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A key part of President Barack Obama’s signature health care reform is set to take effect Oct. 1. That day, Americans around the country will be able to access online marketplaces and compare shop health plans online. But in many jurisdictions, including the Washington region, the rollout may be complicated. While Maryland has been one of the most aggressive states in crafting its own health care exchanges, the state of Virginia has deferred entirely to federally-run exchanges. Meanwhile, the District-run exchange has hit a technical roadblock and may not be fully functional by the Tuesday deadline. Health care experts from around the region explain the local impact of the health care rollout.
- Kathy May Director, Virginia Consumer Voices for Healthcare
- Mila Kofman Executive Director, DC Health Benefit Exchange Authority
- Peter Beilenson CEO, Evergreen Health Cooperative; Former Health Officer, Howard County (Md.)
MR. KOJO NNAMDIA key part of President Obama's healthcare reform is scheduled to go into effect tomorrow, online marketplaces will open up in states across the country, allowing Americans to compare, shop insurance plans and determine their eligibility for federal benefits. It's been up to the states to decide how to comply with the healthcare exchange rule and local jurisdictions have taken different approaches. Maryland has become the Obama administration's poster child and it's been the most aggressive in setting up its own exchange, but just across the Potomac Tuesday's rollout could look a lot different.
MR. KOJO NNAMDIVirginia opted out of setting up its own exchange and will rely on the one the federal government provides. While in Washington officials have been working to get the District's exchange ready for tomorrow's deadline, but technical issues may mean the online marketplace won't be fully functional until November. Joining me to explain what all of this means is Mila Kofman, executive director of the D.C. Health Benefit Exchange Authority. She joins me in studio. Mila Kofman, thank you for joining us.
MS. MILA KOFMANThank you.
NNAMDIJoining us by phone is Peter Beilenson, chief executive officer and president of the Evergreen Health Coop. That's a new health insurance carrier in Maryland. Before that, Peter Beilenson was Howard County's health officer. Peter Beilenson, thank you for joining us.
MR. PETER BEILENSONThanks for having me.
NNAMDIMila, let's start with the District's exchange, which won't be 100 percent ready because of glitches in the technology. What parts of the exchange will be working starting tomorrow and which will be delayed?
KOFMANWell, I'm here to announce very exciting news. We are fully ready to…
KOFMAN…open our doors tomorrow for all small businesses. So starting tomorrow a small business can come on our website, set up a secure account, decide which options to offer to his or her workers. And, of course, you know we have full employer choice. Which means an employer can allow workers to choose all plans, from all insurance companies in a middle level or an employer can allow employees to choose all plans offered by a particular insurer, or the employer can do what most do today, which is pick a plan and pick an insurer. So we are ready with all of the functionality.
KOFMANAn employer can decide how much to contribute toward employee coverage, toward dependent coverage. And open enrollment for employees can start as soon as November 1st. It's really up to the employer. And as long as we get the full payment by December 12th, coverage will be effective for January 1, 2014, for that employer's workers. So we're fully functional.
NNAMDINo glitch-stuff that I mentioned?
KOFMANOn the small business side we are fully functional. We have 267 different insurance plans, HMOs, PPOs, HOC compatible plans all major insurance companies are selling, so we have Etna and United and Kaiser and CareFirst, so no glitches on the shop side.
NNAMDIBut what about the technical glitches reported on last week? What was that about?
KOFMANThere was a lot of misinformation. And I appreciate the opportunity to set the record straight. So people who are ready to shop, they can go online as soon as tomorrow and look at their coverage options, look at all 34 different health policy choices that they'll have on the individual side, and enroll if they would like to. I don't expect a high enrollment because coverage doesn't become effective until January. And they have until December 15th to pay, but people can start shopping and they can enroll and pay if they would like to.
KOFMANWe did have on glitch, which is we can't tell…
KOFMANUnfortunately, with all IT startups and, as you know, with any kind of IT there always are glitches, but we discovered ours early. And so for the month of October anyone who is eligible for Medicaid, they can come to any of our city service center locations and apply. They can apply online and there is absolutely no delay in processing Medicaid applications. And anyone who is eligible for premium reductions, we found a glitch that essentially resulted in inaccurate determinations for a small segment of our test cases. And so we're holding off those until we can fix that properly. And everyone who comes to us and applies in October, they'll get a determination by early November.
KOFMANAnd there's plenty of time to enroll, select and pay. And there is absolutely no delay for their coverage.
NNAMDIPeter Beilenson, Maryland has been the administration's goal star student when it comes to the healthcare exchange rule. The state has been actively setting up its own exchange for many months now. What will this mean for the consumer? How will Maryland's aggressive efforts in setting up an exchange affect the consumer experience when enrollment begins tomorrow?
BEILENSONWell, I think actually we're sort of doing the reverse of what D.C. is doing. Our small business exchange has been delayed a little bit, but we don't think that'll be terribly robust. So the individual exchange opens tomorrow. And just for a quick step back for your listeners, although many certainly do know this, there's still about 66 percent of people don't know that the exchange opens tomorrow. And then 50 percent or so, at least in the country, don't know what it is. So the exchanges are the virtual marketplaces where individuals or small businesses can go to get -- in the individual case, subsidies, tax subsidies, federal tax subsidies that help to make coverage more affordable for people of working class to middle class incomes.
BEILENSONAnd in Maryland the individual exchange opens tomorrow. There don't seem to be any real glitches with it. It certainly will be a rollout period, which we don't expect to be perfectly smooth. There will clearly be some bumps, but there's a six-month enrollment period starting October 1st to March 31st. So we expect tens of thousands of people to be enrolled in Maryland.
NNAMDIBefore we go too far into the details, we need to get one question straight, Peter. Who should be thinking about enrolling in these healthcare exchanges? Who are they designed for?
BEILENSONActually, almost any individual can go on, but they are predominately designed for folks who can't afford coverage now or are not offered affordable coverage and are between basically -- you can be 100 percent, but more likely 138 percent to 400 percent of the federal poverty level, which in real terms means a family of four, for example, making between 28,000 and 92,000 and less for individuals or smaller families -- anybody in that income range is eligible for fairly significant federal subsidy at the lower end of that range and a somewhat significant federal subsidy at the higher end of that range.
BEILENSONAnd the only way you can get that subsidy, to make it more affordable under the Affordable Care Act, is to go on your state's individual exchange.
KOFMANSo in the District, our target population is everyone who lives in the District and District businesses. We are trying to reach people who qualify for premium reductions, as well as people who qualify for Medicaid, as well as people, middle and upper income wage earners who don't qualify for premium reductions, but are looking for easy ways to shop for health insurance, to compare apples to apples and to find competitive priced products. And that's our target. And we want to serve all small businesses. And when people come to our DCHealthLink.com website tomorrow they'll see that we have very competitive, affordable rates for everyone.
NNAMDI800-433-8850 is our number. If you have any questions or concerns about the Healthcare Exchange opening in your state, you can call us at 800-433-8850. You can send email to firstname.lastname@example.org. Send us a tweet @kojoshow or go to our website, kojoshow.org, ask a question or make a comment there. I'm Kojo Nnamdi.
NNAMDIWelcome back, the Washington region is preparing for the Healthcare Exchange rollout which occurs tomorrow, October 1st. So we're talking with Peter Beilenson, chief executive officer and president of the Evergreen Health Coop, a new health insurance carrier in Maryland. Before that Peter was Howard County's health officer. Joining us in studio is Mila Kofman, executive director of the D.C. Health Benefit Exchange Authority. And we're taking your calls at 800-433-8850.
NNAMDIMila, some individuals in our area may be wondering whether they should drop their employer's plan and see if they can get a better deal in their state's exchange, how would they go about making that decision, making that call?
KOFMANSo you do not want to drop your job-based coverage because when you have employer-sponsored insurance your employer's contributing a significant part toward your premium. So I discourage people from dropping job-based coverage that they have today. Now, if they work part time and don't qualify for job-based coverage, I really encourage all of those folks to come to DCHealthLink.com and check out what we have to offer. We are working with large businesses, as well as small businesses, to make sure that everyone knows about the new coverage choices that we'll have starting tomorrow.
NNAMDISame in Maryland, Peter Beilenson?
BEILENSONYeah, basically the same in Maryland. Unless your company is not offering decent coverage or affordable coverage, that basically staying with your employer-sponsored coverage is definitely the best way to go.
NNAMDIOf course enrollment begins tomorrow and maybe the most important service we can provide is to remind people that enrollment begins tomorrow because, as Peter said earlier, a lot of people may not be aware of that. But it lasts until March of next year. Is there any advantage to applying earlier, Peter?
BEILENSONYes. I mean, if you apply before -- as Mila was saying -- generally before December 15th and pay by December 15th your coverage begins January 1st, which clearly is beneficial. If you apply later in the enrollment period, you know, that obviously starts later. Although, the individual mandate, the penalty for which people pay on their taxes, if they don't get coverage only takes affect if you're missing more than three months of coverage during the year. So as long as you apply by March 31st, as far as we know to this point, there's no individual mandate penalty. But you don't get covered until later in the year.
BEILENSONKojo, if I could, could I just mention what we are?
BEILENSONSo under the Affordable Care Act a tiny little section passed when the public option fell out of the bill. Senator Conrad of North Dakota at the time proposed it. And it allows for the setting up of non-profit health insurance cooperatives. A big term basically meaning a non-profit insurance company operated by its members -- so our board will be predominantly members -- to compete with the big guys on the exchanges. And so we're one of 23 in the country. And we're the only one in the region and so I will eventually talk with Mila Kofman about potentially coming down to D.C. if we are successful, which we certainly think we will be.
KOFMANWe welcome you.
NNAMDIJoining us now by telephone is Kathy May. Kathy May is director of Virginia Consumer Voices for Healthcare, a program that has been educating Virginia residents about the Affordable Care Act. Kathy May, thank you for joining us.
MS. KATHY MAYThank you for having me, Kojo.
NNAMDIKathy May, Virginia has deferred entirely to federally-run exchanges. So what kind of experience can Virginia residents expect to have when they try enrolling tomorrow?
MAYWell, it certainly does look a little different here because of that. I think ultimately that Virginians will find that they can enroll, so that they should take advantage of the opportunity, but there's been a lot less buzz, a lot less noise around the build-up to this in Virginia. So there are still some people who are confused and have lots of questions. We also have a lot less manpower on the ground because of our choice to have a federal marketplace, rather than develop our own state-based marketplace. An example is that we had about $1.5 million in funding come from the federal government to support our navigator system. And we have about 20 navigators around the state.
MAYWhereas, I believe in Maryland there are somewhere around 300 or 350 navigators.
BEILENSONYeah, in the Montgomery County area alone there's three times what you have.
NNAMDI800-433-8850's the number to call. I am going now to Chico in Dumfries, Va. Chico, you're on the air. Go ahead, please.
CHICOThank you, Kojo. My question is what is the option for an employee that has insurance coverage with his company, that the company does not contribute the deductions of the premiums physically from the employee. The premium looks very high. What is our option? Can we opt out from the employee insurance coverage?
NNAMDIYou're saying that in this case the employee pays the entirety of cost for the coverage?
NNAMDIOkay. Here's Mila Kofman.
KOFMANSo if you are a District resident or if your employer is located here in the District, certainly the employer can come to us and check out the new options, but you should come to dchealthlink.com and check out your options. You may, in fact, qualify for premium reductions, but even if you don't, our coverage is priced at a very competitive rate. And we offer low deductible, low cost-sharing options. So I strongly recommend that you check that out. You'll probably find it a better deal to come to us.
KOFMANAnd if I can also add that here in the District we have several hundred trained D.C. Health Link assistors, people on the ground who can help you through this very major decision, that's not a quick decision for many people figuring out which health plan is best for them. We also have trained brokers on the ground to provide in-person advice. So I would encourage everyone here, especially in the month of October, to avail themselves of the concierge service, level of customer service that we're trying to provide. And also we're hosting a number of seminars at the libraries, at CVS's, at other locations around the District. So I encourage everyone to come to one of our seminars and learn about the new options that you have.
NNAMDIChico, thank you very much for your call. Peter, Maryland doesn't offer an exchange for small businesses until January 1st for coverage that would start March 1st, yet the law requires individuals to have insurance coverage by January 1st or they could face a penalty. Will the delayed date for small businesses cause some individuals to miss that deadline?
BEILENSONVery, very few. The Shop Exchange, which is the name of the small business exchange, is never expected to be terribly robust in Maryland. So we don't think that's going to be causing a problem. I should mention that the navigator system is also true in Maryland. And there'll be a lot of help for people on the ground. But I think it's important to point out for folks who are going to go on the exchange potentially by themselves that is really not simple. I mean, that's sort of an important message to get across. You're just not going to be able to go online, like you do with Travelocity, which I sometimes use as the analogy for the exchange and pick, you know, the flight to Los Angeles that's leaving at the right time.
BEILENSONThe health care can be complicated. Oftentimes you'll need a navigator to help. And there'll be plenty of help certainly in D.C. and Maryland, but you've got to be careful not to just look at the sticker price. Health insurance companies are trying to sell oftentimes on the premium, and you have to, as Chico was talking about, look at the deductibles and copays and look at the total cost, which can take a little bit of effort.
NNAMDIWe've got a question from an emailer who asks, "If I don't sign up for health coverage during the open enrollment period, will it be available to me enroll next year at this time or is this open enrollment a one-time deal? I live in Maryland." Peter?
BEILENSONOpen enrollment ends March 31st and you cannot sign up again until October 1st through December 31st of next year, except if you have a life event, as it's so called. A divorce, a new child, a 26-year-old child becoming 26 and falling off his parents' plan, all those life-event changes are allowed to go on the exchange in the interim, but otherwise you cannot join until October 1st of next year.
NNAMDIKathy May, how has the Commonwealth of Virginia prepared residents for this part of healthcare reform? And how does that compare to what you're hearing about taking place in the District and Maryland?
MAYWell, certainly I think that the outreach has been more robust in Maryland and the District. I think that state and local governments have been part of rolling this out or providing some of the outreach in education and that kind of commitment hasn't been true in Virginia. I mean it's not a secret that there's been some resistance to the Affordable Care Act in Virginia. Our governor chose not to have a state-run marketplace and our General Assembly is still kind of debating over the Medicaid expansions.
MAYSo I think that it's definitely something that is less in the forefront in Virginia. So the non-profits that are kind of gathering together around this have a heavy load to lift.
NNAMDIHere is Denise in Washington, D.C. Denise, your turn.
DENISEThank you. I apologize if this has already been covered, but do recipients of D.C. Medicaid need to pay attention to this and go online or do they, you know, are they just fine the way they are?
KOFMANSo if you have Medicaid coverage now, you do not have to worry. If you're seeking Medicaid coverage you can go to any of the service centers, as they exist now, and fill out a paper application with the help of one of the service center customer service folks. You can go online to DCHealthLink.com and fill out the long-form application, which is the application for assistance, both Medicaid and premium reductions. And your application will be processed very quickly, without delay, just like Medicaid is processed now.
KOFMANSo if you have Medicaid, no change for you. If you're looking for Medicaid, it's just one more way to access Medicaid coverage.
NNAMDIDenise, thank you very much for your call. Peter, earlier this month a report from the Kaiser Family Foundation found that premiums around the country were generally less than the government originally projected. It was the case with premiums in Virginia, Maryland and D.C. How do you explain the difference between the government's projections and the reality we're seeing?
BEILENSONWell, I think some of it may have been purposefully projecting a little bit more expensive so it would look better, because obviously you want to look at the optics of the thing. Secondly, I think that insurance companies, ours included, have been taking a realistic view at things and were able to offer competitive pricing. In part, though, it's the networks of coverage that people will be offering. So the PPO, the Preferred Provider Organization where you get a pamphlet of doctors and nurse practitioners that you can see may have been broader in the previous system, if you will, than is currently the system.
BEILENSONBut I think people will get very good coverage. As you know there will now be free preventive services, which wasn't necessarily true before, for people under the age of Medicare. And I think part of what's going to happen in the next year or two is seeing how many young people get enrolled. Because the more young people that get enrolled, obviously the lower overall costs. And that will help to keep premiums down. I don't think premiums will stay as low as they are now if we don't get young people enrolled. So it's really important to get that group into the system. And it's going to be easier, I think, than some opponents have said, in that, you know, my son, for example, is 26. He's coming off of our plan.
BEILENSONHe makes about $30,000 as in individual and he'll be paying with subsidies -- or actually $25,000. He'll be paying with subsidies maybe $100 a month. So it's much more manageable than people I think have said.
KOFMANSo here in the District we're slightly different than other states. Coverage that's sold through D.C. Health Link has the exact same networks that coverage has now. So we do not have smaller networks. We have nationwide networks and we have networks throughout the greater Washington area. And that's an important difference to keep in mind. Also, earlier this year our city council passed legislation that encourages and forces real competition based on price. So what we found was once the insurance department posted proposed premium rates, one insurance company went back and voluntarily lowered their rates twice to be more competitive.
KOFMANAnd another one lowered their rates and a third one, not only lowered their rates voluntarily, but added additional products. So what we've seen here is true price competition. And, of course, our insurance regulator did a very good job reviewing rates to make sure that they're fair.
NNAMDIKathy May, your group works to inform Virginia residents about changes on the healthcare reform. How successful have you been in informing people about the change that will happen tomorrow?
MAYWell, I think people still have a lot of the same questions they had from the beginning. And I think the biggest question is how is this going to affect me. And I think until we start seeing people signing up and talking to our neighbors about their experience doing that, talking to our friends and seeing what it's about, that's when some of the, you know, the fears will be calmed. I think that that's still the biggest question we get. It's all about, you know, what is this going to do to my health insurance? And what we have to remember is that for 85 percent of the people there's not going to be any significant change that they'll see.
MAYThere's going to be some positive changes that they'll see, like being able to keep their kids on their plan, but there's nothing significant. It's those 15 percent that have to go out and buy their individual policies that will have more options now.
NNAMDIKathy May is director of Virginia Consumer Voices for Healthcare. That's a program that's been educating Virginia residents about the Affordable Care Act. Kathy May, thank you for your joining us.
NNAMDIPeter Beilenson is chief executive officer and president of the Evergreen Health Coop. That's a new health insurance carrier in Maryland. Before that he was Howard County's health officer. Peter Beilenson, thank you for joining us.
BEILENSONThanks for having me.
NNAMDIAnd Mila Kofman is executive director of the D.C. Health Benefit Exchange Authority. Mila Kofman, thank you for joining us in studio.
NNAMDIAnd thank you all for listening. I'm Kojo Nnamdi.
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