Covered California Launches Community Outreach

Ahead of the Affordable Care Act (ACA) 2015 Open Enrollment, which is set to begin in mid-November 2014 and continue through mid-February 2015, Covered California has launched a community outreach campaign aimed at attracting new enrollments in the state’s public health insurance exchange.

The new ad series, which started September 15th, features residents who have health insurance as a result of the ACA.

“Our campaign on the airwaves will support our community outreach campaign by making tangible the benefits of getting covered,” said Peter V. Lee, Covered California’s Executive Director. “But even more importantly, we hope these ads will foster conversations at family dinners, in churches, and in schools – where Californians will be talking about the benefits of having coverage and making sure no one who is eligible for coverage goes without it. Beyond these conversations, we will build on an expansive network of thousands of Certified Enrollment Counselors, Certified Insurance Agents, and county eligibility workers helping people learn about insurance and enroll.”

The new outreach campaign includes $46 million in advertising statewide and nearly $15 million in community outreach grant funding. Coupled with more than $33 million community outreach groups are expected to spend, the investment for 2015 outreach will reach $94 million.

Grants of $50,000 to $750,000 will be awarded based on a community group’s experience with special populations as defined by language, ethnicity, geography, and employment as well as their ability to effectively educate and enroll (or renew) residents in coverage through Covered California.

Covered California is forecasting a total enrollment of 1.7 million by the end of the 2015 Open Enrollment. That forecast represents a 43 percent increase (about 500,000 new participants) from 2014.

Brokers Complain of Commission Delays by Exchanges

A Las Vegas attorney has filed suit in Clark County District Court on behalf of six insurance brokers who say the Silver State Health Insurance Exchange and its website contractor, Xerox, have failed to pay commissions on coverage they have sold through the Nevada Health Link website.

Collectively, the six brokers are owed a “very significant amount well in excess of $200,000,” according to attorney Matt Callister as reported by the Las Vegas Journal Review. Spokespersons for the state exchange and Xerox say they do not comment on pending litigation.

Meanwhile, in Oregon, members of the Cover Oregon public health insurance exchange say they are making progress in their efforts to process agent and broker commission payments more quickly. Managers of the state exchange included a summary of their commission payment performance in a report to the Board for August.

According to the report, the Beaver State exchange received nearly $900,000 in producer commission deposits in August and it paid about $1 million in commissions. The number of agents or agencies paid increased to 746 in August, up from 698 in July.

Oregon faced considerable problems with its enrollment website this year and has announced it is moving enrollment to the federal exchange website,, for the 2015 plan year, which begins open enrollment in mid-November.

Commissioner Reduces Exchange Rate Increases

Washington State Insurance Commissioner Mike Kreidler has reduced the average increase on Affordable Care Act exchange plan rates for 2015 to 1.9 percent. Insurers had originally asked permission to increase rates in the Evergreen State by an average of 8.6 percent according to the Seattle Times.

Ninety individual health plans marketed by 10 insurers are expected to be part of the Washington Health Benefit Exchange when open enrollment for 2015 starts in two months. The state has approved two Small Business Health Options (SHOP) exchange health plans for 2015. Moda Health Plan will offer coverage statewide, while Kaiser Permanente offers coverage in two counties in southwestern Washington.

“I take the increased interest from health insurers this year as a clear sign that health reform is working,” Kreidler said in a statement. “Consumers will have two more insurers to choose from next year, nearly double the number of health plans, and a record low rate change.”

For 2014, the Washington Healthplanfinder exchange included eight insurers offering 46 approved health plans. The Times reports just eight businesses purchased SHOP insurance in the first year of the exchange.

Two insurers, Health Alliance Northwest Health Plan and UnitedHealthcare, continue to work with Washington authorities to be approved for 2015. Five other health plans applied to market individual health insurance only outside of the state exchange. They include Asuris Northwest Health, Group Health Options, Regence BlueShield, Regence BlueCross BlueShield of Oregon, and Time Insurance.

Network Controversy Sparks New Rules in California

Legislation passed by the California legislature this month would require health plans to ensure they offer adequate provider networks and to produce annual reports for the Department of Managed Health Care (DMHC) on those networks.

Under the bill, SB 964 (Hernandez), which awaits a review by Governor Jerry Brown, the DMHC would also be required to post annual reviews regarding compliance with the new regulation by Medi-Cal managed plans and insurers offering individual health plans through Covered California, the state health insurance exchange.

The legislation was introduced in response to lawsuits against Anthem Blue Cross and Blue Shield of California in which consumers allege they were misled about their health plan provider networks. The two insurers account for nearly 60 percent of sign-ups through the state health insurance exchange.

Anthony Wright, executive director of Health Access California, the consumer advocacy group that sponsored the legislation, told Modern Healthcare there have been long-standing questions about network adequacy. “We thought it was crucial that people, once covered, have access to the care that they were promised. The conversation around Covered California narrow networks only made that more urgent.”

The bill is supported by many health care and consumer groups, including AARP, the California Medical Association, and the National Health Law Program. Health insurers oppose the measure and argue it is redundant and unnecessary because of existing surveys by state regulators. It is uncertain whether Governor Brown will sign the bill. 

UnitedHealthcare Expanding into More Exchanges

UnitedHealth Group, already one of the nation’s largest health insurers, has plans to become even bigger – as it enters a dozen new consumer marketplaces in 2015, including major markets in the southwestern, southern, and northeastern U.S.

The parent of UnitedHealthcare, which offers employer-sponsored coverage, and UnitedHealthOne, which offers individual and family plans, said previously it expected to add “as many as two dozen” state exchanges when open enrollment begins for the new year in mid-November.

Jeff Lucht, a senior vice president responsible for public exchange strategy at UnitedHealthcare, told the Wall Street Journal the exchange coverage expansion is expected to include Alabama, Florida, Louisiana, Mississippi, North Carolina, Pennsylvania, and Texas. An analyst at Deutsche Bank is forecasting entry into Georgia, Indiana, Michigan, and Ohio. The other states remain unnamed so far.

Lucht said the new market entry decision is based on “a combination of the growth opportunity . . . and the extent to which we thought we could offer a competitive product” according to the Journal’s Anne Wilde Mathews.

For the 2014 plan year, the company offered coverage in the Colorado, Maryland, Nevada, and New York exchanges.

Word & Brown Alum to Lead ACA Exchange System

U.S. Department of Health & Human Services (HHS) Secretary Sylvia M. Burwell has announced that Kevin Counihan is joining the Centers for Medicare & Medicaid Services (CMS) team as Marketplace Chief Executive Officer. 

In his new role, Counihan will be responsible and accountable for leading the federal health insurance exchange marketplace, managing relationships with state marketplaces, and running the Center for Consumer Information and Insurance Oversight, which regulates health insurance at the federal level. He will report to CMS Administrator Marilyn Tavenner.

Counihan is the former head of CHOICE Administrators Exchange Solutions, a Word & Brown Company, and most recently served as Connecticut’s Health Insurance Exchange CEO, a role he was chosen for by Connecticut Governor Daniel P. Malloy. Connecticut was the first state to surpass its goal for Affordable Care Act (ACA) enrollees, and the state’s uninsured rate has been cut nearly in half – from 7.9 percent in 2012 to four percent in 2014.

In related ACA news, CMS has extended its technology agreement with Accenture through July 2015. The extension allows Accenture to continue its operation of the website for the federal exchange. The original agreement with CMS was scheduled to end in January 2015, and there was some speculation a new contractor could be named to take over in advance of the start of open enrollment in mid-November. However, CMS decided to extend the current agreement and plans to award a new contract next year.

D.C. Circuit Court to Rehear Exchange Subsidies

The Washington, D.C. Circuit Court of Appeals has announced the full court will rehear oral arguments in the Halbig v. Burwell case concerning Affordable Care Act (ACA) subsidies offered through the federal health exchange.

In July, a divided three-judge panel from the court ruled that subsidies may not be offered through the federal exchange. That ruling overturned a prior lower court ruling.

The D.C. Circuit Court’s order to vacate the earlier ruling is welcome news for supporters of health care reform. Oral arguments for the en banc (or full bench) hearing are set to begin in December. The full panel will include 11 active judges and the two senior judges who participated in the original panel. Barring any change in the composition of the court in the next three months, the 13 includes eight Democrat-appointed judges and five Republican-appointed judges. Four of the judges who will take part in the rehearing were appointed by President Obama.

The Obama administration announced immediately after the July Circuit Court ruling that it would seek an en banc rehearing. While rare, historically, a review by the full court panel is not unprecedented. Legal opinion was split before this month’s announcement about the likelihood of a full panel review.

If the full D.C. Circuit does reverse the three-judge panel ruling, it could set up an appeal to the U.S. Supreme Court; however, legal experts are not sure the justices would take the case, since two other trial court judges and the Fourth Circuit Court of Appeals have upheld the subsidies. 

Class Action Filed Against Anthem on Exchange Network

A new class action lawsuit was filed in August against Anthem Blue Cross alleging the company acted in bad faith by steering Covered California enrollees into narrow network health plans. The lawsuit, which was filed by nearly three dozen policyholders, claims Anthem sought to “maximize it profits while covertly depriving its members access to their trusted physicians.”

The complaint alleges Anthem misrepresented its provider networks and issued members identification cards that said they were enrolled in preferred provider organization (PPO) plans, when in fact they were enrolled in exclusive provider organization (EPO) plans.

Covered California’s PPO plans offer insured participants access to a larger network of health care providers than do EPO plans; they also offer some out-of-network benefits not available through an EPO.

A spokesperson for Anthem told Best’s New Service “Blue Cross Blue Shield Association rules, dating back to the 1990s and relating to urgent or emergency care in other states, required Blue Cross to include the designation in question on ID cards. Anthem Blue Cross subsequently requested a waiver from the rule and has issued new ID cards. Materials at the time of enrollment and in members’ Explanation of Benefits have clearly stated that the plan was an EPO plan, which may not have out-of-network benefits.”

The attorney representing the 33 policyholders who are part of the lawsuit has asked the court to extend class action certification because “potentially thousands of members have been forced to pay out of pocket for medical costs.”

Anthem is not the only California insurer to be challenged over its Covered California provider network. A lawsuit was filed in May against Blue Shield of California. That suit is awaiting class action certification. 

Covered California CEO Earns Bonus

Peter V. Lee, the executive director of Covered California, the Golden State’s public health insurance exchange established as part of the Affordable Care Act (ACA), has won a one-time bonus of $52,528 for his work in connection with its launch and first-year enrollment.

The San Francisco Business Times reported an unconfirmed statewide enrollment of 1.2 million enrollees during the 2014 enrollment period. This number is down from the 1.4 million reported by the state exchange through April, although a spokesperson for the exchange noted that only 80 percent of those enrolled paid for their coverage. Final numbers are still pending from participating health plans.

While Covered California offered 10 health plans through the public exchange, more than 90 percent of enrollees chose coverage through Anthem Blue Cross, Blue Shield of California, Health Net, and Kaiser Permanente. The California enrollment accounts for approximately 15 percent of the total national ACA enrollment of eight million enrollees.

In other personnel-related news, Covered California this month named Amy Palmer the new director of the office of communications and public relations, while Kirk Whelan is the new director of individual and small business sales. Palmer previously served in the California Health and Human Services Agency and Department of Social Services.  Whelan was previously affiliated with Kaiser Permanente. Both report to Yolanda Richard, chief deputy executive director for strategy, marketing, and product development.

Private Exchange Popularity on the Rise

Cigna has announced it is expanding its health care network to include more private exchanges, effective September 1. The top 10 national health plan launched its exchange products earlier this year in a small business market test in the Atlanta, Dallas, Washington, DC, and San Francisco areas. It said at the time it expected to broaden its network later in 2014. The Cigna exchange offering, available to fully insured and self-funded businesses, includes medical, pharmacy, dental, vision, life and accident, and disability insurance coverage.

Meanwhile, in the Southeastern U.S., Blue Cross Blue Shield of Tennessee announced it will launch a private health insurance exchange for employer groups in 2015. Branded as “BlueMarket,” the new exchange will be available to groups with at least 151 employees.

“We recognize that employer-sponsored plans will continue to be the way most people get their coverage and we want to lead the private exchange marketplace for Tennessee,” said Henry Smith, senior vice president of operations and chief marketing officer at Blue Cross in a statement.

The New York Times reported in June that more than three million people signed up this year for health insurance through a private exchange offered through their employer. That number is based on data from Accenture, a management consulting and technology services firm, and it’s nearly three times the private exchange forecast made last fall. Accenture is expecting total enrollment in private exchanges to reach 40 million by 2018, which would dramatically surpass the number enrolled through state and federal exchanges.