As part of a series this blog explores the “nudge theory” as it relates to implementation of the Affordable Care Act (ACA) and the implications to players in areas of state exchanges, meaningful use, and patient engagement.
If you missed the introduction, and wish to further understand the premise of “nudge theory” please visit Introduction.
State Exchanges
Under ACA, the Department of Health and Human Services was called upon to create a program to “help create new, private nonprofit health insurers, called Consumer Oriented and Operated Plans”.¹ Referred to as CO-OP, the program was allotted a $3.8 billion appropriation to lend funds to private and nonprofit groups to establish health plan offerings to individuals and small businesses. The goal: to have at least one health insurance exchange in each state by January 1, 2014.
As to implementation of the law, Karen Greenrose’s observation to prefer provider members reflected on the vagueness insurance providers faced. Her comments, posted in her President & CEO’s Report² on the American Association of Preferred Provider Organization Website:
“As you know, the biggest burdens of implementing the law will fall to the states. HHS guidelines for the set-up of the ACA’s cornerstone, state exchanges, have been slow in coming and vague. The result is that more states have opted to punt that task back to the federal government than do it themselves.”²
So, how are states doing? According to a report on the Status of Health Insurance Exchange Implementation published by the Center on Budget and Policy Priorities, as of last December twenty-five states were on track to establish state-based exchanges; twenty-six declined.³
Grants to support state exchanges are to be provided through 2014. If state exchanges are not created federal exchanges (now referred to as “marketplaces”) will be implemented. The challenge to each state exchange is that continued funding (all funding) will then fall to the state, and the revenue source need for continued funding is staggering.
Once exchanges are available, whether state exchange or “marketplace”, the next challenge is to get people to enroll. There is incentive to educate the public.
In order to be “state exchange eligible” for funding, exchanges need to establish a “navigator” program to educate the public.(4) According to the FamiliesUSA, navigators need not be licensed insurance brokers or agents; whether or not they need to be is being debated.(5) Standards and certification requirements for “navigators” are not yet established.
Existing insurance brokers are trying to stay abreast of exchange activities within their states; commercial carriers as well; books of business will move within the industry (incentive).
Small business enrollment incentives will be another topic; small business owners are unsure of how they will be impacted. Education will clearly need to be a priority for all “navigators”. Any way we look at it, there is a lot of “nudging” without a solid framework.
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