Tuesday Short Cuts: Vermont, Oregon, Freelancers & Low-hanging Fruit

Gov. Peter Shumlin on Friday announced contingency plans for a federal government takeover of the state's troubled health insurance exchange and an alternative hybrid federal-state system.

Vermont Health Connect still isn't meeting its goals, and if it doesn't meet two key ones in the coming months, Vermont could scale back its handling of the project in favor of the federal government, Shumlin said. Those goals include:

  • Allowing consumers by the end of May to use the exchange website to record changes in circumstance, such as a new job, marriage, divorce or the birth of a child. Vermont Health Connect staffers currently have to take such change requests manually, usually over the phone.
  • Being ready for a smooth open enrollment period beginning Nov. 1 for the 2016 coverage year.

...They said the state could go one of two routes if it determines that Vermont Health Connect has failed: It could seek to fold Vermont into the federal exchange, or it could seek to set up a hybrid federally supported state exchange.

The article goes on to note the two major downsides of dropping their exchange and moving to HC.gov. One would be disappointing (losing the Vermont-specific tax credits which are unique to 2 states...VT and MA). The other, of course, would be devastating: A negative King v. Burwell Supreme Court ruling.

I'm on the record as blasting Vermont lawmakers (as well as Rhode Island legislators and potentially Minnesota as well) for giving any consideration to dropping their exchanges until after the King ruling comes out in June...and now that applies to Vermont's Governor as well. In the case of Vermont, it's mainly technical problems which put the exchange at risk. In RI & MN it's more about funding mechanisms than anything else, although Minnesota still has some tech issues as well.

At the same time, I do recognize the bind that these three states are in: The problem here is one of time. Last year, Maryland and Massachusetts were able to scrap their existing exchanges and replace them with new ones which work great, while Nevada and Oregon dropped theirs and moved everything over to Healthcare.Gov. All 4 states managed to pull off their revamps in time for the 11/15/14 launch of the 2015 Open Enrollment Period by scrambling starting in late April.

In the case of the King v. Burwell ruling, that's not expected until sometime in June. That means that states on HC.gov which want to move off of it will have to haul ass starting now...whereas states like VT, RI and/or MN which are considering doing the opposite would have to get their butts in gear very soon as well...except that doing so could also turn out to be a death knell for their exchanges. The only way that would work out would be if Nevada, Oregon and New Mexico are all ruled "off the hook" in the event of a negative King ruling. Since no one knows a) how the court will rule or b) whether the NV/OR/NM model would be included or not, it presents quite a dilemma.

The scaled down post-Cover Oregon health insurance marketplace has a new administrator: Berri Leslie, a deputy administrator of the Oregon Insurance Division.

Gov. Kate Brown signed SB 1 earlier this month, enabling the problem-plagued Cover Oregon to shutter for good June 30. The exchange’s functions will move under a new unit at the Department of Consumer and Business Services, while actual enrollment takes place on the federal exchange at Healthcare.gov.

All I can say about this is...thank God. Yeesh. As noted above, let's just hope that the Supreme Court rules that either a) The federal exchange subsidies are kosher after all or, at the very least, b) states which did "establish" their own exchanges legally but are being technically operated via HC.gov, such as Oregon, are off the hook. Otherwise none of Oregon's trials & tribulations over the past year and a half will mean squat.

Sean Williams used to work at Ford. But when the company offered the 46-year-old Chicagoan a buyout, he seized the opportunity to go back to school and pursue his dream of becoming a cinematographer.

...After more than two years without health insurance, Williams signed up under the Affordable Care Act when he learned he could afford it at $230 a month with a government subsidy.

...Whether by choice or necessity, the freelancing industry has been growing. About 1 in 3, or about 53 million people nationally, consider themselves freelancers in some capacity, according to a recent national survey commissioned by the Freelancers Union, a New York-based freelancers advocacy group. The catch: no benefits.

That's where the health care overhaul steps in to a self-directed worklife. Under the law, individuals who make less than $46,680 or families of four making up to $95,400 qualify for a government subsidy if they also don't have access to health insurance through an employer.

"Obamacare is part of this new rising infrastructure that's coming up around this new workforce," said Dan Lavoie, director of strategy for the Freelancers Union. "It's co-working spaces, job-sharing sites. There's this whole new infrastructure that's coming up to meet this new workforce and so little of it even existed five years ago. … There's kind of a path now (into freelancing) and Obamacare is part of that path for people."

Last year, states that ran their marketplaces saw big coverage gains compared with states that relied on the federal government to manage insurance sales for them. That makes sense considering that the federal website was a technical disaster and those states invested far less in getting the word out to eligible populations.

But this year, the states in the federal system caught up, with some experiencing substantial gains in the percentage of eligible residents who selected plans on HealthCare.gov. The state exchanges that thrived last year, in contrast, saw mostly marginal gains.

...“I think the concern about running out of momentum is legitimate,” said Jon Kingsdale, the former executive director of the health exchange in Massachusetts, before the Affordable Care Act, and now a director at the Wakely Consulting Group. Mr. Kingsdale said that states should be aiming to sign up 65 to 75 percent of eligible residents. “If we end up running out of gas before 50 percent, that’s very disappointing.”

This is an excellent overview by Margot Sanger-Katz of the New York Times of the "low-hanging fruit" issue hanging over Year Three. I noted some of the same points in my "By the Numbers" comparison from a couple of weeks ago, although I was focused more on the even spread of enrollments between the state-based and federal exchange states:

The most noteworthy thing I see in this table, actually, is that unlike the other 3, which have the same pattern (a couple of state exchanges at the top but the rest of them bunched up at the bottom), this one features a remarkably even spread between Healthcare.Gov states and State-Based exchanges; there's no connection between how effective a particular state was in enrolling a certain percentage of their eligible target market and whether they were on HC.gov or not.

What this says to me is that while the state exchanges held the upper hand in 2014 (since many of them had a 2-month head start on HC.gov), this year HC.gov found its stride and caught up.

In fact, if you add up the total eligible populations of the state-based exchanges (7,591,000), they make up 27% of the total...only slightly higher than the 24% of those who actually enrolled this year.

Of course, those numbers are slightly skewed by the fact that Idaho moved off of HC.gov this year while OR & NV moved onto it, but the point is still valid.

In other words, the exchanges, overall, have pretty much reached parity in Year Two. Assuming the SCOTUS doesn't botch everything up with King v. Burwell this summer, I'd expect every exchange, federal or state, to pretty much pull its weight.