Counihan on Oct. 1, 2013, the first day of the first open enrollment period under Obamacare.

As the next big milestone for the federal health law approaches, Connecticut’s health insurance exchange chief is once again warning that things aren’t likely to go smoothly.

“January 1 is going to be clunky,” Access Health CT CEO Kevin Counihan said Friday during a conference call with reporters. Jan. 1 is the first date that plans sold through state-based exchanges like Access Health take effect.

Among the potential problems Counihan cited:

  • One insurer hasn’t programed its system to produce bills that reflect what customers receiving discounted rates really owe, rather than the full, unsubsidized cost.
  • Wait times to Access Health’s call center are averaging 20 minutes  — an amount that Counihan said are too long.
  • The federal government unveiled a new policy Thursday evening that could affect plan purchases by people whose old policies are being discontinued.

And there are nearly 26,000 people who started applications for coverage through Access Health but didn’t complete them. Concerned that some could try to get care in January thinking they’re insured, Counihan said the exchange is notifying each of them by phone and overnight mail that their applications are incomplete but they can still get coverage by Jan. 1 if they complete the enrollment process by Monday.

For people who have completed the application process, most premium bills have been sent out, Counihan said, but he added that “there continues to be, almost daily, some wrinkle that comes up from one of the health plans that are working very hard.”

Lowering expectations again

Counihan spent much of the summer months leading up to the exchange’s Oct. 1 launch lowering expectations about how smoothly the rollout would go, and his statements Friday continue in that vein.

“Like I’ve said for a year and a half, this is complex,” he said. “It’s going to be bumpy. There are people that are going to be unhappy. We’ve asked everybody just to take a deep breath. We’re going to fix the issues and we’re going to make this successful.”

So far, more than 47,000 people have signed up for coverage through Access Health. About half have purchased private insurance, while the rest will receive Medicaid coverage Jan. 1 when the state expands the program to cover more adults who don’t have minor children.

Monday is the deadline for people to sign up and get coverage effective Jan. 1. People who miss that mark have until March 31 to buy a private plan through Access Health, although their insurance won’t take effect until Feb. 1 at the earliest. Enrollment for Medicaid runs throughout the year.

Long waits for call center

The exchange has been getting an average of 1,400 enrollments per day, Counihan said, and its call center has received a surge of traffic, getting 5,500 to 6,000 calls daily.

Counihan said the 20-minute average wait time to speak to a representative is “not acceptable to us,” but unlikely to get much better before Monday.

The wait times had been worse, he noted, before the call center vendor, Maximus, increased its staff from 63 to 114 people earlier this week. Counihan said officials had expected a lower call volume, and he pledged that there won’t be a similar issue in February and March, when the final deadline for enrolling in 2014 plans approaches.

“We blew it and we’re in the process of fixing it,” he said.

Some of the calls Access Health is getting are from people who have signed up but have not received bills from insurers and are concerned about having coverage in January. Counihan said the exchange is passing along enrollees’ information to insurers twice a week and that billing issues are best directed to the individual insurance company. But he said the question of when a person should call Access Health or an insurance company directly is still being determined.

Newest wrinkle: The catastrophic option

Exchange officials are also trying to figure out how to handle a change federal officials announced Thursday evening that would allow people whose previous policies are being discontinued to purchase high-deductible “catastrophic plans.” (On Friday evening, the exchange released instructions for people who wish to take the new option.)

Until Thursday, catastrophic plans — which carry high deductibles but relatively low premiums — were only available to people under 30 or those who received an exemption from the health law’s individual mandate because no other options available would cost less than 8 percent of their household income.

Last month, when the cancellation notices were drawing significant attention, Access Health officials had suggested making catastrophic plans available to people whose old policies were being discontinued, Counihan said. Many people who had purchased individual-market plans were upset about the notices after President Obama’s repeated pledges that people who liked their health policies would be able to keep them under the health law.

But the concept raises some policy concerns and questions, as does the timing, Counihan said. The insurers developed rates for the catastrophic plans based on the assumption that members would be under 30, and set rates for their other plans based on the idea that catastrophic plans wouldn’t be available to older people.

“Are there rate implications? What are the implications to the rest of the risk pool?” Counihan said.

The insurance industry has also raised concerns with the move, saying it could destabilize the market and confuse consumers.

Exchange officials are still trying to determine if the new federal option supersedes state policy.

Currently, the Access Health system is not set to show people who are 30 or older catastrophic plan options, although Counihan said changing it would not be a big deal.

“To be frank with you, the mind reels a little bit that something like this could be introduced four days before the end of open enrollment [for Jan. 1 coverage],” he said.

Arielle Levin Becker covered health care for The Connecticut Mirror. She previously worked for The Hartford Courant, most recently as its health reporter, and has also covered small towns, courts and education in Connecticut and New Jersey. She was a finalist in 2009 for the prestigious Livingston Award for Young Journalists, a recipient of a Knight Science Journalism Fellowship and the third-place winner in 2013 for an in-depth piece on caregivers from the National Association of Health Journalists. She is a 2004 graduate of Yale University.

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