“So what will happen during this sign-up season? “I think the best-case scenario is maintaining [ACA exchange] enrollment at the levels we had last year,” says industry consultant Rosemarie Day, founder and president of Day Health Strategies LLC. In all likelihood, she tells AIS Health, she expects to see a decline in enrollment for federal facilitated marketplaces, “and I think the state-based exchanges will work hard to maintain what they had last year.”
Day and others note that the vast majority of enrollees in exchange plans receive federal subsidies, “so most are sheltered from premium increases.” But, for unsubsidized individuals, there was a big spike in exchange plan premiums last year, she says.
Yet she recalls better-than-anticipated enrollment results in fall 2017. “We did better last year overall with enrollment than the more dire predictions had suggested, and that was good news,” says Day, who was founding deputy director and chief operating officer of the Massachusetts Health Connector, a state-based model for ACA exchanges. She posits that state-based exchanges outperformed federally facilitated marketplaces on sign-ups because of their strong investment in marketing and outreach. “I know a lot of them [i.e., state-based exchanges] and their level of commitment,” she says.
The Commonwealth Fund, in an Oct. 26 report, shows the federal government is spending only 51 cents per uninsured person on advertising and 51 cents per uninsured person on navigator grants. That compares to $13.23 and $13.37 budgeted, on average, respectively, by 10 responding state-based marketplaces. The five states using HealthCare.gov averaged $6.46 per uninsured person on advertising and $8.21 per uninsured person on their navigator programs.
This year, Day notes, federal regulators are allowing the enhanced direct enrollment option for federally facilitated marketplaces, thus letting consumers and agent/brokers shop, enroll and manage changes without having to create an application on HealthCare.gov. This approach “allows an improved shopping experience” and may promote more loyalty to the member’s
current carrier, she says. As for product design, Day says that, “because affordability is such a concern, I think there’s still support for narrow networks, at least in metro areas” with a sufficient number of providers to support them.”
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