Kevin Counihan is resigning as the chief executive of Connecticut’s health insurance exchange to lead the once-troubled federal Obamacare marketplace, officials announced Tuesday.
As CEO of the federal exchange, Counihan will assume responsibility for the HealthCare.gov insurance marketplace, a crucial piece of the Affordable Care Act that is used to enroll people in coverage in nearly three dozen states. The federal exchange’s launch last fall was considered disastrous, and Counihan’s appointment comes less than three months before the Nov. 15 start of the second open enrollment period for private insurance.
Counihan will also run the Center for Consumer Information and Insurance Oversight, a part of the federal Centers for Medicare and Medicaid Services that plays a key role in implementing the health law.
Counihan has led Connecticut’s exchange -- which sells private insurance plans and enrolls people in Medicaid -- since 2012. He previously worked at Massachusetts’ exchange during the state-level health reform effort under then-Gov. Mitt Romney.
The board that oversees the state's exchange will appoint an interim CEO in the next week and conduct a national search for Counihan's replacement, said Lt. Gov. Nancy Wyman, who chairs the board of the exchange, Access Health CT. Counihan's last day at the exchange will be Sept. 5.
Connecticut’s exchange has garnered national attention as one of the country’s better-performing marketplaces, a contrast to the federal exchange, and to some states where the exchanges were nearly nonfunctional last fall.
One state with a troubled exchange, Maryland, decided earlier this year to scrap its model and use Connecticut’s system. Access Health has been marketing its system to other states as an “exchange in a box,” which Counihan has said could be an alternative for states to avoid building their own marketplaces from scratch. Nine states have been in contact with the exchange about it, Gov. Dannel P. Malloy said Tuesday.
More than 250,000 Connecticut residents have signed up for health care coverage through Access Health -- about 70 percent in Medicaid and 30 percent in private insurance plans. Earlier this month, Counihan and state officials announced that more than half of the enrollees had been uninsured previously, something they said indicated a significant reduction in the state’s uninsured rate.
But Connecticut’s exchange hasn’t been free from trouble. A programming flaw led 903 Access Health customers to lose their insurance coverage this year. In June, a data breach occurred when an employee of the vendor that operates Access Health’s call center left a backpack containing notebooks with customer information on a Hartford street. And federal auditors raised concerns about the internal controls used at Access Health, as well as the exchanges run by California and the federal government.
What’s next for Access Health CT
Counihan's successor will arrive amid the re-election campaign of Malloy and Wyman, two strong backers of the Affordable Care Act. Malloy described Counihan's appointment as a validation of Connecticut's efforts.
Connecticut has embraced the health law, becoming the first state to expand Medicaid after the health law passed in 2010. (The decision to expand the program was made by then-Gov. M. Jodi Rell, a Republican, and was largely free from controversy, in contrast to the intense fights over whether to broaden the program in many other states.)
But Counihan’s departure leaves the state’s exchange without a top leader as it prepares for the next round of open enrollment for private insurance plans. Officials are anticipating a dual challenge: Reaching those who remain uninsured -- a population that’s likely to be harder to reach than those who signed up already -- and making sure that existing customers remain covered.
Access Health must also become financially self-sustaining next year, after starting up with federal funds. The quasi-public agency will rely in part on an assessment charged to insurers, and is exploring other revenue streams, including possibly selling the code used for its mobile application to other exchanges. (Letting other states use Connecticut’s exchange system doesn’t bring in money because the code was developed with federal money, meaning it’s free to other states.)
Malloy downplayed concerns about the timing of Counihan's departure, pointing to the exchange's track record so far and the staff in place. And he said it's in Connecticut's interest to have the federal government "get their program in order," noting that some people in the state avoided trying to enroll last fall, wrongly believing the HealthCare.gov problems affected Connecticut.
Counihan's advice: Manage vendors, simplify
Counihan, who said he was recruited for the position, said Connecticut’s exchange had demonstrated that government could successfully handle a complex program.
“I fundamentally think that one of the most important things we did was we showed that government can work,” he said during a press conference announcing his departure, held at Access Health’s downtown Hartford office.
He spoke of the importance of keeping things as efficient, cheap and simple as possible, and the need to maintain clearly defined objectives and avoid “scope creep.”
“I just believe that this is about simplicity and ease in doing everything that either the states or the feds can do to make a complex purchasing decision as easy as possible,” he said.
Asked about the idea of regionalizing exchanges, Counihan said it’s too early to say. But he added, “I don’t think you need 50 of these.”
In the past, Counihan has attributed Access Health’s relatively smooth functioning in part to the decision to outsource many functions at the start, to allow staff to focus on the most important elements of establishing an insurance marketplace. Access Health outsourced its call center and the running of its small-business exchange, for example.
Many problems at other exchanges have been blamed on vendors. But Counihan has said that it’s the responsibility of officials to manage their vendors.
Speaking to the National Association of Health Underwriters in February, Counihan noted that vendors have an incentive to say they can do something.
“Sometimes the client has to be the adult to say, ‘You know what, why don’t we scale this back to the basics?’” he said.
In that speech, Counihan also recommended that the enrollment process be as simple as possible. As with a car, he said, the more features you get, the more likely it is to break.
Access Health officials have worked to minimize their system’s reliance on the federal government for data used during the application process, using state-level data and other information sources to avoid a federal data hub they figured could be problematic.
Thirty-four states rely on the federal government to fully or partially run their exchanges this year. Two other states, Idaho and New Mexico, run their own exchanges but have received help from the federal exchange while they get their IT systems fully functional, according to the Kaiser Family Foundation, which tracks state exchange activities.
The new job will take Counihan from a state that has largely embraced the health law to one where it’s far more controversial (“Going to Washington, you should have your head examined,” Malloy said after congratulating Counihan).
“I fundamentally think, and this may be naïve, but I’m fundamentally optimistic that people really want to do the right thing, and that people understand intuitively that having people uninsured is not right for them or right for the country,” Counihan said Tuesday. “Now, how we go about doing it, people can debate, and there can be solid policy differences. But I’m fundamentally optimistic that even though there are some big ideological schisms, that those can be bridged.”