Working Stronger Together: The ACA ‘Partnership’

Year two of open enrollment for the Affordable Care Act (ACA) has been a significant improvement over the first year. Consumers, insurance carriers, agents and brokers continue to hold out hope for a far smoother and seamless enrollment process. Like it or not, we are in this together. The government has made progress in addressing some of the shortcomings of the initial implementation. I am optimistic that with more consistent dialogue and collaboration, this public-private partnership can achieve its goal of expanding access to affordable health insurance for all Americans.

As attention shifts to tax season, roughly six million of those Americans who went without health coverage last year will be in for a surprise when they see the 2014 tax penalty that accompanies their decision to remain uninsured. For those who can afford coverage, that pain may be lessened by the one-time enrollment extension announced last week for tax filers who owe a penalty for 2014. Those who do not enroll will incur an even steeper fine for 2015. The extension is an apparent response to concerns raised by voices outside the ACA planning process – and that is precisely both the problem and the opportunity. We, the private side of this public-private partnership, are often on the outside calling for change rather than playing an integral role in the conversations that lead to such decisions.

The government has made it clear that the tax penalty extension will not be repeated next year. Why reinvent the wheel? If Americans are already anchored to an April 15 tax deadline and penalties remain on a tax year basis, why not align the ACA open enrollment with the tax filing season and its corresponding April 15 deadline? Allow consumers to shop through the first quarter of a given year and after the often stressful holiday season.

On a similar note, last week the government amended its decision to have the Medicare and ACA open enrollment periods occur at the same time, reducing the overlap to about five weeks. Though this is progress, the timing still creates confusion as Medicare Advantage carriers pound the airwaves with advertising at the same time that the Administration is competing for ad space to create understanding about the virtues of state exchanges (and our obligations under the law). As funds to support things like navigators become scarce, trained, licensed and qualified independent insurance agents and advisors will become increasingly important yet also scarce given the complexity and confusion dueling open enrollment periods present.

Medicare and ACA products are complicated, they work differently and are covered by different rules, requiring agents to focus on one market at a time to provide proper guidance and informed counsel. Overlaps in enrollment periods also create logistical hurdles for carriers particularly those that rely on appointed phone and field agents to meet consumer demand. Keeping the enrollment periods separate reduces consumer confusion and agent conflict, and allows the industry to better serve consumers.

One red flag that the government hasn’t addressed yet is the critical improvement needed in system integration, connectivity and eligibility verification at the federal and state exchanges – challenges that have a direct, monetary impact on private sector players and that we have tried to bring attention to for some time. Given the year one problems with, resources have been focused appropriately on the front-end consumer experience. However (as evidenced by last week’s tax data error that affected 800,000 enrollees), much more must be done to create a seamless enrollment and processing experience for consumers, insurers and agents on the back end.

Moving forward, insurers and agents are hopeful our insight and experience will be encouraged, considered and leveraged to help advance and accelerate needed infrastructure enhancements.

Make no mistake, the government brings key benefits to the table and is the ultimate decision maker when it comes to implementing the federal law. However, any successful public-private partnership needs predictability and transparency to ensure accurate investment planning and that requires the private sector to be a central part of the discussion. The private sector has the experience and expertise to anticipate future issues, manage resources efficiently and maximize the customer experience. In the end, the country will be much better off when decisions are informed by good advice from all parties.



Ken Fasola is the President & CEO of HealthMarkets, Inc.

Morning Consult