When the major provisions of the federal health reform roll out over the coming months, don’t expect a smooth start.
That’s the message from Kevin Counihan, CEO of Access Health CT, the state’s health insurance exchange — a key piece of the law commonly known as Obamacare.
“This project is going to take three to five years to fully implement. It’s going to be rocky in this first year,” Counihan said during a meeting of the exchange’s board Wednesday. “This is not simple. It’s highly complex. It’s unprecedented, and it’s not going to be smooth.”
The exchange Counihan runs is a marketplace for individuals and small businesses to buy health plans, and it’s expected to offer coverage to as many as 100,000 people next year, many at discounted rates. It’s one of the major ways the federal health reform law will chip away at the number of people without health insurance. Another is by expanding eligibility for Medicaid to cover more poor adults who don’t have minor children.
Counihan likened the rollout of Obamacare to the start of Medicare and the Medicare Part D drug benefit, programs that he said took years to stabilize. He said Thursday that he’s trying to give people realistic expectations because opinions are so polarized about the health reform law. People who don’t like it will be looking for errors, and those who expect perfection will be disappointed, he said.
“All I’m trying to do is to manage expectations that this is going to take a good three years to work through,” Counihan said, adding that it’s inevitable that there will be disruptions, such as if the connection to federal data need to handle applications crashes or goes down for maintenance.
But he said the technical difficulties would be outweighed by the benefits of the law, which will allow people with pre-existing conditions to get coverage, prohibit women from being charged more for insurance than men, and eliminate limits on the amount of medical coverage a person can receive in a lifetime.
Counihan’s words of caution come as agencies at the state and federal level work to create the infrastructure necessary to allow for the expansion of health care coverage to millions of American beginning Jan. 1. And they follow a report released earlier this month by the Government Accountability Office that raised questions about whether the federal government would complete the work necessary for exchanges in many states to open on time.
The federal health reform law calls for each state to have a marketplace known as an exchange, to sell health plans to small businesses and individuals. Connecticut is one of 17 states running their own exchanges. The rest are relying more heavily on the federal government to run or play a large role in their exchanges.
The exchanges must begin accepting applications for enrollment Oct. 1, and coverage will take effect Jan. 1. The GAO report focused largely on the federally run exchanges, and warned that “much remains to be accomplished within a relatively short amount of time,” including “several critical tasks.”
One key piece still being worked on is the federal data hub, which provides access to data from the federal government and other sources needed to verify information on people’s applications for coverage through the exchange. It will include the ability to verify a person’s Social Security number, income, citizenship, immigration status and eligibility for other health care programs with data from the Internal Revenue Service, Department of Homeland Security, Department of Defense and other agencies.
In response to the GAO report, the U.S. Department of Health and Human Services wrote that it is “extremely confident” that the exchanges will open on schedule.
A potential pitfall, Counihan said, is that all tests of the enrollment systems being used at the state and federal levels involve hypothetical data, not real information. So it won’t be clear how the connection between the enrollment system and the data from various government agencies really works until the systems go live Oct. 1. And it’s not clear what will happen if someone entering data makes an error, like mixing up a digit on a Social Security number, he said.
But Counihan said Connecticut is better positioned than many states to begin enrolling customers in October.
“I feel confident that we’re going to be up and running on 10-1,” he said. “I’m not sure that every state can say that, but we can say that.”
That means that people will be able to use the exchange’s website to compare health plans side-by-side more easily than they can now. There will also be choices for employees of small businesses. And there will be people trained to help consumers navigate their options, as well as retail stores that people can go to for help.
The state’s exchange staff will also develop contingency plans in case problems develop, such as the federal data hub going down for a period of time, he said.
“We’re doing everything we can to try to mitigate problems, but they’re going to be there anyway,” Counihan said.
People who buy coverage through the exchange will be able to choose between health plans offered by private insurers, including Aetna, Anthem Blue Cross and Blue Shield, ConnectiCare and HealthyCT, a new nonprofit carrier. UnitedHealthcare also plans to offer coverage to small businesses but not individuals, while Aetna will offer coverage for individuals but not small groups.
The exact cost of coverage is still being determined. The carriers have made proposals, but the Connecticut Insurance Department must first review them. The agency can approve the rates as proposed, or require that they be adjusted.
According to the exchange’s figures, an estimated 176,000 state residents will be eligible for federal subsidies to reduce the cost of buying insurance through the exchange. They’re available in the form of tax credits, paid in advance, to people earning up to 400 percent of the poverty level, or around $94,000 for a family of four.
The exchange won’t replace the state’s existing individual and small-group insurance markets, but will be another option for people who get their coverage through them. For people who seek coverage through the exchange but qualify for Medicaid, it will help enroll them in that program.