While the president touted Arkansas last week as an exchange success story, one broker says the situation there is far from praiseworthy.
“Arkansas … has covered almost 14% of its uninsured already. That’s already happened,” said President Barack Obama to applause on Oct. 30 during his Affordable Care Act remarks in Boston. But Joe Childers, broker and owner at Watershed Benefits in Little Rock, says those numbers may be a fluke. That’s because those enrollees were likely able to bypass Healthcare.gov (the state is a federally run exchange) due to a unique Medicaid situation there.
Arkansas is the only state that is expanding Medicaid by “dedicating the funding that would have paid for Medicaid to pay for premiums for private coverage on the marketplace … for anyone at or below 138% of the poverty level,” Childers says. He explains the state sent out letters to the approximately 100,000 people who qualify for food stamps, telling them that if they send back an enrollment form they’ll receive free private insurance.
“Fourteen thousand of those people did send the coverage back, and I believe that’s probably what Mr. Obama is referring to because they were … automatically enrolled into a plan,” he says. “There was no broker involvement in that process whatsoever. In fact, those letters went out prior to the exchanges even opening on Oct. 1.”
Arkansas Department of Health and Human Services’ spokeswoman Amy Webb says the latest numbers, as of Oct. 29, show 65,000 may be subsidy-eligible for what they’re calling the “private option” for Medicaid.
What’s concerning to Childers, however, is that as a result of what he calls this Medicaid “political move,” a separate state program that insures low-income, small business employees is getting cut for 2014. ARHealthNetworks, which according to Webb has nearly 20,000 members, is closing because, “The federal waiver that allowed us to create this program ends Dec. 31, 2013.” Childers says it does not meet the ACA’s essential health benefits requirements and its funding is also likely being redistributed to the new Medicaid beneficiaries. He says because the program was available to those at or below 200% of the poverty level, it’s a generally different group than those who received the food stamp letter.
“My partner and I have about 400 small employer clients representing 2,300 employees on the program,” he says. The exchange’s website flaws have made it impossible to sign those current clients up for new coverage on the marketplace.
“As a broker on the exchange, I set up an ID with CMS, but when I sign on I can’t do anything … I can see my name and that’s it. I’ve sent emails to CMS and nobody’s paying attention to us,” he says. “We’re completely at a standstill. The brokerage market, the individuals who want to go get coverage on the exchange, everybody’s kind of stuck right now.” He says account creation and subsidy determination for consumers hasn’t been much more successful.
The U.S. Centers for Medicare and Medicaid Services did not respond directly to a question about their awareness of this problem for Arkansas brokers, they advised that a help desk is available for brokers and agents to email: FFMProducer-AssisterHelpDesk@cms.hhs.gov.
‘Painful thing to do’
The faulty broker portal has implications on Childers’ entire small business. Earlier this year he made a business strategy change to focus on ACA enrollment and advice — he says he wanted to help the entire uninsured population in Arkansas, and also saw a financial opportunity there. “That’s our revenue model,” he says. “[With the problems,] we’re having to tell people, ‘You’re empowered to do this yourself,’ and that’s a pretty painful thing to do as a broker, to say, ‘We can’t help you, but you can try yourself.’”
Further, he says he’s the only insurance broker in the state of Arkansas to complete the National Association of Health Underwriters’ ACA certification course. When he was at a breaking point recently he did a search through NAHU’s database, hoping to connect with others trying to work with the state’s exchange — he found no one.
“I’m probably more in tune with [the problems] than anyone in the state,” he says. While NAHU’s course is by no means an absolute indication of other brokers attempting to enroll consumers, Childers thinks it says a lot: “I was really surprised, maybe people didn’t feel like they had time to do it, maybe the fact that it was $500 … [or] some of the old school brokers could be disgusted by [health reform].” NAHU spokeswoman Kathryn Gaglione confirms Childers is the only NAHU member who completed the course but says seven other non-members also graduated.
An Arkansas Department of Public Health fact sheet says 474,000 people in the state are uninsured — that’s 18% of their population, according to calculations compiled by Kaiser Family Foundation. The Obama administration and CMS spokespersons have repeatedly assured that the website will be fixed for the “vast majority” of users by the end of November.
“To think that the half a million people who will have to enroll in the state of Arkansas … in a two-week timeframe is absolutely insane and it’s impossible,” Childers says, referring to the time period between Nov. 30 and Dec. 15, when coverage must be purchased to begin on Jan. 1, 2014. “I don’t see any possible way that 500,000 people will take it upon themselves to enroll in a two-week timeframe.”
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