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Reform Update: Insurance enrollment expected to surge on exchanges

(This article has been updated with a correction.)

HHS and consumer groups are preparing for a very busy final month of Americans signing up for insurance on the federal, state and private health insurance exchanges.

With March 31 the last day for consumers to enroll, HHS announced Thursday that it anticipates a “surge in activity” before the deadline. To ready itself, this weekend HHS will transition 1,500 customer service representatives from web chat to direct telephone service so they can help consumers with open enrollment 24 hours a day, seven days a week. The department has also added an additional 800 Spanish-speaking representatives to its call center operations and will provide more training for both call center staff and in-person assistants. By HHS' count, some 14,000 call center personnel and more than 25,000 in-person assistants will be available across the country to help people get covered.

In an announcement about, the initially glitch-plagued federal portal where consumers in 36 states can sign up for coverage, CMS' office of communications director Julie Bataille said, “We keep working to make the site even simpler and more user-friendly. The site continues to perform well—serving consumers with response times of less than half a second and error rates of less than half a percent.”

That's a much different picture than it was last fall, when's disastrous rollout worried consumers, healthcare providers, and policymakers who wondered whether the site would fix its technical and operational problems in time for Americans to enroll.

“There's no question that a significant corner has been turned,” Ron Pollack, executive director of consumer advocacy group Families USA, told Modern Healthcare. He expects momentum to continue throughout March.

The “first, second and third priority” for Families USA in the next month will be to enroll as many people as possible, Pollack said. Toward that goal, the group will continue to work on initiatives such as: building awareness among the Hispanic community, through television and other media, about the health reform law's coverage options; hosting media teleconferences to outline effective enrollment strategies; and serving as an information source to web site navigators and in-person assistants.

The primary focus over the next 31 days should be attracting the previously uninsured, said Sam Gibbs, president of eHealth Government Systems. The company operates, the nation's first private health insurance exchange where individuals, families and small businesses can compare insurance products and enroll online. The company also serves as a web broker with CMS to help people enroll in the exchange plans.

“One of the goals of the Affordable Care Act is to reduce the number of uninsured people,” Gibbs said in an e-mail. “However, a recent survey by McKinsey &Co. showed only 11 percent of consumers who bought new coverage under the law were previously uninsured. There needs to be greater focus on reaching those people.”

Cultural inequality and health literacy

As Families USA reaches out to educate the nation's Hispanic community about insurance coverage options, it faces some major hurdles: a new survey from the Robert Wood Johnson Foundation this week found that just 21% of Hispanics report they are confident that they understand key health insurance terms. Measures of health literacy have shown a 36% rise for non-white, non-Hispanic adults and have jumped to 52% of white adults, according to researchers from the left-of-center Urban Institute which produced the report. Only one-third of white, non-Hispanic adults reported confidence that they understood nine common insurance terms, such as “premium, “copayment” and “deductible.” That number dropped by more than 10 percentage points for non-white, non-Hispanic individuals and by almost 24 percentage points for Hispanics. Without targeted, culturally appropriate outreach efforts, the authors assert, these gaps could have a negative effect on enrollment in both Medicaid and the insurance exchanges in the weeks ahead.

Physician payment formula fix fizzling

March 31 marks not only the last day of open enrollment on the health insurance exchanges, but also the last day of a temporary patch to Medicare's physician payment formula. Momentum on a permanent repeal bill—which had been building until late last month –appears to be waning, as lawmakers have yet to propose a way to pay for the hefty price tag that comes with the repeal. This week, the non-partisan Congressional Budget Office released a cost estimate that found the SGR Repeal and Medicare Provider Payment Modernization Act of 2014—the legislation that the Senate Finance, House Ways and Means and House Energy and Commerce Committees unveiled earlier this month—would cost about $138 billion between 2014 and 2024.

Republican ACA alternative remains to be seen

House GOP leaders still say they're committed to introducing health reform legislation to replace the Patient Protection and Affordable Care Act, but there is no strong sign that it will happen anytime soon, if at all. At his weekly news conference, House Speaker John Boehner (R-Ohio) said there are two big issues for Congress this year: the economy and the Affordable Care Act. “Our old system had its problems, but my goodness, the president's made the problems in our healthcare system 10 times worse,” Boehner said during a briefing in the Capitol. “So we're going to continue to go through a lot of ideas," he said, adding that GOP members have introduced 126 ideas to fix or replace Obamacare. At this point, it's unclear whether Boehner's caucus will come to agreement on anything substantive. The Ohio Republican noted that House Majority Leader Eric Cantor (R-Va.) was scheduled to meet Friday with House Majority Whip Kevin McCarthy (R-Calif.) and Rep. Cathy McMorris Rodgers, chairman of the House Republican Conference, who have convened what the House GOP is calling the “HOAP group” (House Obamacare Accountability Project) to lay out alternatives to the Affordable Care Act. Just last month, Cantor vowed the GOP would pass an ACA alternative this year. But in an interview with the Wall Street Journal this week, Cantor retreated a bit, saying “We may have an opportunity to put an alternative in place.”

Murthy nomination moves forward

The Senate Health, Education, Labor and Pensions Committee this week approved Dr. Vivek Murthy to serve as the nation's next surgeon general. His nomination will now be sent to the full Senate for approval.

Follow Jessica Zigmond on Twitter: @MHjzigmond

(This article has been updated to correct the name of the HOAP group.)



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