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 More than 7 million people signed up for new health
coverage under President Barack Obama's healthcare law for 2014, the
first year in which its main provisions took effect. Obama
celebrated the enrollment milestone on Tuesday as a victory for the
program which has faced relentless opposition from the Republican
Party and major technical hurdles.
Health insurance executives, state officials, lawmakers and policy
experts told the Reuters Health Summit in Washington this week that
the program is still very much in transition and they expect both
major adjustments and smaller tweaks in the year to come.
"This is the beginning of the beginning," said Chet Burrell, chief
executive of CareFirst BlueCross BlueShield, which sells Obamacare
plans in Maryland, Virginia and the District of Columbia.
For health insurers, more discussions with the government are in
store over how to improve and complete the technology behind the
federal enrollment website HealthCare.gov, which serves 36 states,
as well as some of the online exchanges run by 14 states.
The talks will include making it easier for consumers to shop for
new health plans, compare doctor networks and adjust their policies
due to a life change.
"So far none of the exchanges have the ability to handle, in any
automated manner, life event changes," Burrell said. "So what
happens is it's coped with behind the scenes, manually, which is
fraught with problems, inefficiencies, as well as errors."
Dr Ezekiel Emanuel, a health policy expert at the University of
Pennsylvania and a former adviser to the White House, said that such
changes need to happen before enrollment for 2015 begins in
November.
"What I worry about is, we've got 7-1/2 months to the next open
enrollment, we've got to beef up the website, we've got to make the
user experience better," Emanuel said. "You need all of that to come
together. I don't think we're there yet, and the question is whether
we will get there."
The site should allow people to sort options more easily and the
servers need to handle surges of traffic. It should also have a
chief executive officer who can run it like the startup company it
is, Emanuel said.
"COPPER" PLANS
Some insurers are also raising the possibility of changing the kinds
of health plans on offer, from the availability of doctor and
hospital practices to allowing more flexibility in pricing plans
according to the benefits they cover.
Burrell said he would support adding a new tier of plans that would
include fewer benefits and potentially be priced lower. Cigna Chief
Executive Officer David Cordani said that could create more choice
for consumers.
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"I'm not going to say whether a 'copper' program is right or
wrong but to me that's offering some additional choice," Cordani,
referring to the idea of adding a new tier to plans now labeled
"bronze," "silver," "gold" and "platinum." "We are a company that
believes in choice. The open question is how much choice is
available to the individual versus choices taken away."
Among the states whose exchanges are run by HealthCare.gov, Idaho
and New Mexico plan to leave the federal website and launch their
own technology platforms next year. Meanwhile, state-run exchanges
in Oregon, Maryland and Hawaii have grappled with repeated
technology failures.
All of the 14 state-run exchanges face a requirement to become
financially sustainable next year.
The Connecticut marketplace is selling its own technology as an
"exchange in a box" solution to its counterpart in Maryland. Kevin
Counihan, chief executive of AccessHealthCT, said that the U.S.
agency overseeing Obamacare is drawing a sharper line between
exchanges that should operate on their own and those that are
defaulting to the federal government.
"I do get the sense increasingly that states are more on their own
than ever," he told the Reuters Health Summit. "I'm sensing a change
... so if a state says 'I need more money' or 'it'll be tough for me
to be self-sustaining,' then (the federal government) says if you
really think that, you ought to think about moving" to HealthCare.gov.
Longer term, the state exchange structure could change further to
save costs and cut down on infrastructure, from technology
build-outs to call center staff.
"Do we really need 50 (state) exchanges, or can we have regional
exchanges?" Emanuel said.
(Additional reporting by David Morgan; editing by Michele Gershberg
and Jim Loney)
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