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Use state public records laws to cover these aspects of health exchanges Date: 03/04/14

Colorado health reporter Katie Kerwin McCrimmon is a relative newcomer to AHCJ and she shared some of her experiences in covering Colorado’s state health exchange on AHCJ’s electronic discussion list recently.

She used the Colorado Open Records Act (CORA) “to pry information out of our exchange since I dealt with obstructive PR folks and exchange managers for most of 2013.”

Not all states have the same records laws. Not all the states have structured the exchange governance in the same way. And of course, not all the states are running their own exchanges. But her experiences in Colorado are still instructive in trying to get information released.

By Katie Kerwin McCrimmon

In Colorado, the exchange has delayed answers on public records requests but officials never claimed that they were not subject to the Colorado Open Records Act. That was true even though our legislature created the exchange as its own entity outside of state government — a public nonprofit called Connect for Health Colorado. In states where the exchange is part of state government, they must comply with open records laws, which can produce faster results than FOIA.

The trick is to make relatively narrow requests so they aren’t delayed or denied. If the request is just right in Colorado, officials must supply the information within three business days. This fall, I learned that our exchange managers were trying to get raises and bonuses behind closed doors in executive session – even after our exchange had a poor launch and enrollments were lagging below projections. I put in a request for executive salaries and had the information within three days. I did a story and members of Congress were furious. Needless to say, those requests for bonuses and raises were shelved – at least for now.

Here are some ideas for requests that could be helpful in learning about what has occurred in the exchanges over the last few months. Here's a preliminary list for information that would be helpful:

• Technology problems. Ask for emails. These are subject to public records requests. Getting email chains from pre-and-post Oct. 1 launch can be very revealing. You might find evidence of panic and finger-pointing behind the scenes.

• Costs and contracts. How much money are all these exchanges spending? I've obtained contracts for the information technology contractor CGI and other contractors here. We also learned that our exchange had hired outside public relations consultants and got tallies for how much they've been spending on the consultants. In addition, the troubled launch nationally and in states has forced some states to spend much more than planned on contingency efforts like beefed-up call centers and people who are processing paper applications. It would be amazing to know about additional expenses that have had to replace or supplement "Travelocity-style" systems. In Colorado, our phone center is jammed and exchange managers have had to hire outside contractors to call frustrated customers. U.S. Sen. Michael Bennet of Colorado even got stuck forever on hold and we reported on that. Here people are hunting for in-person help wherever they can find it because they find signing up online complex and overwhelming. It seems to be a fallacy that online sign-ups alone will suffice for consumers.

• Executive salaries. These seem to be variable. It would be really great to have comparisons for all state exchanges. Have others requested raises during the launch period like ours did?

• Travel records. In our state, the exchange folks haven't been doing much travel, but in a state like California, you might get some interesting evidence of spending there.

• Demographics. In addition for the age breakdowns (which some states and HHS are now giving) see if you can get geographical breakdowns for sign-ups. We got a great story here when we found out that health insurance rates in ski resort areas are far higher than other parts of the state. Enrollment specialists in high-cost areas like Vail, Aspen and Summit County can't get many people to sign up and one of our members of Congress called for waivers for them. County-by-county sign-up data might yield some interesting trends elsewhere as well.

Feel free to get in touch with me with your suggestions or to share data you find in your state. I’d be eager to do comparison stories about salaries, sign-up systems and demographics. Get in touch with me at katie.mccrimmon@gmail.com.

Katie Kerwin McCrimmon is a reporter for Health News Colorado, an independent, nonprofit media outlet that specializes in in-depth coverage of health and health policy issues in Colorado. Her last tip sheet for AHCJ was the prescient “Seven ideas to cover health exchanges before the rollout.”