The federal government is doing everything it can to ensure public health insurance exchanges are ready to begin enrollment on October 1. However, the head of the agency that is building the marketplace warned it will be a close call to the finish and everyone must work together to ensure that happens.

Speaking at America's Health Insurance Plans' annual policy forum in Washington in mid-March, Gary Cohen, director of the Center for Consumer Information and Insurance Oversight at the Centers for Medicare and Medicaid Services, said we are at a crucial moment. "If this was a horse race and October 1 was the finish line, I think we are rounding the final turn and heading into the home stretch," he said. "My problem is I'm not sure if I'm the jockey or the horse."

To that end, Cohen revealed that the federal government is making contingency plans to be in place should the exchanges not be ready to start enrollment. While he would not say what those contingency plans are, he was hopeful that they would not have to be implemented - noting the progress that has been made up to this point.

"We've been working very hard for three years to get to this point, almost all of the regulations are completed, but now you have a very good picture of what the policy is and what the rules of the road are," he said. "... I think it's important to take note of where we are - most of the policy is really nailed down. ... We are seeing good progress in building infrastructure to have qualified health plans participate in the marketplace."

Despite candidly expressing concern that the exchange system may not be ready, he said that "the administration is on track and on schedule to meet our goal. We are continuing to work on finalizing the IT environment. We will continue to provide technical assistance to states and issuers and I would note that the staff at SCIO has done a phenomenal job. It seems almost every day there is a webinar or conference call."

He noted to the room of insurance professionals that they will need to continue to work closely with the federal government to insure implementation, but pledged to continue to work hand-in-hand with them. "You are the ones we are depending on for products that will be on the shelf, and we want to provide you will all the resources you need. We will continue to provide guidance through calls and webinars," he said. "We are focused right now at CMS on working with you to build to the new [qualified health plans]."

Henry Chao, deputy chief information officer and deputy director of the Office of Information Services at CMS, said that now is the time not to focus on basic things like the size of text on the screen or the color of the website for the exchanges, but to ensure the system is ready on time. "You don't get to affordable care overnight and don't get there in a lifetime, but you strive to keep your eye on the objective," he said. "As you make your way there, there are tradeoffs to be made, but you don't lose sight of your objective - which is to enroll people come open enrollment. I bang the drum about three to four times a day about how little time we have left."


A broker's role: TBD

Its expected brokers will play a large role in the exchanges as well, as many employees will be selecting benefits previously decided by an employer. "The state exchanges are not going to be ideal decision-making tools," said Ja'Nene Kane, chief operating officer of BenefitsConnect at an EBA-sponsored conference late last year. "The state exchanges will give employees options, but [these] are very difficult decisions to make. Just because [a consumer] can compare three plans does not mean the consumer can make a decision. They will look just at the deductible and not understand what ancillary benefits they need.

However, a broker's role within the exchange is also still being determined. In early April, CMS confirmed following the release of proposed rules on navigators and what they're calling non-navigator assistance personnel, that the information is not necessarily intended for brokers. At press time, the agency told EBA that more details were coming soon.

The CMS rule does say that agents and brokers can become navigators if they so choose but, "holding an agent or broker license is neither necessary, nor by itself sufficient, to perform the duties of a navigator, as these licenses generally do not address areas in which navigators need expertise, including the public coverage options that would be available to some consumers."

The report goes on to say that any agent or broker interested in becoming a navigator must meet all the requirements of that job. This includes the fact that all navigators are prohibited from receiving compensation "directly or indirectly from any health insurance issuer in connection with enrollment of consumers into QHPs or non-QHPs ... and we interpret that provision to apply to the receipt of trailer commissions." It confirms, though, that agents and brokers who sell other lines of insurance are not prohibited from compensation by issuers on those other lines of sale.

While the job of the navigator seems to overlap with the existing role the broker, many states that are opening exchanges have said that brokers will continue to play an essential role in their current capacity.

"Just about everybody that I've talked to has come full circle and see them controlling the small group market," says Vince Ashton, president and CEO of Health Pass New York. "They're not trying to go around them."

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