Some Quick Fixes For The Exchanges Could Work

By now even those of us who originally thought that we were seeing minor teething troubles are no longer deluding ourselves. Healthcare.gov, the federal health insurance exchanges (HIXs), and many of the state HIXs are in deep trouble.

One summary of many articles about this is up at ProPublica. But now that the House Republicans have stopped trying to destroy the country and themselves, attention will turn quickly to this problem, and–much worse–beyond the politics, there is now only eight or so weeks to get ready for actual enrollments for Jan 1, once you take out Thanksgiving and the Christmas holiday. Getting 10 million or 20 million new customers on board, not to mention the small businesses who want to move from their current insurance onto the exchanges, seems like an impossible task.

But, if we can muster the will, there may be a solution. (And yes, I want it to work, faut de mieux). Quietly last summer two private online insurance brokers, eHealth which runs the eHealthInsurance.com site, and GetInsured, struck deals with the U.S. Department of Health and Human Services which allowed them to enroll individuals in plans that qualify for the mandate under the ACA, and more importantly, connect with the “Health Exchange Data Hub” that figures out whether the enrollee qualifies for a subsidy (theoretically by connecting to the IRS).

That part of the transaction, though, could be done by attestation and dealt with later. In other words, someone buying health insurance could state what their income will be in 2014 (or was in 2013) and if it ends up varying dramatically on their 1040 then in 2015 they will pay or receive the difference. Essentially this is something all Americans recognize–the IRS asks you for more or gives you a tax refund well after the fact, and H&R Block and their competitors make a business of giving you the refund right away (and of course charge you for the privilege).

That is important because what seems to be crippling the HIXs right now is not the back end, it’s the front end.  Showing people options, comparing plans, setting up accounts–that’s all standard web stuff and most of the HIXs can’t do it. Those private brokers have both smoothly done this for years and at least the two I mentioned have built comparative tools for the new insurance plans. 

So why can’t we put prominent links to eHealthInsurance.com and GetInsured on the Healthcare.gov site and move people over there? I asked both company’s CEOs. Here’s what GetInsured’s Chinni Krishnan said:

As you have observed,  Getinsured and other private health insurance exchanges are already certified by CMS to sell federally subsidized coverage on their sites and can soon play a significant role in enrolling uninsured Americans in states covered by the Federally Facilitated Marketplace.

As for timing – not just yet but we are near completing final testing with healthcare.gov and will turn on our shopping experience very soon. Once we do, we will absolutely offer the high-quality customer experience that we have always provided to individuals and families buying health insurance. Once this happens, I would envisage additional forms of cooperation such as the one you have visualized.

And eHealth’s Gary Lauer basically agreed but went further to say that the state HIXs, too, could join in:

For non-subsidy eligible consumers in the 36 FFM states, yes, a redirect to eHealth would be easy and quite workable. Prospective subsidy-eligible consumers could be provided the same eHealth option as soon as eHealth is able to connect through the FFMs to allow subsidy applicants to validate their subsidy eligibility.

The same access capability should be provided on the state exchanges as well – the result is more enrollment, which is the overall Affordable Care Act objective and purpose. Perhaps the states need to be reminded of the real ACA objective – maximum enrollment.

Basically they are both saying, “we can handle a lot of traffic right now, and although we’re not set up with the hub yet we soon will be”. But even that need not be a problem. If consumers were allowed to estimate their incomes and get an appropriate subsidy without the connection to the hub–so long as they were made aware that they may have to pay some money back later just like underpaying your taxes–then the connection to the hub could be turned off until everyone is sure it’s working.

So why not? I know this wasn’t the original intent of how the exchanges were supposed to run, but we are in a desperate position and for the good of the Administration. and more importantly the good of the millions the ACA was designed to help (like this guy), we need to act fast.

How about it, HHS?

Matthew Holt is founder of Health 2.0 and The Health Care Blog, where this article originally appeared.