Special report: A rocky rollout for the health reform law

by Lauren Dubinsky, Senior Reporter | February 18, 2014
From the January/February 2014 issue of HealthCare Business News magazine

Right after the health insurance marketplaces opened for enrollment on October 1, a wave of problems crashed down on consumers and physicians.

Consumers are still faced with everything from registration website malfunctions to narrow networks and many physicians are crying foul over what they believe will be low reimbursements from insurance companies. President Obama acknowledged that there would be glitches in the ongoing rollout of the exchange, but the question remains as to whether these are just glitches or lasting problems.

The push to boost enrollment
Since open enrollment began, it has been the primary goal of many hospitals to get people on board. Each exchange must have two organizations that are certified as navigators and one must be notfor- profit. In August, Health and Human Services Secretary Kathleen Sebelius announced that 105 groups, including a number of hospitals, had been chosen to be navigators and would get a piece of the $67 million federal grant.

About twelve of the hospitals that are a part of the American Hospital Association received funding, but many of the others have become navigators voluntarily. “Hospitals are community-based organizations who are focused on providing service to the community,” says Ellen Pryga, director of policy development at the AHA.”For years, they have dealt with some of the tragedies that can come from people being uninsured, so when there is an opportunity to help people get insured there’s a very strong incentive to up the level of support for the community.”

Hospitals will often undertake community outreach efforts at local meetings and fairs, provide information on their websites and utilize contractors to help get people enrolled. “It’s to connect people to both information and the processes to enroll in coverage if they are uninsured,” says Pryga.

The AHA is unsure of the exact number of people who have enrolled in the exchanges as a result of their outreach, but they describe it as a “fluid situation.” What is known is that by the end of 2013, there were 2.1 million Americans who signed up for health coverage on the health exchange.

Too many glitches
Health insurance exchanges were included in the Affordable Care Act as a place where consumers could go to shop for affordable health insurance, or to see if they qualify for subsidies to purchase a plan.

Every state had the opportunity to create a fully state-based marketplace, enter into a state-federal partnership marketplace, or be a part of the federally-facilitated marketplace. The Kaiser Family Foundation found that 17 states created a state-based marketplace, seven went with a partnership marketplace, and 27 are a part of the federally facilitated marketplace.

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