Posts tagged with Exchange
Enrollment in health insurance via the Obamacare marketplace surged in December, with 1.8 million people nationwide selecting a plan last month versus just 400,000 in October and November combined.
In Kansas, according to federal officials:
- 14,242 people had selected a marketplace plan;
- 5,508 were steered to Medicaid by the marketplace;
- 27,763 have completed applications, that possibly would cover 45,228 lives; and
- 18,896 were determined to be eligible for financial aid.
The figures are part of new enrollment data released today by the U.S. Department of Health and Human Services.
Administration officials touted the numbers as proof of strong interest in the benefits of the health reform law.
"We're pleased to see such a strong response and heavy demand for the health insurance marketplace," said HHS Secretary Kathleen Sebelius in a teleconference with news reporters. "The numbers show that there is a very strong national demand for affordable health care made possible by the Affordable Care Act."
Of the 2.2 million people who have so far selected a private insurance plan via HealthCare.gov:
- 55 percent are ages 45 to 64
- 30 percent are ages 26 to 44
- 54 percent are female
- 79 percent will receive tax subsidies
- 60 percent selected a Silver plan
- 20 percent selected a Bronze plan
- 13 percent selected a Gold plan
- 7 percent selected a Platinum plan
- 1 percent selected catastrophic coverage
Michael Hash, Director of the Office of Health Reform, said enrollment so far mirrored the expectation that older people would enroll first, while younger people would wait until the deadline. Open enrollment for 2014 ends March 31.
"The trends so far, as we've released in this report, are suggestive of an appropriate mix in the marketplace. But we're only halfway through the open enrollment period and we expect an increase in the proportion of young adults," Hash said.
Sheldon Weisgrau — director of the Health Reform Resource Project, a foundation-funded initiative to educate Kansas consumers and businesses about the health reform law — said it would be difficult to draw many conclusions from the data released today.
"The key to appropriate risk balance in insurance pools is really healthy versus unhealthy. Because we no longer ask about health status on insurance applications, we usually use age as a proxy for health status. That’s appropriate for the most part, but is not the whole story. For example, an insurer would probably prefer a healthy, older enrollee to a sick, younger enrollee. But we don’t have these details," Weisgrau said.
"That said, the percentage of younger enrollees is lower than ideal given their representation in the population," he said, citing a recent study by the Kaiser Family Foundation that estimated that people ages 18 to 34 make up about 40 percent of the eligible population.
"So, the hope would be that they make up about 40 percent of enrollees," Weisgrau said. "But it’s much too early to draw conclusions. It was entirely predictable that the first people to sign up would be those most desperate for insurance coverage – people with pre-existing conditions who were previously denied coverage; people with very high premiums because of poor health status, etc."
Weisgrau said he expected enrollment figures would spike in March as the enrollment deadline comes.
Projections are that less than one-third of the uninsured population in Kansas would buy coverage via the insurance marketplace, Weisgrau said.
"So, assuming 360,000 uninsured in Kansas, at most 120,000 would be expected to purchase in the marketplace; 45,228 lives is about 38 percent of that number...that’s not bad," he said.
The head of the National Association of Insurance Commissioners and two members met today with President Obama to discuss the troubled rollout of the Affordable Care Act.
Kansas Insurance Commissioner Sandy Praeger, a moderate Republican who has generally supported the law, was invited but chose not to attend. NAIC President Jim Donelon, the Republican insurance commissioner from Louisiana, organized the meeting.
Praeger said she wasn’t trying to distance herself from the controversy surrounding the law’s problem-plagued rollout.
But she said the meeting was “premature” because the NAIC had not worked with its members to develop consensus on how to address remaining problems with the law’s implementation.
“It’s a huge honor to be invited to the White House,” Praeger told KHI News Service. “But I want to make sure that we use the president’s time wisely and that we are really able to have some constructive and meaningful dialogue.”
Praeger said the NAIC typically has been a “consensus organization.”
“As a past president of this organization, I think we have a real responsibility to communicate with the leadership and make sure that when we have a meeting that it’s not just representing a single point of view, but it's representing a consensus point of view that’s been arrived at through a vetting process,” she said.
In a joint email sent to their counterparts late Tuesday, Praeger and other commissioners who decided not to attend the meeting said they had “serious reservations about both the process and the policy issues surrounding such an important meeting.”
Adam Hamm, the Republican insurance commissioner from North Dakota, gave similar reasons for skipping the meeting in a statement to the New York Times.
“Because the topic for the meeting (Affordable Care Act) is so delicate and potentially divisive among the nation’s insurance commissioners, a meaningful discussion between all the commissioners needs to take place before a meeting with the president,” said Hamm, who like Praeger is a former president of NAIC. “Unfortunately, that did not happen so I had to respectfully decline to participate in today’s meeting.”
Bob Hanson, a spokesperson for the insurance department, said Praeger also wanted to remain in the state so that she could continue to work with Kansas insurers attempting to comply with President Obama’s recent request that the companies allow customers to temporarily keep policies that don’t meet the ACA’s minimum coverage requirements.
“The Commissioner and her department personnel are in the middle of conferring with companies on how the president's changes might be implemented,” Hanson said in an email. “Those business and regulatory discussions are keeping the commissioner here in Kansas to make sure any details are hammered out in the best interest of our citizens.”
Blue Cross Blue Shield of Kansas, the state’s largest health insurer, announced Tuesday that it would comply with the president’s request and work to reverse approximately 10,000 policy cancellations already in process, allowing policyholders to keep their nonconforming plans another year.
“This governmental change will allow many of our members to keep the benefit plan they already have and like, while still allowing them to consider new plans that they may be able to purchase with the help of a tax subsidy or small business tax credit,” the company said in a news release.
Praeger said reversing the cancellations likely would be costly to BCBS-KS and other insurers and could lead to premium increases. The main reason, she said, was that companies had based their rates on the assumption that many young, healthy people who had nonconforming policies would purchase more comprehensive plans thereby broadening the insurance pool. If significant numbers of those people decide to hang on to their current plans, the mix of policyholders enrolled in more comprehensive plans will be older and less healthy, Praeger said.
“If you’re going to let these healthier folks stay out of the mix for another year, there’s going to be a (cost) impact,” she said.
There are a lot claims circulating online and in the media about Obama's campaign pledge "If you've got a health care plan that you like, you can keep it" ... many of those claims miss the mark. So here's the lowdown:
If you bought your insurance plan before Obamacare was signed into law (March 23, 2010) your plan is grandfathered, and so long as you keep renewing it, you can keep it indefinitely.
Otherwise, your plan is not grandfathered. Some of those plans purchased after March 23, 2010 do not meet the law's requirement to cover "essential health benefits" (that includes covering childbirth and basic preventive care, for example). If you have one of those plans, you are one of the roughly 5% of Americans who received a letter saying you will have to update coverage to a plan offering the essential health benefits.
The state's largest insurer — Blue Cross Blue Shield of Kansas — has said that about 65% of people who purchase its individual plans (vs group or employer coverage) have grandfathered plans. Many of the remaining 35% already have plans that include most — if not all — of the essential health benefits and so their coverage and premiums will not change dramatically. Nevertheless, they may receive a letter notifying them of their options to update their coverage to comply with the law. Again, this only applies to people who enrolled in their current plan after March 23, 2010.
Of those people required to update their plans, some may see their total premiums go up.
However, many will now qualify for tax credits to buy updated insurance plans via the new marketplace — and so the amount they actually pay could be slashed dramatically. Those with incomes between 100% and 400% of the poverty level will qualify for tax credits. For example, a family of four earning between $23,050 and $92,200 will qualify for tax credits. Until HealthCare.gov is working properly, you can go to InsureKS.org to see how much tax-credit assistance you qualify for.
→ More coverage of Obamacare at khi.org/healthreform.
Perhaps it is a case of could-have-been.
Two years ago, Gov. Sam Brownback rejected a $31.5 million federal grant to set up a health insurance marketplace tailored for Kansas — defaulting instead to the federally run exchange that was launched Oct. 1 but which continues to be beset by problems.
Gary Schneider — the technology expert who was poised to lead Kansas' marketplace development until Brownback opted against it — left instead for Colorado, one of 16 states that chose to run their own marketplace. He now is the IT project manager for the Colorado Health Benefit Exchange.
In Colorado, so far, things are going smoothly, Schneider said.
More than 700 people have enrolled in insurance plans using Connect for Health Colorado, the state’s marketplace. And more than 30,000 people have created accounts on the website allowing them to compare plan options and see if they qualify for tax subsidies.
"We had some bumps in the road with our system when we first turned it on, but most of those have been resolved," Schneider said.
Like the federal marketplace, Colorado's website initially was overwhelmed with traffic.
"Until you turn a system like this on ‘live’ and experience a real load, you can't be sure how it's going to react," Schneider said. "That was the first couple days, but things got pretty stable pretty quick."
CGI, the contractor that built the Colorado marketplace, also built the federal exchange. But Schneider said the fact that so many states went the way of Kansas — opting to use the federal marketplace, HealthCare.gov — greatly complicated the task for the national government.
"If they had anticipated 35 or so states being in the federal marketplace, I'm sure they would have done some things differently,” he said. “But that just panned out in the last 18 months, where states made these decisions to opt out. I don't think they anticipated more than a handful of states to be in the federal marketplace.”
Schneider said he wasn't surprised that the federal marketplace is off to a rocky start “given the tight deadline and the fact that so many states opted to not have a state-based marketplace. That made their task extremely challenging...because there are business rules that apply to different states."
President Obama today held a press conference to reassure those frustrated with HealthCare.gov, saying that "nobody is more frustrated by (the glitches) than I am."
But, said Obama, "even with all the problems at HealthCare.gov, the website is still working for a lot of people, just not as quick or efficient or consistent as we want."
That complexity has been the federal marketplace’s undoing so far, said Timothy Jost, an expert on the health reform law and a professor at Washington and Lee University School of Law.
"The main culprit is just a very, very complex system that must be established to enroll millions of people in hundreds of different health plans," Jost said. "The fact that 36 states refused to participate I think was completely unexpected. And Congress has not appropriated funds — since the initial appropriation, that I know of — for the federal exchange," he said, referring to the federal marketplace.
"Instead Congress has held numerous hearings that have tied up key government officials and kept them from getting their job done. So I think Congress is probably more to blame than anybody else."
Jost also laid blame on "the states that have opposed implementation, including Kansas."
“The states' decisions to not run their own exchanges has had a very serious effect,” he said. “States that are running their exchanges are showing a lot of success.”
States including Hawaii, California and Colorado experienced problems in the opening days of their marketplaces, but according to most reports those have now been largely resolved.
Switching to a state-based marketplace
Should Kansas change direction and decide to run its own insurance marketplace — which for now seems unlikely given the opposition to Obamacare among the state’s Republican leaders — it could have the option of implementing proven software, such as that running Colorado's marketplace.
Schneider said he is in talks with several other states about using the system Colorado built, but Kansas isn't among them.
Kansans frustrated by their inability to shop for health insurance coverage on the federal marketplace website can now do much of the legwork on the state insurance department’s updated website, InsureKS.org.
Late Friday afternoon the department upgraded the site first launched in early September so that consumers in any county can access a list of the health plans available in the federal marketplace along with their prices.
“We’re pretty excited because if somebody goes on our website they can find out whether they qualify for a tax credit and they can take that information and look at the rates and plans and come pretty close to figuring out which plan they're interested in when they’re able to get on the (federal) marketplace. So, hopefully it will give them a little bit of a head start,” said Linda Sheppard, director of health care policy and analysis at the insurance department.
Consumers can do about everything on the insurance department website that they could do on the official federal site – if it were working – except finalize a purchase.
The marketplace website operated by the U.S. Department of Health and Human Services — HealthCare.gov — has been plagued by problems and has been mostly inoperable since its launch Oct. 1, though there were indications of progress Friday.
Officials with a consortium of nonprofit organizations training and deploying navigators to help consumers shop for plans said that, by day's end, five Kansans had managed to purchase coverage using the federal marketplace.
Sheppard said Kansas officials didn’t seek federal approval to add the work-around tools to the state site, which also includes a feature allowing users to locate navigators and marketplace-certified agents nearest them.
Kansas is one of 36 states that opted to have the federal government design and operate its marketplace rather than building its own.
Republican Gov. Sam Brownback returned a $31.5 million federal grant that Insurance Commissioner Sandy Praeger had obtained to build a state-based marketplace, sometimes called an "exchange."
Sheppard said Kansans she's talked to at meetings across the state haven’t been angry about their inability to use the marketplace, but they have been frustrated by their inability to get information about the coverage options available to them.
“They don’t seem angry about it, they just generally say something like, ‘Yeah, that’s what I expected,’” she said.
A new report finds some 78,000 Kansans are among those not poor enough for Medicaid but too poor to qualify for tax subsidies under the Affordable Care Act
About 78,000 Kansans are among 5.2 million poor, uninsured adults who will fall into the “coverage gap,” created by 26 states choosing not to expand Medicaid under the federal health reform law next year, according to a study released today by the Kaiser Family Foundation.
These people are projected to have incomes too high to qualify for their state’s existing Medicaid programs, but below the federal poverty level (nearly $11,500 for an individual) required to be eligible for tax subsidies to buy private coverage on the new insurance marketplaces set up by the Affordable Care Act, or ACA. Medicaid is the state-federal health insurance program for the poor.
“Millions of adults will remain outside the reach of the ACA and continue to have limited, if any, options for health coverage,” the study concludes.
The law provides full federal funding for three years to states that expand Medicaid to cover residents under 138 percent of the poverty level (or just under $15,900 for an individual).
But the Supreme Court made that requirement effectively optional for states, and most Republican led-states have opted against expanding the program.
There is no deadline by which states must opt to expand Medicaid, and a few states are still considering it.
Nearly half of the uninsured in the coverage gap live in Texas (1 million), Florida (763,980) and Georgia (409,350) — largely because those states have the most uninsured and limited Medicaid eligibility today.
Kansas among states with coverage gaps
In Kansas, about 78,000 adults will fall into the coverage gap, according to the report.
Alabama, Mississippi and Louisiana also will be especially hard hit, with more than a third of their uninsured adults falling into the coverage gap next year, the study shows.
In Kansas, 29 percent of uninsured adults fall into the coverage gap.
These states will feel the pinch because they have higher rates of poor uninsured adults and their existing Medicaid programs have some of the nation’s the tightest eligibility rules.
In Kansas, adults with children are eligible for Medicaid coverage if they earn less than $7,421 (for a family of three). Childless Kansans are not eligible regardless of income level.
Gov. Sam Brownback and the Legislature have shown no desire to expand Medicaid and seem unlikely to approve it this year.
Federal officials have said they have little ability to address the coverage gap, given the Supreme Court's ruling. The only way to fix that would be for Congress to modify the health reform law.
Will it come in with a big bang, dramatically and forever changing Americans’ health care? Or will it be something more like a whimper?
Tomorrow is the much-anticipated first day that millions of Americans without affordable health insurance will be able to turn to the new, online marketplace that is one of the central elements of the Affordable Care Act, commonly known as Obamacare.
Supporters of the health reform law have trumpeted the big moment for months and likewise there has been an onslaught of public relations campaigns from the law’s opponents, including a high-profile showdown in Congress over it that threatens to shut down much of the government.
But some of those most familiar with how the new system is expected to work here, particularly the insurance marketplace, are saying it wouldn’t hurt for Kansans simply to wait a bit before they try to sign up for coverage.
“Don't focus on Oct. 1,” said Sheldon Weisgrau of the Health Reform Resource Project. “The information will be available then, but whether you buy your policy Oct. 1, Nov. 1 or Dec. 1, won’t make a difference because the coverage won’t start until Jan. 1. I'm actually encouraging people to take a deep breath and wait because there might be a few bugs to work out.”
“Basically, when we've been out talking to the crowds in various locations, we’ve been encouraging them to wait maybe two or three weeks to let some of the potential bugs or glitches smooth out,” said Linda Sheppard, one of the top officials at the Kansas Insurance Department and one of the state’s leading experts on the Affordable Care Act.
Sheppard is suggesting people sit back until as long as Dec. 15 before choosing a plan.
People eligible to use the new marketplace will have until March 31 to sign up, so Oct. 1 is merely the first day of a six-month open enrollment period.
Slow start and limited awareness
Even if everything goes smoothly Day One with the marketplace enrollment system, it could be six months or longer before most Americans understand they can use the marketplaces.
A survey released today by the Commonwealth Fund showed that 76 percent of Americans between the ages of 19 and 64 know they are required by the Affordable Care Act to have health insurance next year.
But only two in five, or 39 percent, were aware of the new marketplaces or that they would be able to use them to apply for financial help with their premium costs.
Meanwhile, the so-called “navigators” certified to help people enroll in the marketplace plans remain in short supply with only about two dozen of the 250 planned for Kansas currently trained and ready to go, though that number is expected to quickly grow over the course of the next few weeks.
Because of the expected slow start to the new program, the Congressional Budget Office projects that only 7 million of the 48 million uninsured in America will enroll in plans through the marketplaces in 2014, though that number is expected to grow to a peak of 25 million a year by 2018.
About 52 percent of Kansans already have coverage through their employers, and another 29 percent already are enrolled in public health plans, which means a relatively small percentage of people here are expected to gain coverage through the new marketplace.
Of the state’s 365,000 uninsured, only about 188,000 — or roughly half — are expected to benefit from the marketplace, according to the Kansas Health Institute.
However, it is thought highly unlikely even that many will actually use it in 2014, given the historical “take-up” rates for government programs and the fact that many of the uninsured earn too little to face the new tax penalties for not having coverage.
And since Kansas is among the states where political leaders have chosen against expanding eligibility for the Medicaid program, there will be about 58,000 poor Kansans who fall into a coverage gap. Those Kansans — with earnings between about 32 percent and 100 percent of federal poverty guidelines — earn too much to be eligible for Medicaid but are too poor for subsidized health coverage through the new marketplace.
Tax subsidies to buy insurance
For those Kansans without access to affordable insurance through their employers, subsidies will be available on a sliding scale to those with incomes starting at 100 percent and up to 400 percent of federal poverty guidelines, which is $45,960 for an individual or $94,200 for a family of four.
Even with all the talk from Capitol Hill to Main Street about Obamacare, many people don't know what they have to do to comply with the law’s requirement that almost everyone have insurance beginning in 2014.
For those who are uninsured, the key to satisfying that requirement could be the new online health insurance marketplaces, which are set to open Oct. 1 for shopping. Policies will go into effect Jan. 1. Seven million Americans are expected to find coverage there.
More than 500,000 Kansans would have some reason to consider using the health insurance exchange to obtain coverage — such as those with a pre-existing condition — according to the Kansas Health Institute.
Here are 15 basic things you need to know about the marketplaces:
The insurance marketplaces are open to nearly everyone, but If you have insurance through work, Medicare or Medicaid, it’s likely you won’t need to shop for coverage there. They are really for people who are uninsured or folks who buy individual policies now.
Many people will qualify for subsidies to make coverage more affordable there. These subsidies — tax credits to help pay your premiums - will be available to people with incomes up to 400 percent of the federal poverty level. That's about $46,000 for one person or $94,000 for a family of four. And there are cost-sharing subsidies to reduce deductibles and copayments, depending on your income.
Immigrants who are in this country illegally are barred from buying on the exchanges.
You can enroll until March 31, 2014, though you'll generally need to sign up by Dec. 15 of this year, to be covered as of Jan. 1. You can find your state’s marketplace at healthcare.gov.
Through the marketplace, you can compare health plans in your area. The prices are based on where you live, your family size, the type of plan you select, your age and whether you smoke. All the plans have to comply with the Affordable Care Act’s requirement to have a basic benefits package, but the amount you have to pay in premiums, co-pays and deductibles will vary among plans.
When you apply for coverage on the exchange, you will find out if you’re eligible for subsidies to help pay for premiums. Or, if you have a low income, you can also learn if you are eligible for Medicaid coverage.
Your income — not your assets, such as your house, stocks or retirement accounts – will count toward determining whether you can get tax credits. When you buy your plan, you estimate your income for next year, and your tax credit is based on that estimate. The next year, your tax returns will be checked by the IRS and compared against your estimate.
If you qualify for a tax credit to pay your premiums, you can choose to either have the credit sent directly to the insurer or pay the whole premium up front and claim the credit on your taxes. If you qualify for cost-sharing subsidies, that subsidy will be sent directly to the insurer, and you won’t have to pay as much out of pocket.
If your income increases during the year, notify the exchange promptly so that you can avoid having to pay back the credits. On the other hand, if your income goes down, you could be eligible for a bigger subsidy. Either way it's important to notify the exchange if your income changes.
Each plan covers 10 “essential health benefits,” which include prescription drugs, emergency and hospital care, doctor visits, maternity and mental health services, rehabilitation and lab services, among others. In addition, recommended preventive services, such as mammograms, must be covered without any out-of-pocket costs to you.
You won’t have to pay more for insurance if you have a medical condition and that condition will be covered when your policy begins. But older people can be charged more than younger people and smokers could face a surcharge.
The prices for the marketplace plans are likely to be similar to those sold privately. If your broker offers you a plan that is also available on the exchange, you may be eligible for subsidies.
Your insurer generally can't drop you, as long as you keep up with your insurance premiums and don't lie on your application. Generally, people will be able to enroll in or change plans once a year during the annual open enrollment period. This first year, open enrollment on the exchanges will run for six months, from Oct. 1 through March of next year. But in subsequent years the time period will be shorter, running from October 15 to December 7.
There are certain circumstances when you would be able to change plans or add or drop someone from coverage outside the regular annual enrollment period. This could happen if you lose your job, for example, or get married, divorced or have a child.
The number of plans that you can choose from is likely to vary widely. In some states, only a couple of insurers have announced plans to offer policies though the marketplace, while in others there may be a dozen or more. Even within a state, there will be differences in the number of plans available in different areas. You can expect that insurers will offer a variety of types of plans, including familiar models like PPOs and HMOs.
Some 27,000 people in Wyandotte County have no health insurance. Health officials are hoping Obamacare and the new insurance marketplace expected to be operating soon in Kansas can help change that.
“We assume quite a few (of the 27,000) are going to be able to qualify” for subsidies through the marketplace, said Joe Connor, director of the Unified Government of Wyandotte County Health Department.
The marketplace, which federal officials have pledged will be ready to launch on schedule Oct. 1, is aimed at making affordable health coverage available to thousands of Kansans who otherwise might not have it.
Nationally, the state marketplaces — also sometimes called insurance exchanges — are expected to serve millions of Americans and are a key component of the Affordable Care Act, which became law in 2010.
‘Misinformation and polarization’
Officials here have a task force that earlier this month began planning ways to get the word out about the exchange to some of the people considered most likely to benefit from it.
The panel is part of the Healthy Communities Wyandotte initiative and is chaired by former Kansas Medicaid Director Barb Langner. She now works at the University of Kansas Medical Center but is working on the initiative as a volunteer.
Langner said the group doesn’t want to duplicate public-awareness work that will be done by others, including the federal government and the Kansas Insurance Department, but that a local touch is needed if everyone in the county is to be reached.
“This is a county that's used to creating some local solutions,” Langner said. “I think the statewide (public outreach) effort will be all well and good, but there are some pockets of people you will not reach unless you have local involvement. A lot of people are not going to go to a public meeting about this. It has to be a little more user friendly.”
Langner said the task force hopes to provide easily understandable information about the exchange to people who already are trusted in the neighborhoods so they can disseminate it to likely exchange users.
“I think because of the misinformation and uncertainty and sort of the polarization on this topic, it’s going to take someone who is trusted to explain it. And you're going to be dealing people that most likely don't have a lot of familiarity with insurance products, so I think personal contact with someone they trust will be important,” Langner said.
“Our role is to get whatever information has been produced to the people who have the contacts in the community. The logical places are churches, perhaps daycares, schools, small businesses, salons. We’re still in the planning phase right now,” she said.
Little time left
Whatever the group does will need to happen soon, because Oct. 1 is looming. The coverage plans offered through the marketplace become effective starting Jan. 1, which isn’t too distant in time, either.
The big push by federal officials to get the word out in the next few months about the Affordable Care Act mostly will bypass Kansas, but even in this generally anti-Obama red state there are organizations and community groups gearing up to inform the public about the new health insurance exchange scheduled to launch on Oct. 1.
“I think that there's a lot of misunderstanding about what the Affordable Care Act is and how it works and there's so much noise from a political perspective that people can't really focus on what it is they need to know” about it, said Roberta Riportella, a professor of community health at the Kansas State University Extension. “What we're going to try to do is cut through that noise.”
Riportella has been on the job at K-State for about three months and for at least the next several will be spearheading an effort to use county extension agents and faculty members to inform the Kansas public about the federal health reform law, particularly the new insurance exchange through which millions of Americans and hundreds of thousands of Kansans are expected to purchase their health coverage.
The extension is a long-trusted K-State institution with agents working in all 105 counties. They do all sorts of things to help people, ranging from counseling on best farming practices to helping seniors enroll in Medicare Part D drug programs. They teach 4-H kids to make jelly and other skills, give parents tips on home economics, and are the state’s most persistent crusaders against musk thistle and other noxious pests.
Over the next several weeks, including as part of their annual training sessions in August in Manhattan at the K-State campus, the agents will be learning details of the Affordable Care Act and how to communicate its meaning to the people intended to benefit from it.
In at least one county, (Shawnee, home of Topeka), there will be as many as three extension agents working to get out the word.
They and their colleagues across the state will be trying to inform a public that still knows relatively little about the law three years after it was passed. A recent poll by the Kaiser Family Foundation showed that most Americans still don’t know much about the law commonly referred to as Obamacare.
“I think it will take a big educational effort and I don't expect everybody to get it by the deadline,” said Cindy Evans, a K-State extension agent who works in Shawnee County. “We'll just have to keep working at it and hopefully, if it turns out to be a good thing, people will tell their friends and family about it. It won't be just an agency like (extension) carrying the message. You’ll need community connections, churches and other groups letting people know.”
Each year for the past six, Evans said, she has worked one on one with seniors to help them enroll or re-enroll in the Medicare prescription drug program. But she said it would be impossible to work individually like that with people on the Affordable Care Act simply because of the thousands expected to use the insurance exchange.
'Keep politics out'
Sue Peterson has served for years as K-State liaison to the Kansas Legislature and she knows very well the revulsion the state’s elected conservative Republicans have for Obamacare. Gov. Sam Brownback campaigned for the job pledging to fight the law "every step of the way.”
“It was envisioned by the United States Congress when they passed the Hatch Act and Smith Lever acts, (that) research and extension would provide information to the public who needed or wanted information. The university, and research and extension provide unbiased scientific research findings or information to the public at large around the state,” Peterson told KHI New Service in an email when asked if she expected the university to face political repercussions at the Statehouse because of extension agents doing their jobs.
Evans said she didn’t want her efforts to be misconstrued as political.
“I think extension's role is going to be what it always been — education,” she said. “I don't want to be political at all on this. I just want to keep politics out. People have feelings on both sides on whether they think it will work or cost the system too much. It’s not my role in extension to be political. My role in health literacy and senior health counseling, is to just accurately help people understand the law as it is today.
“I’m not trying to take a stand whether it’s good or bad,” Evans said. “My major area is family finance and people spend a lot of money on insurance and health care and I want to help. My role in family finance is to help them make a good financial decision and not be political.”
Federal officials are preparing for a major public awareness campaign to be most evident in August and September that in some ways has already started. Today, for example, the U.S. Department of Health and Human Services announced a new website and a telephone call center in anticipation of the Oct. 1 exchange launch.
But the major focus of the marketing blitz by the feds and national health consumer groups is expected to be in states with high numbers of people without health coverage, including California and Texas.
Kansas is among the states where federal officials will run the new health insurance exchange but the state’s top insurance regulators said they hope to inject a local flavor.
Insurance Commissioner Sandy Praeger said her agency has been in discussion with the feds about having some of the more complex calls to the exchange’s toll-free helpline roll over to her department so that Kansas consumers come in touch quickly with local people more familiar with the Kansas insurance plans offered in the exchange and the governing regulations.
“We’re discussing how we can make a quick, relatively seamless transfer,” of appropriate calls to the Kansas Insurance Department, Praeger told KHI News Service.
“Our expectation is if you call the 800 number and if you have really simple questions like ‘I don't think I have the proper web address for the exchange or my password isn't working,’ a very operational question, they would handle it,” said Linda Sheppard, the insurance department’s director of health care policy and analysis. “But if it’s questions specifically related to anyone's benefits or coverage, those would be forwarded to us.”
The department already routinely fields calls from consumers with complaints about denials of insurance claims or delays in processing, so it only makes sense to carry that practice forward with implementation of the Affordable Care Act, Praeger said.
The exchange or marketplace is scheduled to be operational in each state by Oct. 1 with coverage purchased through the exchange effective Jan. 1.
'Hiccups along the way'
Some Republican officials have questioned whether the exchanges will be up and running by Oct. 1. Praeger, who has been generally supportive of the new law, is not among them. But she predicted it wouldn’t be a smooth start.
“Oh, I think they'll be up and running,” she said. “There will be some hiccups along the way. That's putting it mildly, especially if you look at how the Medicare prescription drug program rolled out in the Bush administration and this is much more complicated.”
→ Related story: Kansas insurers gearing up to market new plans on exchange
School administrators here say they are alarmed and confounded by the looming, new costs they face with the implementation of the Affordable Care Act.
“We've been talking about it (in anticipation) the last two years. I wish there was somebody smarter than me to find a solution,” said Chris Hipp, director of the North Central Kansas Special Education Cooperative Interlocal 636.
“We are not built to pay full health benefits for non-certified folks who work a little over 1,000 hours a year. I've spent hours and hours running every possible scenario. We can't pay for any of them, so it’s all kind of an academic effort really," he said.
As part of the federal health reform law, commonly referred to as Obamacare, larger employers across the country have a new set of insurance coverage obligations and fees they must pay. The new rules apply to commercial enterprises with 50 workers or more but also to public employers such as cities, school districts and the state of Kansas.
Kansas officials estimate the new fees alone will cost the State Employees’ Health Benefit Plan at least $4.7 million in 2014, or about $63 per worker. That’s without reckoning the added costs of the law’s new coverage requirements, much of which the plan already is absorbing.
For many businesses and larger governmental units, the new obligations are unwelcome but not unmanageable because they can be passed through either to customers or, at least partially, to health plan policyholders.
And for some governmental units, the expected costs represent a small percentage of overall spending. Lawrence officials, for example, estimate the new Obamacare fees will cost the city $137,200 in 2014, which could be considerably less than the potential costs of complying with a new conceal-carry firearm law passed earlier this year by state lawmakers.
Rural school districts
But the new health reform rules are particularly challenging for rural school districts and special education cooperatives, where officials say they have little or no place to turn for additional money, especially since state school aid has been held flat or reduced and more often than not the so-called “local option” school budget authority already has been maxed out.
“A lot of the districts and co-ops are looking at various options, including the option of getting out of offering health insurance and acknowledging that the most economical step for them is to pay the penalty and have their employees go to the exchange and get what's available through the marketplace. But a lot have not made that decision yet,” said David Shriver, assistant executive director for insurance services at the Kansas Association of School Boards.
The situation at the Phillipsburg special education cooperative offers a stark example of the complications many Kansas schools are facing, Shriver said.
The interlocal co-op is funded by 11 participating school districts that together cover an area of about 4,500 square miles spanning eight rural counties slightly west of the geographic center of the conterminous United States. It is square in the heart of the heartland. The districts collectively serve about 3,700 students, of which about 670 are in the special education program.
Hipp said NCKSEC Interlocal 636 has about 85 “certified” employees (mostly teachers) but also employs about twice that many people as “non-certified” teacher assistants or “paras” and other support staff.
Those workers, earning close to minimum wage, also are offered health benefits by the co-op. But about 100 of them don’t take it because it is too costly for them. The imbalance between their wages and their health insurance costs is so pronounced, Hipp said, that some of the para-educators who use the co-op’s health plan end up writing checks to the co-op two or three times a year just to cover their share of the benefits.
Under the health reform law, Hipp said, the interlocal must offer health coverage that meets the federal standard of affordability or pay a penalty for each employee that gets insurance through the subsidized federal exchange. The exchange — sometimes called a marketplace — is scheduled to be in operation by Oct. 1, with the coverage effective for policyholders beginning Jan. 1, 2014.
Here’s the dilemma for the co-op and similar organizations: On one hand, they can’t afford to pay their “non-certified” workers enough to make premium costs an affordable percentage of their incomes. But nor can the organizations afford to maintain a health plan and pay the annual penalties that must be paid by employers that have workers who opt for coverage through the insurance exchange.
Kansas insurance companies are preparing to sell a range of health plans on a new, online exchange being created by the federal government in an effort to make coverage more available to the thousands of people who have struggled to obtain it.
The Affordable Care Act, often called “Obamacare,” requires the new health insurance marketplaces to be up and running in every state by October, with the coverage sold through them effective on Jan. 1. But large numbers of Americans who stand to benefit most from the exchanges still know little to nothing about the law or how it will affect them, according to a recent poll by the Kaiser Family Foundation.
Anyone will be able to use the online marketplaces to purchase health coverage, but they are being created mostly to make private coverage more affordable for the uninsured and individual policies more widely available to those who don’t have access to group coverage through an employer.
“It’s going to create new opportunities for people who don’t have any insurance at all,” said Andy Corbin, chief executive of Blue Cross Blue Shield of Kansas, the state’s largest private health insurer. “And for those who don’t make much money, it may save them some dollars.”
Corbin said that plans offered on the exchange will “probably be more expensive” than the individual and small-group policies the company now sells. But he said in many cases the amount that consumers actually pay would be lower because of federal subsidies.
The exchange, or marketplace, also will give small businesses — those with fewer than 50 employees — new options. Rather than purchasing group insurance, they will be able to select a plan on the exchange and allow their workers to purchase individual policies. The businesses will have the option of helping their employees pay for the coverage, or not.
At least three insurance companies will sell multiple plans on the Kansas exchange, which will be operated by the federal government because Gov. Sam Brownback, a Republican opponent of the health reform law, declined to establish a state-run exchange. The companies are Blue Cross Blue Shield of Kansas, Coventry Health Care of Kansas and Blue Cross Blue Shield of Kansas City, which does business in two Kansas counties, Johnson and Wyandotte.
Subsidies to blunt higher premiums
Ron Rowe, a vice president for BCBS of Kansas City, predicted the cost of premiums for new, non-group policies would trend higher.
“Some people’s rates are going to go down and some are going to go up, but in aggregate it’s going to be about a 30 to 35 percent increase for that entire block of business,” he said.
But those increased costs could be mitigated for many. People who already have individual policies can keep them. And those who qualify for federal subsidies could end up paying less for more expensive and more complete coverage.
“Many people who are going to see big, high rate increases are going to qualify for a subsidy,” Rowe said. “And the amount that they’re going to pay out-of-pocket, net with the subsidy next year, will be less than they’re paying today even if the premium is significantly higher.”
For example, a person with annual earnings equal to 150 percent of the federal poverty level — $17,235 — would pay about $460 a year for a $5,000 policy, according to a cost-estimating tool developed by the Kansas Insurance Department. Federal tax credits paid directly to the insurance company would cover the remaining $4,540.
The credits, available only through the exchange, will be calculated on a sliding scale up to 400 percent of federal poverty guidelines, or annual earnings of $45,960 for an individual. But at that top level, the subsidy would amount to only about $630 leaving the consumer responsible for the remaining $4,370.
Despite the likelihood that many consumers purchasing through the exchange could pay less, both Corbin and Rowe said they anticipated a backlash from those forced to pay more.
“We’re trying to get out in front of the negative that’s going to come,” Corbin said.
To do that, he said, the company planned to do as much as it could to educate consumers about the exchange, the subsidies available and why some coverage would cost more.
Higher risks mean higher costs
Premiums are expected to rise because the reform law prohibits insurance companies from continuing practices they have historically used to reduce their risks. Those practices include denying or limiting coverage for high-cost individuals or capping their benefits. Going forward, the companies must sell policies to anyone regardless how sick they might be.
Kansas Insurance Commissioner Sandy Praeger, a Republican who has bucked the party line in supporting the law, said the old system often denied affordable coverage to people who needed it most.
“If you had any kind of pre-existing condition, you probably couldn’t buy (insurance) at all,” Praeger said. “You could be denied coverage because of allergies.”
Lawrence call center expected to add positions to handle insurance exchange calls.
Four states that have snubbed the federal health law by defaulting to the federal government to build new online insurance marketplaces and not agreeing to expand Medicaid are getting new jobs at call centers that will help consumers understand their new coverage options this fall. Kansas is one of the four states.
Up to 9,000 jobs are expected to be created at call centers to support the new federally run marketplaces. A U.S. Department of Health and Human Services spokeswoman said some of them will be added to existing Medicare call centers in Phoenix, Chester, Va., Lawrence, Kan., and Tampa, Fla. — all states with Republican leaders who oppose the law.
A fifth center in Coralville, Iowa and a sixth in Corbin, Ky., will also be expanded, she said. Plans are still being finalized for other locations, she said.
Of those states, only Kentucky is setting up its own online insurance marketplace that will help people shop for individual or small employer coverage. Iowa, will run its exchange in partnership with the federal government. The other states are relying entirely on the federal government.
Of the six states getting call centers, only Kentucky has committed to expanding Medicaid in 2014, even though governors in Florida and Arizona say they support it. So far, 22 states have agreed to expand Medicaid.
The jobs are through Vangent, a General Dynamics Information Technology subsidiary, which was awarded a $530 million one-year contract by the federal government to set up call centers to answer inquiries related to the insurance marketplaces in 34 states where they will be run in whole or part by the federal government.
The government estimates that next October, when the marketplaces go live, the call centers will be open seven days of the week, 24 hours a day, handling 6.1 million phone calls and 23,000 e-mails. The contract could be renewed for up to nine more years, making it potentially worth more than $5 billion.
States running their own marketplaces will have their own call centers.
The marketplaces are expected to expand health coverage to about 27 million people by 2016. Under the federal contract awarded to Fairfax, Va.-based Vangent, the company will also field inquiries about Medicare, Medicare Advantage and “other relevant programs,” the award announcement stated.
With the filing deadline approaching, the nation’s largest tax preparation company is letting its customers know how they are likely to be affected by the Affordable Care Act.
“After the ACA was upheld by the Supreme Court in 2011, we did some focus groups and some surveys to try and measure the public’s understanding of what all is in the ACA,” said Meg Sutton, senior advisor for tax and health care services at H&R Block. “It became pretty clear that there needed to be a process for educating our clients.”
Sutton called the 2010 federal health reform law the “biggest tax-code change in the past 20 years.”
The company’s tax preparers, she said, have been calling their customers’ attention to the ACA’s penalties for not having health insurance and to the subsidies that will be available to low- and modest-income families.
The information also is available on an H&R Block website.
“Client reaction has been very positive,” Sutton said.
The company’s surveys, she said, had found that 77 percent of its clientele didn’t realize their 2013 tax returns would be used to determine their eligibility for health insurance subsidies and that 44 percent of those between ages 18 and 34 were unaware of the penalties for being uninsured.
Sutton said the company’s tax preparers do not tell their customers to buy - or not to buy – health insurance. Instead, she said, customers are “informed of their options” based on the information in their 2013 tax returns.
The ACA’s mandate that almost all Americans either have health insurance or pay a penalty takes effect Jan. 1, 2014.
Marvin Lawton has been a tax preparer at the H&R Block office in Topeka for the past eight years.
“I’ve found there to be quite a cross section in the way people react – all the way from being OK with it to being dismayed by it,” he said. “Some are OK with it because they already have insurance and won’t be affected by it, some are bewildered over how they’re going to afford it and some wonder why they have to pay a penalty if everybody in their family is healthy."
Most of his customers with little or no health insurance have seemed pleased to hear about the subsidies, he said.
“I’ve had a lot of people who used to have insurance through their job but ended up getting laid off in the past year,” he said. “They know how expensive health insurance is. So when I tell them about penalties, they say ‘But I can’t afford it.’ Then, when I tell them about the subsidies and how they’ll be able to buy it through the exchange and be part of a larger pool, they’re OK with it. They say they’re OK with it if it’s affordable. And I say that’s the intent, that’s why it’s called the Affordable Care Act.”
H&R Block customers have the option of signing up for email alerts on changes in the new health reform law.
Sutton said, H&R Block appears to be the only national tax preparation firm helping its customers predict the law’s effect on their 2014 taxes.
Surveys have shown that about 60 percent of the nation’s taxpayers use tax preparation companies. H&R Block accounts for almost 20 percent of the tax-preparation market.
Kansas Health Consumer Coalition Executive Director Anna Lambertson said she welcomed the company’s initiative.
“I think it’s great,” Lambertson said. “I give them high marks.”
The coalition, she said, has been looking for ways to launch a similar informational campaign in Kansas.
“We can’t do it alone,” she said. “And H&R Block can’t do it alone. It’s going to take everybody getting involved.”
Sheldon Weisgrau, a spokesman for the Health Reform Resource Project, also praised the company.
“I assume they’re hoping this will lead to more people coming to them to have their taxes done,” he said. “But that’s fine. Anytime you’ve got someone providing accurate information it’s a positive.
Weisgrau said federal officials have announced plans for launching a major outreach campaign in June.
“They don’t want to start too early, which makes sense,” he said. “The exchange won’t be up and running until October.”
Mary McBain, chief executive of the Kansas Society of Certified Public Accountants CEO said the H&R Block initiative had not gone unnoticed.
“The major accounting firms have definitely been ramping up for this,” she said. “Some of the bigger firms have hired people just to work on ACA – that’s all they do.”
MacBain said her organization was committed to providing its members with accurate information about the law.
“All of us, I think, need to take a deep breath and not get caught up in all the emotion that’s comes with health care reform,” she said. “We need to be informed because, frankly, there’s a lot of misinformation out there.”
→ Find more information on health insurance exchanges and other health reform topics at khi.org/healthreform.
After months of trying to dance around the politically charged issue, the administration of Gov. Sam Brownback has openly acknowledged that the $139 million Medicaid enrollment system that it is building will be interconnected with the online health insurance exchange required by the Affordable Care Act, and that the system will be ready to go by the Oct. 1 federal deadline.
“It's just a connectivity kind of a thing,” said Dr. Robert Moser, secretary of the Kansas Department of Health and Environment, which is spearheading the project to overhaul the 26-year-old, paper-based system to a modern online one.
“I certainly appreciate the concerns that are tied to the political angst, but this program was well on its way when I came on board and my job is to make sure it gets completed successfully,” he said.
Entangled with the exchange
Overhauling the state’s antiquated Medicaid enrollment system has been in the works since at least 2009, when the project was called K-MED.
The project stalled briefly in August 2011, when Brownback returned a $31.5 million federal grant, most of which had been earmarked for developing the state’s new Medicaid enrollment system. Brownback said he was returning the grant because it was tied to the Affordable Care Act — which he he had pledged he would not implement prior to the U.S. Supreme Court ruling on the law, and later until after the 2012 federal elections.
Then that same month, administration officials announced a new contract with Accenture to develop the Kansas Eligibility and Enforcement System (KEES), using $118 million in federal funds to pay for the $139 million projected cost. K-MED became KEES.
A key condition of the federal funding was that the KEES system would have to be “interoperable” with the coming health insurance exchange — an online marketplace scheduled to launch Oct. 1 where consumers can compare and buy coverage that will begin Jan. 1, 2014.
In Kansas and the 25 other states that elected not to run their own health insurance exchanges, the federal government will build and operate them.
Moser said interoperability of KEES and the exchange means that — for consumers — there will be a single entry point for enrolling in private health insurance or in Medicaid, the state-federal health care program for low-income, elderly and disabled persons. Medicaid in Kansas is known as KanCare.
“You enter in some information, most of it is going to be yes/no. If you're eligible for Medicaid then it would pop up the KEES patient portal,” Moser said. “If it shows that your income level is such that you don't qualify for Medicaid…it's going to push your information over to the federal exchange. So those two systems literally will be handing back and forth inquiries.”
Moser said the fact KEES would interface with the insurance exchange was no different than integration with other federal computer systems, such as Homeland Security or the Internal Revenue Service.
“It doesn't really have that significant of an implication in my mind. But then again, I'm a physician and a little bit more patient-centered and look at the convenience factor. If that person is in a hospital setting and I think they need admitted, but they're worried about the cost because they don't have coverage, I'd like to be able to determine at that point in time 'Are they eligible for coverage' and use that as leverage to get them in to the hospital,” Moser said.
Kansas Insurance Commissioner Sandy Praeger said today that she wants to meet this week with Gov. Sam Brownback about how to move forward with implementation of the federal health reform law.
Specifically, Praeger said she wants to talk to Brownback about the state partnering with the federal government on a health insurance purchasing exchange. Kansas no longer has the option of designing its own online insurance marketplace but it can still partner on one with federal officials, if it acts quickly, she said.
Praeger said partnering with the federal government on an exchange would allow the state to maintain its authority to review and license insurance plans.
Praeger, a moderate Republican who supports the reform law, said she must let federal officials know by Friday, Nov. 16 whether the state intends to partner on an exchange. But she said she needs the governor’s blessing on that and a grant application her department has prepared, which must be submitted by Thursday, Nov. 15.
“The governor needs to agree that he won’t oppose us applying for the grant,” Praeger said. “He doesn’t have to give tacit approval necessarily, but just indicate it’s OK if we want to move forward on this.”
Brownback, a conservative Republican, voted against the Affordable Care Act as a member of the U.S. Senate and as governor has tried to block its implementation pending the outcome of a U.S. Supreme Court ruling on the law and then later the outcome of the presidential race.
Brownback in August 2011 rejected a $31.5 million federal grant intended to help Kansas develop an exchange as part of a program to develop models for other states to use.
Praeger said President Obama’s re-election means that the reform law won’t be repealed. It also means that states that have been slow to act will have to play catch up to meet approaching implementation deadlines.
Under the law, each state is to have an exchange operational by Jan. 2014.
“It’s time to stop resisting,” Praeger said.
The board responsible for overseeing the digital exchange of Kansans' health records today unanimously approved transferring its duties to a state agency within a year, provided the Legislature acts to make the transfer legal.
If the Legislature amends the law, as is now expected, the functions of the Kansas Health Information Exchange would be transferred to the Kansas Department of Health and Environment by October 2013. Under the transition plan drafted by KDHE, the 17-member KHIE board currently appointed by the governor would become an advisory committee appointed by the KDHE secretary.
The goal of transferring the authority to KDHE is to reduce costs. Operating the board was expected to cost about $400,000 a year as an independent entity versus about $54,000 a year if the board's regulatory functions are assumed by the state.
The decision came at the same time that health information exchange is beginning in Kansas.
"This is a way to get the state to have some skin in the game. Right now the only people who have skin in the game are (medical) providers," said board member Jerry Slaughter, who also is executive director of the Kansas Medical Society.
Leading up to the decision, some board members and others had expressed concern that a state agency wouldn't represent the interests of patients or health care providers as well as an independent board would do so.
Related story: Kansas breaks ground on statewide digital health network
State insurance regulators are preparing a recommendation for Gov. Sam Brownback on what basic benefits should be available to Kansans who seek health insurance through the new online purchasing exchange that federal officials expect to be operational here within about 16 months.
A three-hour hearing to collect public input on what should constitute the state’s “essential health benefits” benchmark plan is scheduled for Wednesday. It is set to start at 9 a.m. in Shawnee Room A at the Maner Conference Center, which is next to the Capitol Plaza Hotel in Topeka.
“Our plan is to get some summary information (including a recommendation) over to the governor within a week or so after the hearing is over, and at that point it will be up to him to decide if he wants to make an election,” said Linda Sheppard, director of the accident and health division at the Kansas Insurance Department. Sheppard also is the agency’s project manager for matters dealing with implementation of the Affordable Care Act, the controversial federal health reform law that Brownback has pledged to have no part of until after the November presidential election.
Brownback, like other conservative Republicans, opposed the Affordable Care Act, first as a U.S. senator and then when he campaigned for governor in 2010. In August 2011, under pressure from GOP party activists, he spurned a $31.5 million federal “innovator” grant to Kansas to help the state create a health insurance exchange model for use here and possibly in other states.
He then said his administration would have nothing to do with “Obamacare” until after the U.S. Supreme Court ruled on the reform’s constitutionality. After the court largely upheld the law in June, he said he would do nothing to implement it until after the election.
Republican presidential nominee Mitt Romney and most Republicans running for Congress have vowed to repeal the law as a first order of business, if elected. In Kansas, conservative Republicans continued to use the reform law to bludgeon more moderate opponents in the party’s August primaries and were mostly successful with the tactic.
Insurance Commissioner Sandy Praeger is a moderate Republican who helped craft portions of the Affordable Care Act as part of her work on behalf of the National Association of Insurance Commissioners. She has consistently said that the law has shortcomings but allows flexibility to states in how it is implemented in some areas, and that Kansas should exercise those options in order to have programs more in tune with the state’s needs and desires.
The health reform law stipulates that the federal government will run the insurance exchanges in states that choose not to create their own and will have them up and running by Jan. 1, 2014. Likewise, in states where governors decline to choose the models for “essential benefits” offered through the exchanges, the federal government will do so.
Sheppard said if the federal government chooses the benchmark plan for Kansas, it could be one that is less affordable than a plan selected by those more familiar with the Kansas market.
Spokesmen for Brownback this week said they were unable to say whether the governor would pass on making a recommendation regarding essential benefits as he did on returning the exchange grant.
According to Sheppard, federal officials have set a Sept. 30 deadline for hearing from governors on their benchmark plan choices.
After nearly four hours of discussion Wednesday, the board responsible for regulating digital health information exchange in Kansas postponed its vote on a proposal to dissolve and turn its regulatory authority over to a state agency.
Instead, members of the Kansas Health Information Exchange board decided to form a committee to develop a list of the dissolution proposal's pros and cons and return with a recommendation for the board to consider at its Sept. 12 meeting.
In Kansas, privately owned networks handle the transfer of patients' digital health records over a health information exchange — which went live last week. The KHIE board was set up in 2010 as a public-private regulatory body to be independent of political influence.
The proposal to fold KHIE's functions into the Kansas Department of Health and Environment would eliminate more than half of KHIE's $400,000 projected annual costs and transfer the rest to taxpayers. Under the proposal, the 17-member KHIE board currently appointed by the governor would become an advisory committee appointed by the KDHE secretary.
"I feel like we haven't fully vetted and understand the long-term implications of making this transition," said board member Karen Braman.
"I absolutely agree that we have to look at efficiencies in operations wherever we can. That's going on in every sector, every business, every household in the country right now. And I do think we have to capitalize on the synergies that can be gained in collaboration with KDHE. I think that's been one of the cornerstones of this public-private partnership that we've all been involved in for so long," Braman said.
Board member Jackie John of the Great Plains Health Alliance asked what assurance there would be that KDHE would continue to ensure the privacy and security of patient health information.
"When the state goes through their budgeting process, how do we know that there's going to be enough value, that this process is going to continue with the resources necessary to provide the quality of services we're committed to?" John said.
"At least until a change in administration, there's a commitment to do this. But I'm not going to sit here and say that we can guarantee things for all eternity — that's just not realistic," said Aaron Dunkel, deputy secretary at KDHE. "At least with this administration, which we're hoping will be a little bit longer, we've got a commitment."
In the wake of today's U.S. Supreme Court ruling, Kansas could still avoid ceding total control of its health insurance exchange to the federal government if it moves quickly, Insurance Commissioner Sandy Praeger said.
“That’s probably the best-case scenario now from an exchange standpoint,” Praeger said.
But that would require a meeting of the minds between Praeger and Gov. Sam Brownback and meeting a mid-November deadline for alerting federal officials to the state's intentions.
Last year, Brownback returned a $31.5 million federal grant that would have helped the state develop its own exchange. And today, after the court's decision, the governor vowed he would do nothing to implement the Affordable Care Act's provisions until after the November elections.
“Stopping ObamaCare is now in the hands of the American people," Brownback said. "It begins with electing a new president this fall.”
Opposition from Brownback and Republican legislative leaders resulted in Kansas missing deadlines for establishing its own exchange. Under the federal law, each state must have an operational exchange by Jan. 1, 2014, with plans for it certified by Jan. 1, 2013. States that choose not to implement an exchange on their own would cede that authority to federal officials.
Kansas missed the cutoff for developing its own exchange but could still partner with the federal government on one, an arrangement that Praeger said would allow state officials to set rules for insurance company participation in the online marketplace and direct consumer assistance efforts.
“Plan management and consumer assistance are two functions that our industry and our agent community are most concerned about. So, I think they would like us to retain control,” Praeger said.
Praeger said federal officials have told her that she doesn’t need explicit authorization from Brownback to proceed. She could sign the letter declaring the state’s intention to partner with the federal government on an exchange.
Despite those assurances, Praeger, a moderate Republican who supports the health reform law, said she doesn’t want to circumvent Brownback, a conservative Republican who continues to fight the law.
“Even if I’m allowed to sign the letter, I’m not going to do that unless the governor at least agrees they won’t try to block our efforts,” Praeger said. “After the dust settles, I think we (Praeger and Brownback) will have a conversation and we’ll sort through all of the issues.”
As outlined in the Affordable Care Act, individuals, small-business owners and people whose incomes qualify them for federal subsidies and tax credits would shop for policies using the exchange websites that would help the shoppers sort through coverage and price options. The exchange also could be used to determine eligibility for the Medicaid program, eligibility for which would be expanded under the law where states choose to do so.
→ More in-depth coverage of the Supreme Court's ruling on health reform and its implications for Kansas at khi.org/aca-ruling.
Jennifer Brull’s father needed urgent medical attention.
Brull, herself a physician, was helping him collect everything he needed, including his most recent laboratory and scan results. Then she learned that one set of her father’s X-rays were at a hospital four hours away.
"We had to drive to pick them up," she said, recalling the incident, which occurred earlier this spring. "It was a real pain in the butt. You know, it's during a stressful time and we were dealing with a bunch of other things. This was just one more thing that we have to deal with, something that should have been easy. There's no reason in this day and age that we shouldn't have been able to accomplish that electronically.”
Dr. Jennifer Brull, who practices family medicine in Plainville, is a national leader in adopting electronic health records.
It isn’t the technology itself that is the barrier to more medical providers exchanging electronic records, she said, but the lack of a secure network to transmit them without risking patient privacy.
"We said, 'Just email it — it's fine, we'll sign a waiver.' They said they just couldn't do it," Brull recalled of the hospital’s refusal to transmit her father’s X-ray records and spare the family the long drive.
Developers of a new statewide digital health records exchange say the needed secure network is coming to Kansas this summer. They call it a groundbreaking event that is expected to improve patient care and help cut medical costs by avoiding redundant and ineffective treatments. It’s also expected to reduce errors.
The statewide health information exchange is scheduled to go live July 1, allowing medical providers registered with the network to share and search for patient records.
Dr. Robert Moser, secretary of the Kansas Department of Health and Environment, said the exchange would safeguard patient privacy.
"We can assure patients that this information will be secure and safe and only available to those providers that need it, and at the time they need it," he said.
Patient information available on the network at first will be limited to demographics, medications, allergies, lab results and medical history, including diagnoses, procedures, surgeries and immunizations. But officials at the Kansas Health Information Exchange Inc. predict the system will grow to include more kinds of information, such as a doctor's notes or dictation recordings.
Substance abuse data will not be available on the network unless explicitly authorized by a patient.
About a third of Kansas patients receive care from a provider who is or will be connected to the exchange in the near future, officials said.
Benefits of exchange
As it is more widely adopted, health information exchange, or HIE, will take the place of paper records, which are typically transferred via fax, discs, mail or by patients themselves. And quicker access to more complete patient information should translate into benefits for patients.
"Right now we wait sometimes a month or more to get records," Brull said. "That time delay certainly impacts how you provide care to that patient."
She said the current paper system relies heavily on the patient to relay information from one care provider to the next. But too often patients don't know exactly what was done or learned by another provider.
"If you know real information, you're a lot less likely to order another test," Brull said. "That's what the free exchange of information gets you — you've helped the patient and eliminated costs."
Less paperwork also will mean less administrative cost, she said.
"I hope people look back 20 years from now or 50 years from now and say, ‘This was when health care in the United States changed. There's way less cost and better health care,’" Brull said.
→ Continue reading about health information exchange at khi.org/HIE — including information about network security and privacy concerns that patients need to know.
New privacy notices
Starting June 1, patients of Kansas health care providers who are connected to the new statewide network will receive privacy notices telling them that their health records may be shared electronically, under the same legal protection that currently applies to their paper-based health records. Those who don’t want their records to be available on the network must mail in an "opt-out" form, which is available at the website KHIE.org.