After two enrollment seasons under the Affordable Care Act's exchanges, the easily accessible and amenable are signed up for health care. With year three starting this fall, the task will be tougher to target the remaining uninsured, who are harder to reach.

It is going to be “hand-to-hand combat, for lack of a better word,” in reaching those remaining uninsured, said Michael Marchand, director, communications at the Washington [state] Health Benefit Exchange.

The biggest shift needs to come in data and knowing who is left to sign up for coverage, he said March 24 at the World Health Care Congress in Washington. “Take out those 2% who you never sign up for anything [and] the 10% who don’t qualify, [who’s] actually left?” he asked. “And of those left, where are they?”

It's time to put away the carrot and break out the stick, he explained. “At what point do penalties and other necessary evils come into play,” he added. “It can’t all be done by folks like us. … At some point there will be another motivator, there is no better motivator then a financial penalty — positive or negative.”

Also see: HHS Inspector General turns focus to health care exchanges

And who better to drive the message home, Washington state thinks, than brokers? If you want to get people insured, you go to agents and brokers, Marchand said. “That’s what they do. We need to figure out how to get agents and brokers” more involved in the exchange.

A better working relationship

As of September 2014, a report by Wakely Consulting Group found that 1,399 brokers produced 42,323 unique qualified health plan enrollments for year one open enrollment, ending March 2014, or 60% of all assisted QHP enrollments.  The report encouraged the exchange board to create “opportunities for brokers and navigators to better understand and respect one another in order to encourage better working relationships.”

To that end, the exchange has held social mixers, created joint speaking opportunities at enrollment events and addressed each party’s misconceptions about each other, among other recommendations that were implemented.

In an exchange board presentation provided by Keith Wallace, a broker with Bellingham, Wash.-based Rice Insurance and member of the exchange advisory committee, the board notes it is working to increase broker participation, and therefore increase enrollment participation, through a number of agreed upon initiatives.

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These include system improvements to the SHOP website, alerting clients to important mail with different envelopes and influencing the timing on year three open enrollment to “relieve pressure on brokers who also work in the Medicare market,” among others.

“The exchange has really changed their tune with brokers and I was told personally by Catherine Bailey, the SHOP director, that the exchange underestimated the role of the agent,” Wallace says.  “Our NAHU team has been working with the [exchange] and the governor’s office to review and work on a list of broker requests.”

Wallace says brokers will be helpful in reaching the uninsured since they earn incomes directly related to enrollments. 

At the same conference, Maryland exchange officials in a separate session also said they were looking to brokers to reach those remaining uninsured. That including rotating brokers into their call centers, which exchange executive director Carolyn Quattrocki called a win-win for all. Alan Schulman, president of the Maryland Association of Health Underwriters said his local NAHU chapter recently met with Quattrocki and the secretary of the state’s health department to “build on our record of success by enabling the exchange to continue to utilize the resources of licensed producers.”

If he had a magic wand, Washington’s Marchand would make the Affordable Care Act and exchanges more open to partnerships and commissions for agents and brokers. While he says his state has worked diligently and overcome some major hurdles, “to get to the hardest to reach population and ensure we have a successful SHOP, you need to get the agents on brokers on board.

“Bottom line,” he added, “[we] need to figure out a way to for agents and brokers to make this happen. They see the people who pay, and we need the people who pay.”

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