Reform Update: Consumer outreach, education on backburner in exchange planning

As states and the federal government work feverishly toward having health insurance exchanges ready for enrollment by Oct. 1, much of the discussion has focused on technology readiness, guidance from the CMS and competition from insurers. But one crucial element not brought up as often but still significant is outreach and education of consumers who will be the marketplaces' customers.

As a poll from the Kaiser Family Foundation this week brought to light, outreach efforts still have a long way to go. The Kaiser tracking poll found that many Americans are confused about the healthcare reform law, given that 42% of respondents were not aware the law is in place, while another 12% thought the law was repealed by Congress.

Timothy Jost, a healthcare policy expert and professor at the Washington and Lee University School of Law, said he would like to see the federal government spend more on outreach to consumers, but figures their resources are constrained by the current sequester. However, he adds that getting out the message about the reform law and exchanges has been hampered by what he calls a “misinformation campaign” promulgated by some groups.

For example, Jost told Modern Healthcare that a neighbor recently received an e-mail about the reform law, though with information based on an early House version of the Patient Protection and Affordable Care Act. The feds “could use a $1 billion campaign that contains facts” about the law to counteract the misinformation,” he says. “I wish the administration had more resources to devote to that.”

Even state insurance commissioners are worried about a barrage of questions and concerns from consumers as Oct. 1 approaches. “My biggest concern is how to handle consumer calls,” Kansas Insurance Commissioner Sandy Praeger (R) said today at the National Health Insurance Exchange Summit in Arlington, Va., adding that in “the first year, it's going to be very time consuming.”

Addressing outreach concerns at a conference Wednesday in Washington, acting CMS Administrator Marilyn Tavenner said the agency would hold off its big outreach push for enrollment until late summer or early fall, as it is closer to the Oct. 1 start of enrollment.

At least one director of a health exchange said that the outreach should begin sooner rather than later. Speaking at the exchange conference today, Connecticut Health Insurance Exchange CEO Kevin Counihan said “it's a mistake” for the administration to delay outreach. “This implementation is so complicated (it's ripe) for political fodder,” he said, adding there should be a coordinated plan from HHS so that consumers get the right impression about the law. “A more aggressive, coordinated outreach and communications plan would be good.”

The CMS on Wednesday released further guidance on the role of agents, brokers and online brokers in exchanges. An agent or broker can enroll a consumer either directly through an insurer's website, which is known as an insurer-based pathway, or through the exchanges. Under the former method, a broker must notify the customer that they are providing only information on plans they do business with and can access other plan options through the exchange, but an agent will be paid directly by the carrier. Under the other process, known as the exchange direct pathway, a broker accesses the exchange directly with all plan options shown and assists the consumer.

In a state-run exchange, a state can choose whether the state or insurer will compensate an agent, while in partnership and federally facilitated exchanges, the federal government will not offer compensation, though a state can choose to do so.

A pair of bills introduced last week in the House would require the president, vice president, members of Congress and their staffs to get their health insurance through a marketplace. Congressional leaders, including Sen. Majority Leader Harry Reid (D-Nev.) and House Majority Leader Rep. John Boehner (R-Ohio), are said to be in talks over an exemption for lawmakers and their staffers, according to a report in Politico on April 24. The rationale for the exemption is that it is unclear whether lawmakers and their aides would continue to have their premiums subsidized by the federal government if they are required to get coverage through an exchange, said Sabrina Corlette, project director at the Center on Health Insurance Reforms at Georgetown University's Health Policy Institute.

The bill introduced Friday by Rep. Dave Camp (R-Mich.), chairman of the House Ways and Committee, would “provide that the only health plans that the Federal Government may make available to (federal employees) are those created under the Patient Protection and Affordable Care Act or offered through a health insurance exchange.”