Worries abound about second ACA enrollment season

healthcaregovThe second ACA enrollment season begins Nov. 15 – after the Congressional elections. While it’s hard to imagine problems worse than last year’s rollout, there’s still plenty that can go wrong.

Kevin Counihan was just named the new CEO of HealthCare.gov – a position that incorporates the old Center for Consumer Information and Insurance Oversight (CCIIO) director job at the Centers for Medicare and Medicaid Services (CMS) and also consolidates some of the responsibility for the exchange that had been scattered throughout the Department of Health and Human Services. An old hand at health care, Counihan played a role in the Massachusetts state reform before running Connecticut’s state exchange last year. (Here’s a Connecticut Mirror piece by Arielle Levin Becker about him).

After his CMS appointment, Counihan spoke to the New York Times’s Reed Abelson and gave a preview of headaches to come. It’s hard to know how many of these problems will still feel big and threatening in November, and to what extent he’s playing a “lowering expectations” game. HHS is under new management with Secretary Sylvia Burwell and the new team would clearly benefit from some headlines that say, “Hey, it didn’t melt down.”

In some respects, this year’s enrollment period will be more complicated, Counihan told the Times, “Part of me thinks that this year is going to make last year look like the good old days.”

The HealthCare.gov team is going into its second year with baggage from year one. Not just the public confusion and political controversy, but also lingering problems with the “back end” of the federal site – the part that consumers don’t see but that insurers rely on.

We’ll be having a webcast on Sept. 23 about what states must do to get ready. Here are four issues worth covering:

Premium costs: They are all over the place. Some are going up, some are going down – even in the same state. Overall, the trend is modest increase, but that’s not true everywhere.  (Here’s a post we did earlier on how to understand premium changes and a recent Kaiser report on a slight drop in premiums in benchmark plans in major cities.)

Renewal/auto-renewal: The administration hopes to get about 5 million more people to sign up. But the current 8 million has to re-enroll.  Those that don’t shop for a new plan (or opt out of the exchange coverage) will be auto-re-enrolled Dec. 15. But sticking with the same plan, while convenient and perhaps good for continuity of care, isn’t necessarily going to be the best financial deal for everyone.

Compressed enrollment time: In 2014, people had six months to sign up (plus a bit of spillover into April to make up for the tech problems). This year, the enrollment period lasts three months. If people assume they have until March or April, as they did last year, they’ll have a rude surprise.

Plan Cancellations: Some states are allowing plans that don’t comply with ACA rules to be sold for 2015 (or longer). Some aren’t. Some people will get cancellation notices (and some small businesses will also see price hikes as their plans have to come into compliance). This won’t be as widespread as last year, but it will nevertheless cause some upheaval and give critics of the health law another chance to remind everyone of President Obama’s “if you like your plan you can keep it” pledge.

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