Bracing for new challenges in Year 2 of health care law

  • Article by: REED ABELSON , New York Times
  • Updated: September 2, 2014 - 9:32 PM

A swing in prices and shorter time frame have some worried it may be worse than Year 1.

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Kevin Counihan, head of insurance marketplaces for the federal government, is preparing for a second year of enrollment and hoping for less confusion than the first.

Photo: Christopher Capozziello • New York Times,

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The first year of enrollment under the federal health care law was marred by the troubled start of HealthCare.gov, rampant confusion among consumers and a steep learning curve for insurers and government officials alike.

But insurance executives and managers of the online marketplaces are already girding for the coming open enrollment period, saying they fear it could be even more difficult than the last.

One challenge facing consumers will be wide swings in prices. Some insurers are seeking double-digit price increases, while others are hoping to snare more of the market by lowering premiums for the coming year. At the same time, the Obama administration is expected to try to persuade about 5 million more people to sign up while also trying to ensure that 8 million people who now have coverage renew for another year.

Adding to the complexity is the shorter time frame for choosing a new policy: three months instead of six.

“In some respects, it’s going to be more complicated,” said Kevin Counihan, the former chief executive of Access Health CT, Connecticut’s online marketplace, who was just named as the head of the insurance marketplaces for the federal government. Connecticut’s marketplace was among the most successful state-based exchanges, sharply reducing the number of uninsured in the state.

“Part of me thinks that this year is going to make last year look like the good old days,” he said.

No one expects to face last year’s technological hurdles, in which consumers sometimes could not navigate the federal or state websites to buy a policy. HealthCare.gov is running relatively smoothly, and the states have been working to address technical problems with their marketplaces.

People will be renewing at the same time that others are enrolling for the first time, starting a week and a half before Thanksgiving, on Nov. 15. To ensure that they have a new plan by the beginning of the year, those who renew will have to sign up by Dec. 15.

Exactly how the renewal process will work has not yet been determined.

“We’re still waiting on the details of the process,” said Paula Steiner, chief strategy officer for Health Care Service Corp., which offers Blue Cross plans in five states. “We haven’t gone through any testing yet of any changes to the system for 2015.”

“I think there’s a possibility that there’s equal or more confusion this fall,” she said.

Those responsible for the federal marketplace say they are working hard to make the process as easy as possible. “We’re putting in place the simplest path for consumers this year to renew their coverage,” said Andrew Slavitt, principal deputy administrator for Medicare, which oversees the insurance marketplaces.

Those who prefer to stay with the same plan will be able to renew their coverage automatically, as many do with employer coverage. People can renew by doing “absolutely nothing,” he said.

Some of the large insurers, like some of the Blue Cross plans, have requested steep increases. Florida Blue, for example, expects to raise its rates by an average of 17.6 percent for 2015. Others, like some of the co-op plans, have been keeping prices low or even reducing rates.

Molina Healthcare, a company that has traditionally offered Medicaid coverage and now sells exchange policies, says its renewal strategy for the coming year is to emphasize that its members need not be concerned that the plan they selected will be more expensive. “One thing you can count on is the rates are flat or down,” said Lisa Rubino, senior vice president of exchanges for Molina.

In California, the state exchange is trying to get a step ahead by allowing people to begin renewing their plans Oct. 1. But anyone who wants to switch plans will still have to wait until Nov. 15, and many individuals may well want to shop around.

In the Sacramento area, for example, someone who selected an HMO plan from Anthem for 2014 faces a possible increase of nearly 17 percent, compared with a 2 percent increase for an HMO plan from Kaiser Permanente in the same area.

Consumer advocates and others say nearly everyone with coverage should review their options, as well as whether their federal tax subsidy is likely to shift — either because their income may have changed or because the cost of the benchmark plan used to calculate the tax credit has changed.

Experts like Sabrina Corlette, a policy expert at Georgetown University’s Center on Health Insurance Reforms, say persuading those who did not sign up for coverage during the last open enrollment period to get coverage for 2015 will also present a significant challenge. People in this group were unaware they could get assistance with the cost of their premiums, decided the coverage was not worth the cost or simply found the process of enrolling too challenging.

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