional mistake on the agent’s part resulting in the client’s harm. Fortunately, I have never had to file a claim with my E & O company nor have I had a complaint filed against me with a state insurance commission. I must also undergo and complete a minimum of 30 hours of continuing education every 24 months in order to keep my license. A record of this is made the State Insurance Commissioner. My license binds me to the same rules and regulations regarding my client’s privacy, confidentiality and personal information as the aforementioned professionals with whom you share the same type of information. Any compromise in it could result in revocation of my license not to mention civil liability on my part.

 
Who pays for these tests, licenses, continuing education and insurance? I do. It comes out of my personal income. Not to mention the cost of all my supplies, office overhead and gas utilized in seeing my clients at their convenience. Oh yeah . . . and I pay for my own health insurance. And I have never minded these expenses. These are merely the costs of doing business and I was happy to pay them when compared to the alternative which would have required being someone’s employee. So these are pretty much the facts as to my professional background, what is required of me and the protection afforded you by such.

 
Before contrasting this with the alternative – consider:
“The 2010 (ACA) law is intended to prod millions of Americans to buy health insurance, many for the first time. Those seeking coverage must provide details on citizenship, family size and income to determine whether they’re eligible for subsidies, and complete a form that can stretch to seven pages.” – Bloomberg 08.23.13

 
And the alternative to licensed agent or broker? As of October 1st, you will also have the option of going through a “Navigator” hired by your state and whose compensation will be subsidized with federal funds. (Clue: federal funds is code for your tax dollars). The Navigator’s job is to be educate you as to your options and help you elect one before being turned over to an enroller, otherwise known as a customer service representative. The latter will make this happen mechanically and it will most likely be accomplished by you going to a link and completing an electronic enrollment form estimated to be up to 21 pages or greater in length. (We don’t know yet. They and the premiums for coverage are yet to be released.)

 
While the requirements will vary from state to state, the federal requirements for Navigators are 20 hours of training. The federal health insurance exchange will apply in Texas, Indiana and Ohio. These are three of four states where I am licensed. There will be no background checks involved in the hiring process for Navigators as we are told there is no time for such. The administration says “we need to get as many people as possible to sign up as quickly as possible.” The Navigators will not be licensed. They will not pay for errors and omissions insurance. You will pay for their supplies, their insurance and their benefits.

 
I certainly don’t have to be your agent but these are factors you might want to consider before seeking assistance in enrolling in your new health insurance plan. If you feel I have unfairly or otherwise misrepresented things, please feel free to comment as much. In the feature articles below, some opposing or off-setting opinions are expressed–mostly by administration officials.

 

 

Admin. – Kenton Henry

 
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Coming Articles: Biggest Traps of the Affordable Care Act for Medicare Recipients
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Feature Articles:

 
BLOOMBERG August 23, 2013

 
State Laws Hinder Obamacare Effort to Enroll Uninsured
By Alex Nussbaum & Alex Wayne – Aug 23, 2013 2:32 PM CT

 
New laws passed by a dozen Republican-led states, the latest in Missouri last month, may make that harder, imposing licensing exams, fines that can run as high as $1,000 and training that almost doubles the hours required by the federal government. Republicans say the measures will protect consumers. Obamacare supporters say they’ll undermine the effort to get as many people as possible enrolled.
The rules are “like voter intimidation,” said Sara Rosenbaum, a health law professor at George Washington University in Washington, D.C., who supports Obama’s act. “In many, many cases these laws may be a direct interference with outreach assistance and that’s going to be quite serious.”
The Obama administration awarded 105 grants last week, steering money to hospitals, social-service agencies, local clinics and other groups. The navigators are meant to offer “unbiased information” to help people through the complexities of the new system, with its deductibles, copays, provider networks and tax credits, according to an Aug. 15 statement from the U.S. Department of Health and Human Services.
October Deadline
The grants were issued barely a month before the online exchanges are scheduled to open for enrollment on Oct. 1. The administration has said about 7 million people may enroll next year and it needs to motivate millions of young, healthy customers to sign up to keep the markets financially stable.
The state laws may complicate that task. The restrictions go farthest in a handful of states like Georgia and Missouri, where Republican legislators have already refused to set up the new insurance websites or spend money to promote the law.
In Florida this week, Governor Rick Scott told a Miami audience that federal privacy protections for consumers working with navigators were “behind schedule and inadequate.” He urged people to use brokers and agents instead.
Georgia Governor Nathan Deal, a Republican, believes navigators need state regulation because they’ll give advice on “a highly complicated and highly important topic,” his spokesman, Brian Robinson, said in an e-mail. They will also handle personal information that is open to abuse.
Consumer Protection
“This is a consumer protection issue more than anything,” said Kenneth Statz, an insurance broker on the legislative council of the National Association of Health Underwriters, a Washington-based group representing agents and brokers. “We just want to make sure that somebody who is sitting down with a consumer, trying to help them make this major decision, is going to be properly prepared.”
The state laws have passed with the backing of insurance agents and brokers, who view the online exchanges as competition and navigators as potential rivals with an unfair advantage absent new rules.
States require agents to be licensed and undergo periodic training, said Statz, who’s based in Brecksville, Ohio. He also has to carry insurance to protect clients who may be hurt by bad advice or malpractice, he said.
The 2010 law is intended to prod millions of Americans to buy health insurance, many for the first time. Those seeking coverage must provide details on citizenship, family size and income to determine whether they’re eligible for subsidies, and complete a form that can stretch to seven pages.
Federal Requirements:
While states controlled by Democrats such as Maryland, New York, Minnesota and Illinois have also passed rules, these generally follow federal requirements, said Mark Dorley, a health-policy researcher at George Washington University.
Other states have been more restrictive.
Georgia’s navigators need a license from the insurance commissioner. Each person assisting the uninsured has to pay a $50 application fee, complete 35 hours of training — 15 more than the federal requirement — pass an exam, and complete a criminal background check. Licenses must be renewed every year, requiring another $50 and 15 more hours of training.
Missouri defines navigators more broadly than the federal government, said Andrea Routh, executive director of the Missouri Health Advocacy Alliance in Jefferson City. Violating certification requirements risks a $1,000 fine.
Seeking License
Routh’s group, which seeks to educate people on the health law, didn’t apply for a grant. It may seek a license just to be safe, she said.
“Anyone who does outreach and education, or anybody who assists anyone with enrollment had better be checking that law to see if they need to be licensed,” she said.
Missouri voters approved a ballot initiative last year barring Governor Jay Nixon, a Democrat, from setting up the exchange without the assent of the Republican-controlled legislature, which has declined to act so far.
The rules may scare off churches, clinics or others who want to help, said Cindy Zeldin, executive director of Georgians for a Healthy Future. The Atlanta-based nonprofit was part of a group that won a $2.1 million grant.
Georgia’s law implies “navigators are somehow problematic,” she said in a telephone interview, “rather than that they’re groups that likely have a history of working in communities and are trusted.”
‘In Conversations’
The Obama administration has been “in conversations with states” to ensure their laws don’t hinder the effort, said Chiquita Brooks-Lasure, a deputy director at the federal health department, in an Aug. 15 conference call with reporters.
The federal law doesn’t require background checks, though navigators must provide quarterly reports and can lose their grants in cases of fraud or abuse. The administration is requiring them to undergo an initial 20 hours of training.
Some people opposed to Obama’s overhaul “want to see it fail,” said Missouri Health’s Routh. “If you put a lot of barriers in place that make it tough for nonprofits to go out and educate people and assist them in understanding the exchange, that may be one way to have it fail.”
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The Washington Post
Health and Science
States scramble to get health-care law’s insurance marketplaces up and running
By Sarah Kliff and Sandhya Somashekhar, Published: August 24
With a key deadline approaching, state officials across the country are scrambling to get the Affordable Care Act’s complex computer systems up and running, reviewing contingency plans and, in some places, preparing for delays.
Oct. 1 is the scheduled launch date for the health-care law’s insurance marketplaces — online sites where uninsured people will be able to shop for coverage, sometimes using a government subsidy to purchase a plan. An estimated 7 million people are expected to use these portals to purchase health coverage in 2014.
The task is unprecedented in its complexity, requiring state and federal data systems to transmit reams of information between one another. Some officials in charge of setting up the systems say that the tight deadlines have forced them to take shortcuts when it comes to testing and that some of the bells and whistles will not be ready.
“There’s a certain level of panic about how much needs to be accomplished but a general sense that the bare minimum to get the system functional will be done,” said Matt Salo, executive director of the National Association of Medicaid Directors. “It will by no means be as smooth and as seamless as people expected.”
Oregon announced this month that it will delay consumers’ direct access to its marketplace, opening the Web site only to brokers and consumer-assistance agents in order to shield consumers from opening-day glitches.
“Even though we’re testing now, once you actually have the system up, you don’t know what the bugs will be,” said Amy Fauver, spokeswoman for Cover Oregon, the state agency implementing the law there.
In California, which has the nation’s largest uninsured population, health officials have begun hinting that they may have a similar problem.
“It’s a complex system, and there’s a lot of navigation that needs to happen,” said Oscar Hidalgo, a spokesman for Covered California. He said the agency will know by early September whether the system will be ready in time.
If not, he said, customers will still be able to log on to the Web site and peruse insurance plans and view prices. When they get to the final step, however, they will not be able to sign up. They will have to contact a customer service representative to complete the final enrollment step.
Officials with the District of Columbia’s Health Link decided to put off building a Spanish version of its Web site until later this year, giving its staff bandwidth to complete other tasks they see more critical to the launch.
Until then, the District will have bilingual call-center workers and in-person helpers who will be able to help Spanish speakers navigate the site.
The hiccups are troubling to advocates, who worry that there will be mistakes that result in people being erroneously rejected by Medicaid or denied subsidies to which they are entitled. They are concerned that impediments will discourage the uninsured from signing up for coverage.
“There will be something up and running, but there will be serious, serious difficulties with it” that could result in delays and errors initially, said Robert H. Bonthius Jr., a lawyer at the Legal Aid Society of Cleveland. “It’s an extremely ambitious program, well-intentioned, that is going to be very difficult to accomplish, and it’s going to be months and maybe years before it really gets sorted out.”
With a key deadline approaching, state officials across the country are scrambling to get the Affordable Care Act’s complex computer systems up and running, reviewing contingency plans and, in some places, preparing for delays.
Oct. 1 is the scheduled launch date for the health-care law’s insurance marketplaces — online sites where uninsured people will be able to shop for coverage, sometimes using a government subsidy to purchase a plan. An estimated 7 million people are expected to use these portals to purchase health coverage in 2014.
See how the states have sided on some of the key provisions of the Affordable Care Act:
The task is unprecedented in its complexity, requiring state and federal data systems to transmit reams of information between one another. Some officials in charge of setting up the systems say that the tight deadlines have forced them to take shortcuts when it comes to testing and that some of the bells and whistles will not be ready.
“There’s a certain level of panic about how much needs to be accomplished but a general sense that the bare minimum to get the system functional will be done,” said Matt Salo, executive director of the National Association of Medicaid Directors. “It will by no means be as smooth and as seamless as people expected.”
Oregon announced this month that it will delay consumers’ direct access to its marketplace, opening the Web site only to brokers and consumer-assistance agents in order to shield consumers from opening-day glitches.
“Even though we’re testing now, once you actually have the system up, you don’t know what the bugs will be,” said Amy Fauver, spokeswoman for Cover Oregon, the state agency implementing the law there.
In California, which has the nation’s largest uninsured population, health officials have begun hinting that they may have a similar problem.
“It’s a complex system, and there’s a lot of navigation that needs to happen,” said Oscar Hidalgo, a spokesman for Covered California. He said the agency will know by early September whether the system will be ready in time.
If not, he said, customers will still be able to log on to the Web site and peruse insurance plans and view prices. When they get to the final step, however, they will not be able to sign up. They will have to contact a customer service representative to complete the final enrollment step.
Officials with the District of Columbia’s Health Link decided to put off building a Spanish version of its Web site until later this year, giving its staff bandwidth to complete other tasks they see more critical to the launch.
Until then, the District will have bilingual call-center workers and in-person helpers who will be able to help Spanish speakers navigate the site.
The hiccups are troubling to advocates, who worry that there will be mistakes that result in people being erroneously rejected by Medicaid or denied subsidies to which they are entitled. They are concerned that impediments will discourage the uninsured from signing up for coverage.
“There will be something up and running, but there will be serious, serious difficulties with it” that could result in delays and errors initially, said Robert H. Bonthius Jr., a lawyer at the Legal Aid Society of Cleveland. “It’s an extremely ambitious program, well-intentioned, that is going to be very difficult to accomplish, and it’s going to be months and maybe years before it really gets sorted out.”
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