State, Insurer Spending Could Lead to Better Exchange Enrollment

Written by Jim McLaughlin | May 06, 2013

Becker’s Hospital Review

There’s a wide gap between states on how much money is budgeted to recruit and assist residents to enroll on the online health insurance exchanges, meaning a similar gap could develop in how much the uninsured population shrinks for providers in different states, according to a report by Kaiser Health News and the Washington Post.

Florida, like most Republican-led states, declined on the health law’s provision for states to build and run their own exchanges with federal grants, defaulting to a federally run marketplace. And like many states that opted for federal exchanges, Florida has a large uninsured population, nearly 4 million people, who will likely be eligible for premium subsidies available through the exchanges, according to the report.

Florida has a $6 million outreach budget for exchange enrollments, eclipsed by Maryland’s $24.8 million budget to bring its just 730,000 uninsured to its state-run exchange, according to the report. States that take control of their own exchanges receive more federal grants for outreach under the health law.

The private health insurance industry, which may add millions of new customers and billions of dollars in revenue from the exchanges, also has skin in the game, with companies launching their own outreach efforts, especially in states with federally run exchanges according to a report by Politico.

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Latino Outreach Could Bolster Support for Healthcare Overhaul

A new Latino Decisions survey indicates that Latinos think the Affordable Care Act is a good thing for the Hispanic community after they learn some basic information about it. (Wavebreakmedia Ltd./Getty Images)



May 2, 2013

Latinos are very interested in the Affordable Care Act but a new survey shows they don’t know much about it yet.

Targeted outreach to the Hispanic community might go a long way, however, in increasing public support for the law.

The Obama administration is battling fierce opposition to implementation of the law…and looking to gain as much support as possible from allies. President Obama even spoke last week at a Planned Parenthood conference, becoming the first sitting president to address the group in person. The women’s health advocacy organization has been a staunch supporter of the law and Obama said he will need help from it and other groups with implementation.

Latinos could fall into that category, but they don’t yet. Hispanics generally support the law and they stand to be hugely impacted by it — some studies indicate more than five million uninsured Latinos are likely to gain coverage — but a new impreMedia-Latino Decisions survey indicates they find it confusing and are wary about how it will impact them.

More than half of Latinos surveyed said they were “not that informed” or “not at all informed” about President Obama’s healthcare overhaul. More than two-thirds said the healthcare plan is confusing and less than 15 percent said public officials in Washington, D.C. took the health needs of the Latino community into account as the bill was developed and passed.

But the community is eager to know more — nearly 90 percent said they want to learn more about the law.

Here’s the interesting part: After they were provided some basic information about the law, three-quarters said it was a good thing for Latinos.

Those numbers indicate a couple of things. One, that more outreach specifically targeted at Latinos is needed. And two, that Latino support for the law increases after that outreach.

In other words, there’s untapped support for the law in the Latino community. A little targeted outreach could harness it.

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Florida legislature ends session without Medicaid expansion

Article published May 4, 2013

By Brendan Farrington / Associated Press

Posted: May 4, 2013 – 7:15 am ET

Tags: Associated Press (AP), Education, Ethics, Medicaid, Payers, Tax exempt


Florida lawmakers ended their 60-day session Friday, waiting until the final hour to pass a $74.5 billion budget and then leaving town without passing a bill to extend healthcare coverage to 1.1 million Floridians.

The Legislature did send Gov. Rick Scott an elections bill that attempts to fix problems with long lines and vote-counting delays that made Florida a joke across the nation last November. Among other things, the bill allows elections supervisors to hold up to 14 days of early voting instead of the eight days now in law, a reversal for the GOP-led legislature from two years ago. It also allows more early voting sites.

The $74.5 billion budget was approved just before session ended, but the House and Senate never bridged a wide gap on a healthcare plan.

The Senate wanted to use $50 billion in federal money over the next decade to expand healthcare coverage as allowed under the federal healthcare law, while the House doesn’t want to accept any federal money for Medicaid expansion.


The Senate began Friday by sending Scott a bill that would speed up the residential mortgage foreclosure process.

Among bills that died on the final day were a measure that would have helped the Miami Dolphins with $400 million in stadium renovations, prohibited judges from applying foreign law in Florida cases, banned abortions based on the race or gender of a fetus and created a needle-exchange pilot program, among others.

Still, Scott already has signed many major bills into law, including a ban on Internet cafes offering slot machine-like games, a wide-ranging ethics bill, an increase in campaign contribution limits and more. Scott vetoed a bill that would have ended permanent alimony.

Scott said he will sign the elections bill.

The Republican governor was also able to claim victories on his top two priorities: a sales-tax exemption for manufacturers and teacher raises.

“When you go across the state and listen to Florida families, they all want a job and they want the education system improved. That’s exactly what they want and that’s exactly what they got,” Scott said after the session ended.

The Legislature approved a bill that will exempt manufacturers from paying the 6 percent state sales tax on new equipment from April 30, 2014, to April 30, 2017. He wanted to permanently eliminate the tax. Lawmakers also included $480 million in the budget for teacher raises. Scott wanted raises for all teachers, but the Legislature is basing the increases on teacher performance.

“I think the governor gets two wins. I think it gives him a lift going into the summer and into the election cycle,” said Senate President Don Gaetz, R-Niceville. “And I’m for Rick Scott for governor, so I’m glad he got the wins.”

Gaetz and House Speaker Will Weatherford praised the work done in the session and the passage of most of the major bills, the healthcare plan being the big exception.

“When we set out on session, we talked about having priorities, and we didn’t say they’d be House priorities or Senate priorities, we said they would be legislative priorities,” said Weatherford, R-Wesley Chapel. “We went four for five and that’s pretty doggone good.”

Unlike last year, when the Legislature didn’t finish its business until midnight, or the year before, when the budget was passed at 1:55 a.m., lawmakers wrapped up the annual session with the “sine die” hanky drop ceremony an hour before sunset.

“It will be kind of neat to sine die and not be tired and having absorbed copious amounts of caffeine all day long and a Red Bull at the midnight hour,” Rep. Matt Hudson, R-Naples, said as the session was nearing a close. “That’s a huge plus. That’s a win right there.”

States managing their own exchanges get more money for outreach to consumers

May 5, 2013 2:12 pm by Kaiser Health News – Stories (Full text) |


Florida is on course to spend $6 million to reach out to nearly 4 million uninsured people and help them sign up for coverage in the federal health law’s online marketplace this fall.

Maryland will spend more than four times as much, or about $24.8 million, to help about 730,000 uninsured. The District of Columbia expects to spend about $9 million assisting 42,000 uninsured.

The wide variation in spending to hire and train people to provide consumer assistance in the first year of the new marketplaces could have a major impact on how many people actually get coverage under Obamacare, experts say.

Yet states with some of the nation’s highest uninsured rates, such as Florida and Texas, are getting far less federal money per uninsured resident than states with low rates, such as Maryland, Vermont and Rhode Island, according to a Kaiser Health News analysis.

That’s because states relying on the federal government to run their marketplaces are getting far less money than states setting them up themselves because of how the health law was written. In addition, some states such as Maryland that are running their own operations are supplementing the federal dollars with states funds. That’s widening the gap.

“The spending difference could have a huge impact,” said Jon Kingsdale, a consultant who helped launch the Massachusetts health insurance exchange in 2006.

Consumer assistance is considered key to enrolling the uninsured for several reasons. Polls show most people are unfamiliar with the law’s benefits, including new government subsidies that take effect next year. For example, those subsidies will apply to a family of four with an income as high as $94,000.

The online marketplaces, which open for enrollment Oct. 1, were envisioned to be as easy to use as travel websites like Expedia, but experts say that many people will need help figuring out which plan is best for them and what information they might need to sign up for coverage.

Some have never applied for health insurance coverage before and may need assistance even to navigate the website, said Sonya Schwartz, program director of the National Academy for State Health Policy, and project director of State Refor(u)m, a discussion forum about implementation.

The marketplaces, also known as exchanges, are the key way the law expands health coverage to about 27 million people by 2016. That’s where people will shop for and enroll in private coverage and determine if they are eligible for premium discounts, or for Medicaid, the state-federal health insurance program for the poor. While many customers will be uninsured, others with coverage will use them to take advantage of government subsidies.

“It’s a shame that we see states with lower rates of uninsured putting more money into education and outreach than states with higher rates of uninsured,” said Deborah Bachrach, a former New York State Medicaid director who is special counsel at the law firm Manatt Phelps & Phillips.

To be sure, consumer assistance is only one way that potential enrollees may learn of new insurance options and how to sign up for them. Additional federal dollars will go to advertising on radio, television and billboards. And insurers, hospitals and nonprofit groups may supplement public education efforts in many states.

The biggest reason for the uneven spending on consumer assistance is that when Congress passed the health law in 2010, it assumed most states would run the online marketplaces, and it authorized broad funding for that. As it turned out, only 16 states and the District of Columbia agreed to do so.

The law did not set aside money for the federal government to operate the marketplaces, either alone or in partnership with the states, as it is doing in at least 34 states. To remedy that, the Obama administration recently moved $54 million from the law’s prevention fund to provide money to hire and train people to assist consumers in those states, based on their number of uninsured.

That money will be awarded directly to organizations that agree to hire and train people to assist consumers. Those eligible include church groups, local health agencies, community health centers, chambers of commerce.

“This is a huge challenge,” said Laura Goodhue, executive director of Florida CHAIN, a consumer advocacy group. “As community based groups start to really plan and get ready for October, they are realizing just how difficult a job they will have and how the funding will only go so far.”

She estimates about 1.7 million people in Florida could benefit from subsidized coverage in the marketplace run by the federal government, but few know it will exist.

“We are equally concerned about a lack of consumer assistance or any type of consumer advocacy at the state level to help resolve issues related to enrollment and eligibility,” she said.

Texas, with the nation’s highest uninsured rate of about 24 percent, will get as much as $8 million to enroll about 5 million uninsured in a federally run marketplace. That’s less than $2 per uninsured resident— compared to about $31 per person in Maryland.

Virginia, with 845,000 uninsured, is getting $1.4 million for consumer assistance to help people sign up for its federally run marketplace.

Several states with high rates of uninsured are running their own marketplaces, and as a result, have more money for consumer assistance. New York, for instance, expects to spend up to $32 million on consumer assistance. Washington state has budgeted $6 million; Nevada, $2.3 million through 2014; California has budgeted $49 million through 2014.

Small states running their own marketplaces also have relatively big budgets to hire and train people to assist consumers. Rhode Island, which has 116,000 uninsured residents, plans to spend nearly $2 million over 18 months.

A handful of states, including Maryland and Vermont, are also spending state taxpayer money to supplement their federal grants. Maryland has put up $8.6 million on top of $16 million it got from the federal government. Vermont, which has about 55,000 uninsured, has put up $400,000, for a total of $2 million.

Genevieve Kenney, senior fellow at The Urban Institute, said that while the amount of money channeled toward consumer assistance is important, other factors also will have an impact. For example, states can streamline enrollment in Medicaid and make other efforts to make the process as consumer friendly as possible.

A number of states are also counting on help from private organizations. The California Endowment, a large health foundation has offered about $29 million to help California’s already well-financed outreach effort—mostly to help find and enroll people in Medicaid.

“While some private foundations and consumer groups will try to help, ultimately it’s what states invest in education and outreach that’s going to matter the most,” said former Medicaid director Bachrach.

Health advocacy groups in Maryland, meanwhile, are giddy at the $24 million that state is putting toward getting people signed up for insurance. The money will pay for 300 consumer assistance jobs created by six groups, including county health agencies and nonprofits.

The Baltimore area is getting $7.9 million of that to help find and enroll about 220,000 uninsured. That will be coordinated by HealthCare Access Maryland (HCAM), a nonprofit group that helps people get coverage, which will work closely with local hospitals, the YMCA, homeless shelters, community health centers and religious groups.

Asked about how Baltimore will have more money for consumer assistance than the entire state of Florida, HCAM CEO Kathleen Westcoat laughed.

“Maryland is putting its money where its mouth is,” she said.


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