As public health insurance exchanges run by states or in partnership with the federal government edge toward financial self-sufficiency in 2016 as stipulated under the Affordable Care Act, adjustments are being made to achieve greater operational efficiencies for their third annual open-enrollment season and beyond.

One such example is Get Covered Illinois, whose bold plans gave way to considerable manpower challenges. Also known as the Illinois Health Insurance Marketplace, it’s one of seven state-partnership exchanges operating alongside 14 stand-alone state exchanges, 27 federally facilitated marketplaces and three federally supported marketplaces, according to the nonprofit Kaiser Family Foundation.

With the substantial federal grants that helped launch these state marketplaces finally disappearing, the search for other sources of capital has included overtures to state governments and higher assessment fees on participating health insurance carriers.  

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GCI’s federal funding was slashed to $20 million from more than $100 million, which forced the layoff of most staffers and an unknown number of counselors. The money, which will be used to help maintain a call center and website, must be spent by February 2016. However, GCI will need to foot this bill in future years.

Claire McAndrew, a senior health policy analyst with the nonprofit Families USA, says any assessments levied by state exchanges on participating insurers to finance homegrown efforts would mirror the FFM approach. In that case, a 3.9% fee that the U.S. Department of Health and Human Services administers on FFM carriers pays for the website, call-center activity and navigator grants.

There were other notable shakeups at GCI. Karin Zosel, who was hired in March to run the exchange, decided to leave after just a few months and return to her former employer. Now a much leaner operation with just two leaders at the helm, GCI is planning a reportedly far more modest marketing campaign than previous years featuring billboards, print ads and TV spots.

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The exchange also will earmark its remaining $5 million federal grant to hire as many as 150 certified application counselors, also known as assisters, to help enroll state residents. Other assistance will include providing consumers with tools to make better coverage choices and following up to ensure they received health insurance cards or scheduled doctor appointments.

But it’s also telling just how far off the Illinois exchange is from its earlier ambitions. “The difference between where they were and where they are now might be more drastic than what you might see in other states because their partnership exchange was more of a bust than other partnership exchanges,” McAndrew says. Indeed, GCI was once on track to transition to a full state-based exchange model.

Alissandra Calderón, a spokeswoman for the Illinois Department of Insurance, credits “external partners and vendors” with helping operate a partnership exchange over the past two years with the federal government, which also has supplied funding. “GCI is confident that it will be able to successfully provide Illinois consumers needed information and assistance with their health insurance enrollment needs in this third year and beyond,” she says.

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The Illinois Department of Insurance took over the administration of GCI from Governor Bruce Rauner’s office on August 1 as part of an effort to “streamline program processes, improve efficiency and align services leading to increased access to health coverage for Illinoisans,” according to a statement by Anne Melissa Dowling, the department’s director. “Consolidating marketplace activities under a division at the department will promote a potential path to long-term operational sustainability for Illinois to continue as a partnership marketplace.”

The news release noted that since March, more than 290,000 Illinois consumers have enrolled in GCI.

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