What’s a health insurance exchange?
Wisconsin’s health insurance exchange, or marketplace, will be a website where individuals can go to shop for health insurance. You will fill out an application and then be able to compare plans based on price, benefits, quality and other features. You will find out if you: can get lower costs on your monthly premiums for private insurance plans, qualify for lower out-of-pocket costs, and qualify for free or low-cost coverage available through Medicaid or the Children’s Health Insurance Program. Enrollment starts Oct. 1, with coverage beginning as early as Jan. 1. For more details, visit
The state Office of the Commissioner of Insurance is holding an information session about the Affordable Care Act from 2 to 3:30 p.m. today at the Appleton Public Library, 225 N. Oneida St.
With enrollment in the new health insurance exchanges scheduled to start Oct. 1 — less than four weeks away — there are a lot of questions about how the exchanges will work, how much insurance will cost on them and how people will be able to buy insurance on them.
While Gov. Scott Walker has chosen to have Wisconsin’s exchanges largely set up by the federal government, the state still is heavily involved in the process.
One example came up Tuesday, when the state insurance commissioner’s office released an analysis that showed premium cost increases — some very large — for individual coverage bought through the exchanges. Critics immediately charged the office with trying to scare people for political reasons and criticized it for downplaying the federal subsidies that low-income people will receive and for not giving enough information about the basis for the analysis.
Four state officials who are dealing with the exchanges and the outreach effort around them — Health Services Secretary Kitty Rhoades, Health Services Deputy Secretary Kevin Moore, Insurance Commissioner Ted Nickel and Deputy Insurance Commissioner Dan Schwartzer — spoke with Post-Crescent Media on Wednesday to answer questions about the exchanges.
Here’s an edited transcript of the interview:
On the premium estimates:
Schwartzer: No. 1, we’ve been saying all along, wait until October. The exchange will be up. You can see all the rates. You can make comparisons as to what rate increases are coming. But we continued to get some questions and requests — can you give us anything on it? So we decided to make, as best we could, an apples-to-apples comparison to a simple $2,000 deductible with drug coverage today, and what would it be in January 2014 — just the individual market, just the single plan and just for three different age categories, broken up into geographic regions.
We looked at that $2,000 deductible in, let’s say Appleton, and then what plans were offered in Appleton and then what’s the average of those plans on a Silver plan and how does that compare to a rate for today’s market?
We tried to throw in as many disclaimers as we could to say comparisons are difficult, it’s based off a $2,000 deductible, drug coverage. It’s not looking at subsidies and how that might affect what purchase premiums are. We think it’s important to keep those two things separate. The premium is the premium, period, no matter what happens with the subsidy.
We released it to give some information to consumers about what they potentially could expect in the individual market, based on where they lived, in terms of what rate increases might take effect, and then we threw in the caveats — wait till October, see if you’re eligible for subsidies, see what that subsidy is and make your comparison then.
I think those who criticize would criticize no matter what we released or if we didn’t release anything, frankly. As we keep saying, we’re certainly not trying to scare anyone. We’ve done more outreach as an agency as the agency has ever done to get information to consumers. We’re not trying to scare anyone, but at the same time, we’re not trying to sugar-coat anything either. Our job is to be informative, give honest information and let the consumers do with that information what they need to do with it, which is be better consumers and figure out what they need to do.
On the insurance commissioner office’s role:
Nickel: Our job is to make sure the marketplace works. Our job is to tell consumers what to expect, make sure consumers are protected, make sure insurance companies are behaving themselves in the marketplace, make sure they’re following laws.
So what we’ve been dealing with pretty much since the day we walked in the place is trying to figure out how we make sure Wisconsin’s marketplace isn’t harmed by the Affordable Care Act, make sure all of the insurance companies operating in this state continue to be there and that consumers are going to be protected throughout this process.
On the state’s outreach:
Rhoades: We want to take some of the things we learned from Medicare Part D and apply them to how we’re going to implement and educate about the Affordable Care Act. In Part D, there was a giant media blitz by the government, trying to explain, and basically, people said, “Hmm. That was sponsored by the government, saying it’s good for me. I’m not sure that I trust that source.” We found that the majority of them were getting their information from their pharmacist.
These people make decisions based off who they trust. So we said this media blitz will enhance some who pay attention to it, but most won’t, so what works? We looked around and saw that there was an organization in Milwaukee called the Milwaukee Health Partnership, which is a very grass-roots organization. When it comes from the bottom up, people trust it. They listen to it and they believe it. When it comes from the top down, they tend to be very skeptical.
We also realize not all of Wisconsin is exactly the same. What works in the southeast isn’t going to work in the northwest. So we divided the states into regions and we’re holding town-hall working sessions with all of the stakeholders we can find in these regions — libraries, hospitals, pharmacies, counties, aging and disability resource centers — whoever and wherever they know people go is where we’re going to use to get the word out on how to enroll.
They’ve been incredibly well-attended and one of the over-arching themes is wherever you are on the spectrum doesn’t matter. We’re all in this together now, so let’s figure out how we’re going to do this. We want to make sure that people have access to the information, that they know how to go about doing this. We want to make this as easy as possible and as close to a one-stop kind of shop as we can.
On the regional enrollment networks — Outagamie, Winnebago, Calumet and Waupaca counties are in the East Central network:
Moore: We’re more of a steering committee to help coordinate activities. The punch line is really in getting our local public health, our aging and disability resource centers. The key is that we’re able to leverage works best in each community. Some communities may have a very strong hospital that’s going to drive enrollment. Others may have community organizations that may be more active and want to help out more. We want to build on that.
These plans are due back to the department on Sept. 16, so that’ll be a good indication of where each of the individual enrollment networks are and where those points of contact are going to be. If you look at it, though, a lot of these points are points where people already have contact, with FoodShare, Medicaid or aging and disability resource centers, where seniors have contact and touch points, too.
On enrollment in the exchanges:
Schwartzer: Open enrollment and effective date are totally different. Let’s skip the first year for a second. Going forward, every year, there will be an open-enrollment period in the individual market, from Oct. 15 through Dec. 15. You have to enroll in that open-enrollment period to make sure your coverage is effective in January of the next year. This first year, there’s an extended open-enrollment period. It starts Oct. 1 and ends March 31. If you enroll from Oct. 1 through Dec. 15, you’ll have the Jan. 1 effective date. So the real deadline for Jan. 1 is Dec. 15. But, in the first year, when there may be a whole bunch of people getting into this, they extended the enrollment period another three months.
It’s also important to understand that, if you miss signing up, your next available opportunity to sign up is the next year. You’ll end up without coverage. There’s no HIRSP. So you’ll literally be uninsured for a year if you don’t sign up.
There are exceptions — you lose your job, you just get married, you get divorced, you have a change in family status — all of those will have special open-enrollment periods and you’ll have 60 days from the date of event to sign up.
On why individual premium costs are increasing on the exchanges:
Schwartzer: The age band is one of those things you can kind of take note as to why premiums are going up. That’s one of the big ones. Younger folks paying a lot more and, potentially, older folks paying the same or less.
The plan designs will have a large impact on all markets. This is what we’re trying to make sure consumers know. Most of the plans you have today you won’t have anymore because of the minimum deductibles and the maximum out-of-pocket. When they squeeze those into those four medal tiers — the Platinum, Gold, Silver and Bronze — they really limited the type of plans you can have in the market and most people have plans, particularly in the individual market, that are greater than the $6,350 maximum out-of-pocket that you can have. So that is now the new floor or ceiling, depending on your point of view. You can’t have an out-of-pocket greater than $6,350 for in-network.
That, in theory, will change your provider potentially because there’s a lot of narrowing of the networks. There are a lot of insurers getting out of service areas that they’re currently in. You hear a lot about the grandfathering and “you can keep that plan” but, in reality, that’s not going to happen. Most of the plans will be changed — for the good, for the worse, that’s personal opinion.
Another key factor that we’re trying to get out to consumers is that, if you currently have individual insurance or if you currently are getting coverage through an employer-sponsored plan, it is highly unlikely you’ll see changes to that plan or increases that would be associated with changing your plan until next year. Most folks are doing what’s called an early renewal because the law goes into effect on plans that renew on or after Jan. 1.
What’s the impact of all of this on Wisconsin? Increases in premiums, which I think for the most part was predicted. It’s the same things most folks are talking about. There’s more risk for an insurer, with the HIRSP (Health Insurance Risk-Sharing Plan) population going into the individual market. There are increased benefits — most people are buying up. Even though you’re getting the increased benefit, you’re paying for it. The 3:1 ratio age-band ratio for premiums is another big reason why costs are going up. There are a lot of taxes and fees on insurers now. Those are usually just pass-throughs to consumers. So for all of those reasons, premiums are going up. It just depends on where you fit.
On if they expect the exchanges to be ready Oct. 1:
Rhoades: We tell stakeholders that operational and ready may not be the same as liking.
Schwartzer: The website will turn on on Oct. 1. It’s not going to necessarily check eligibility or premium tax subsidies or transfer seamlessly to the insurers — all the stuff behind the scenes. I can’t believe there won’t be problems with anything. From what we know, the site will turn on on Oct. 1
Rhoades: We will be ready with our part.