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Mixed messages, overloaded computers and a tangle of health plans harder to navigate than Interstate 15's "spaghetti bowl." Sound familiar?
If past is prologue, Tuesday's debut of the Affordable Care Act's insurance marketplace, or exchange, will be marred by the same hiccups that dogged Medicare Part D.
"They are eerily similar," said Darren Hotton, manager of the Utah State Health Insurance Counseling and Assistance Programs, which helped seniors enroll in President George W. Bush's prescription drug plan back in 2005.
Both programs are technologically fraught attempts to entice millions of Americans to buy insurance online. Neither was very popular in the months leading up to launch, with political leaders casting doubt on success and consumers wary about what it will cost.
"That first day I spent two hours helping a guy from Moab pick a drug plan because the system kept crashing," recalls Hotton of Part D.
Since then, the technology has improved and the "feds have had eight years of hindsight to get enrollments down," said Hotton, who predicts shopping on the exchange will soon be routine.
Starting Tuesday, Utah's 380,000 uninsured will get their first peek at the exchange — http://www.healthcare.gov — which David Simas, a special assistant to President Barack Obama, recently touted as an historic health care advancement.
"For the first time there is a real honest-to-goodness market that allows people to see what they can buy, compare it apples to apples," he said in a discussion with a group of reporters. "And then they can decide whether it works for them."
Consumers will be asked to provide their name, address, age and gross income — information that will be verified and used to identify who is eligible for Medicaid, which assists low-income people, and who will receive a subsidy to put toward their insurance purchase, and how much that subsidy is.
Utahns will have their pick of 96 health and 28 dental plans.
They will be able to compare plans of varying quality, with the subsidy already factored into the cost. The price on the screen will be the price the person would pay each month.
Once participants pick a plan, they will be expected to pay the first month's premium immediately and won't be able to change their mind until open enrollment in 2014. For this reason, Simas said, the White House expects some window shopping in October but big spikes in enrollment in December, right before the plan year starts in Jan. 1, and then again in March, when the open-enrollment period ends.
"Oct. 1," he said, "this is the beginning of the period, not the end of the period — not the most important day."
Shopping the exchange won't be as carefree as booking a flight on Travelocity or Expedia.
"My only concern is that people look carefully at the plans," Hotton said, "and don't just go for the cheapest, which is what many seniors did with Part D, only to realize that their out of pocket costs were higher."
An army of insurance brokers, navigators and call center operators exists, however, to help consumers with their choices, each with their own strengths and weaknesses:
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Navigators • The working poor and some middle-income families are probably best served by federally funded navigators. Utah has a network of more than three dozen nonprofits intimately familiar with Medicaid, the Children's Health Insurance Program and other public aid programs.
As of Monday, navigators were still scrambling to get trained and certified, but Jason Stevenson, a spokesman for the networks' hub, Take Care Utah, said, "We are ready to rock, and we will be available on Oct. 1."
A website — bit.ly/utahnav — will direct families to the navigator nearest them. Navigators are leveraging churches, schools and community centers to reach as many families as possible.
But there aren't enough of them to answer everyone's questions, acknowledged Lincoln Nehring, a health policy analyst at Voices for Utah Children. "The insurance broker community dwarfs the navigators in size. We're going to need to rely on them, too."
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Insurance brokers • Brokers may not be familiar with the ins and outs of Medicaid, but they know health insurance.
"Navigators can only help you fill out an application. A certified insurance agent can recommend and discuss plans," said Justin Peterson, an agent with Laub Insurance Agency.
Brokers are familiar with Utah's hospital networks and insurance company track records, said Peterson.
They can help consumers anticipate their health costs, based on prior spending, and find coverage matched to their budgets and specific health needs, he said. "Those are the kinds of questions we deal with on a daily basis."
Some work for insurance carriers and have financial incentives to steer consumers to that carrier.
But many brokers are certified to sell all plans on the exchange, said Peterson. Commissions are built into the premiums shoppers pay, whether they use a broker or not, he said.
Find a certified broker near you at bit.ly/brokerfind.
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Call centers • Operators are already answering questions about health reform on the 24-hour hotline at 1-800-318-2596.
By Tuesday, about 9,000 help desk agents will be answering questions about the Affordable Care Act in English, Spanish and about 150 other languages. Roughly 2,000 of those employees will be based at call centers in Utah, one in Layton and in Sandy, but calls will be coming in from throughout the nation, so don't expect your call necessarily to be answered by a local.
While employees are specially trained to help consumers compare plans and walk them through the application process, agents can't choose a plan for a consumer, said Mike Fierberg, a spokesman for the Centers for Medicare and Medicaid Services.
"We know that a large proportion of people don't understand health insurance and the call center people are there to provide guidance," Fierberg said. Still, "they do not make recommendations. That's always the customer's decision."
Tribune reporters Matt Canham and Jennifer Napier-Pearce contributed to this story. —
Trib Talk • Affordable Care Act
and small business
O Open enrollment on the federal health insurance exchanges begins Tuesday and that means not only new plan options for individuals but new requirements for small employers. Who has to comply with the new law? And what does the Affordable Care Act require small business owners to do?
On Tuesday at 12:15 p.m., Trib Talk's Jennifer Napier-Pearce talks about how the act will affect small businesses with Patty Conner, director of the state-run health exchange for business called Avenue H; Dan Schuyler of Leavitt Partners, a health care consulting firm; and Aaron Call of G&A Partners, a human resource consulting firm.
You can join the discussion by sending questions or comment to the hashtag #TribTalk on Twitter and Google+ as well as in the comment section in the story below. The live chat video will appear at the top of this page a few minutes before the chat begins. —
More at sltrib.com
Utahns get their first peek at the cost of plans sold in the federally run exchange for individuals and families. —
Utah's uninsured
The Affordable Care Act promises to drastically reduce the uninsured rate, which remained flat in Utah in 2012.
An estimated 376,600 Utahns, or 13.2 percent of the population, went without health coverage in 2012, compared to 377,700 in 2011, according to a report released Monday by the Utah Department of Health.
The state's estimate, culled from a telephone survey, is lower than estimates provided by the U.S. Census. New Census data indicate 417,274 Utahns had no health insurance last year.
A good chunk of Utah's uninsured would qualify for Medicaid if the state were among those choosing to expand the safety net. Gov. Gary Herbert is still weighing the costs and benefits and hopes to make a decision in the coming months.
O Read the full report online. > bit.ly/utahuninsured