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The health insurance exchanges are heading down the home stretch toward their Oct. 1 debut. While some advisors wonder whether this foreshadows the end of their practice, others see opportunity.

Beginning Oct. 1, millions of Americans will be able to sit in front of a computer, pick up the telephone or sit down face-to-face with an assistant, and sign up for health insurance under the Affordable Care Act (ACA). That day will be the culmination of years of political name-calling, Tea Party protests, court challenges and the threat of a government shutdown.

The Congressional Budget Office estimates that 9 million Americans will enroll during the first year in which the insurance marketplaces, also known as exchanges, are in business. Jan. 1, 2014, is the earliest date in which that coverage will take effect, and open enrollment will close in March 2014.

Health insurance advisors aren’t going away any time soon, said a leader of the National Association of Health Underwriters (NAHU).

“Most health insurance agents can be trained in the regulations so that they can access the exchange information and get people enrolled in coverage,” said Russ Childers, CLU, of Americus, Ga., who is chairman of NAHU’s Exchange Committee. “In fact, I plan to advertise in my community and tell people that they can come to our office and we will help them get coverage.”

Even though people can go online to the exchanges or access a call center and see what health plans are available, they are still more comfortable talking with an agent, Childers said. “In fact, I believe that agents will still be selling insurance and they will be selling it to people who couldn’t afford it in the past. I believe our market will increase as a result.”

States Health Insurance Marketplace Decisions

As for how agents will get paid for enrolling people in health coverage through an exchange, guidance issued by the Department of Health and Human Services (HHS) in May states that health insurance agents may continue to earn a commission for policies they sell inside the federally-operated exchange. This is in contrast to “navigators” and “assisters” who will receive funding through HHS to present information and answer questions about coverage options. These navigators and assisters may not receive a commission from an insurer and are not permitted to recommend a particular plan to a consumer.

The difference between receiving information from an “assister” and obtaining advice from an advisor is what will provide an advantage to the advisor, Childers said. “Even with the training that the navigators and assisters receive, they still will have minimal knowledge of the details of how health coverage works,” he said. “That is more reason for people to meet with a licensed agent who can help them select an insurance plan.”

One of the biggest tasks remaining to be done before Oct. 1 will be training the navigators and assisters, those who will present information and answer questions about coverage options. This army of helpers will be needed to help consumers sift through all the available information and decide on the right health care plan.

The Affordable Care Act requires marketplaces to establish a navigator program to help consumers understand their options and help them find the coverage that best suits their needs. Each marketplace will have at least two types of entities serving as navigators, and at least one type of entity will be a community and consumer-focused nonprofit organization.

The Centers for Medicare & Medicaid Service (CMS) will fund $54 million in grants to navigators in states with federally facilitated or state partnership marketplaces. CMS is expected to announce in mid-August who will receive the grants. Following that announcement, the in-person assisters will be hired and trained, and the goal is to have them in place and ready to help consumers on Oct. 1. This leaves only about six weeks in which to have everyone trained and ready to go.

More than a dozen states have added their own rules for navigators beyond what’s already required by the federal government. Those rules include additional training, background checks and licensing. 

Meanwhile, the time to put the finishing touches on the system is running out. So, a big question in all of this is will the exchanges be ready for business when we flip the calendar page from September to October?

Federal and state officials overseeing the exchanges replied with a confident “Yes.”

“We have already met key milestones and are on track for open enrollment to begin on Oct. 1,” said Alicia Hartinger of the U.S. Department of Health and Human Services (HHS).

“It won’t be a smooth roll-out, nothing of this magnitude ever is, but we are doing our best to be ready for Oct. 1,” said Cindy Crone, deputy commissioner of the Arkansas’ Health Connector Division.

But other government officials say, “Not so fast.”

In early August, the Office of Inspector General warned that the federal health exchange was in danger of missing its Oct. 1 target date because the contractor responsible for developing a system to protect applicants’ privacy had not met the deadlines for putting the system into place. Those who visit the health exchange website will be required to provide Social Security numbers and income information in order to determine whether they qualify for a subsidy toward buying coverage. Privacy advocates have voiced their fears that applicants could risk identity theft and breaches of privacy if safeguards are not put into place.

Also, in mid-July, the Government Accountability Office (GAO) expressed concern that certain aspects of the exchange implementation were running behind schedule. In a report, GAO said that 17 states and the District of Columbia – all of which are operating their own exchanges outside the federal exchange – were behind schedule in implementing their exchanges. The GAO cited delays in awarding funding for navigators, which in turn delayed their training, and further concluded that whether the exchanges would be up and running in time for October “cannot yet be determined.”

In early August, the chief executive of Access Health CT, the Connecticut health insurance exchange, said that he expected “low satisfaction” among consumers at the start of the exchange and that it could be up to three years before that turns around.

Another issue is the debate over whether premiums for plans offered on the exchange will be a bargain for consumers or not. Much depends on the state in which someone lives. New York made news in July when its insurance officials announced that individual plans available on the exchange would be 50 percent less than similar policies currently available on the open market. But Ohio reported that premiums for individual policies on its exchange would increase by an average of 41 percent.

The other major tasks in getting the exchanges ready will be: making sure the website for online enrollment is tested and ready to go, approving the qualified health plans (QHPs) that will be available on the exchanges, and educating the public about how to sign up for coverage.

Having the technology ready for opening day will be crucial. The website has been established as the main web-based information source for all consumers seeking to apply for coverage, examine options and enroll in a health care plan. Those who live in states that are operating their own exchanges will be directed to the exchange website in their particular state. Consumers already can go to this website to set up a user name and password and establish an account in advance of the Oct. 1 exchange launch.

“Because the plans won’t be available to view until Oct. 1, we are expecting that first day to be more of a shopping experience than a buying experience,” Crone said of the Arkansas exchange. “A few people may be ready to decide on their plan right away, but most people will be looking for information first, then coming back to make a decision.”

As a preliminary to having the website up and running, HHS and the state-run exchanges already have staffed call centers to answer questions from consumers before Oct. 1. The federal call center operated by HHS will be able to assist callers in 150 languages, Hartinger said.

For those without computer access, or who would be more comfortable speaking face-to-face with someone, hundreds of walk-in centers will be open for business. The U.S. Health Resources and Services Administration (HRSA) awarded $150 million to 1,159 health centers across the nation to serve as outreach and enrollment assistance centers. CMS has branched out to form a partnership with the Institute of Library and Museum Services, helping the nation’s librarians to assist the public with accessing information on the health care exchanges.

The most visible part of the ACA implementation will be promoting the program to the general public. The price tag for this outreach is expected to be as much as $684 million, according to an Associated Press report. Outreach will include everything from traditional mass media advertising, to social media, to grass roots outreach in churches, barber shops, community centers and door-to-door. HHS Secretary Kathleen Sebelius recently addressed a convention of female bloggers, inviting them to help spread the word about health coverage to their audiences. 

“We are anticipating that a lot of people will go online Oct. 1, then we expect to see another upswing after Jan 1,” said Crone of the Arkansas exchange. “But we expect that a lot of people will wait until the very last day they can sign up.”

Susan Rupe is managing editor for InsuranceNewsNet. She formerly served as communications director for an insurance agents' association and was an award-winning newspaper reporter and editor. Follow her on Twitter @INNsusan. Contact her at [email protected].

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