Brokers and agents say the state exchanges did little to engage them during the first enrollment period under the Affordable Care Act, identifying several barriers that impeded their participation. And many in the industry agree improving the partnership between the exchanges and brokers will be critical to the survival of the state marketplaces as federal and state funding for navigators and assisters fades out.

“The marketplaces are only going to succeed if they can get as many people enrolled as possible over time, not just in year one,” says John Barkett, director of health policy affairs for Towers Watson exchange solutions.

The marketplaces are expected to be solvent by 2016, he adds, meaning they can’t rely on grants from the government to operate in the black.

“The way they’re going to do that is through fees on folks enrolled in the marketplaces,” he says. “They need all the people they can get. …Brokers are really good at helping people purchase insurance and yet they haven’t been warmly received by the public exchanges. It’s a missed opportunity to date, but I think the public exchanges are realizing they should embrace brokers.”

That’s particularly true considering grants designated under the ACA to fund navigators will end next year, Barkett says. “The states will be looking around for anyone that can help enroll people in health insurance and what’s going to be left will be the brokers.”

There’s a lot of repair work to be done to mend that relationship, however, as most brokers say the marketplaces have done little to adopt brokers as part of their marketing and enrollment strategy, according to a report released this month from the Urban Institute about brokers and the ACA.

The broker community was treated as an “afterthought,” one broker in Washington told the Institute, which says the comment echoes a common theme among those interviewed as part of the Institute’s larger project examining the implementation and effects of the ACA.

Brokers in some states took umbrage at what they saw as the marketplaces’ use of negative language to characterize brokers, with one broker in Vermont asserting the exchange’s ultimate goal was to “eliminate the role of brokers,” the report says.

Important role of brokers

As the 2014 open enrollment period progressed and efforts to enroll people intensified, however, several marketplaces came to recognize the important role brokers were playing, the report found.

In fact, another broker in Vermont reported that the state formed a broker advisory group “late in the game” after “they realized they needed us.”

Brokers in California, Connecticut, the District of Columbia, Illinois, New York and Rhode Island reported that the marketplaces made a concerted effort to communicate and work with them over the open enrollment period.

In California, the marketplace found that brokers were driving a significant percentage of their non-Medicaid enrollment and became more proactive in their outreach to the broker community, the report says. And ultimately, 39% of the state’s non-group enrollment into 2014 marketplace plans was broker-assisted, the Institute says.

The report’s findings that brokers were essential to the enrollment of people on the state exchanges does not surprise Ronnell Nolan, president and CEO of Health Agents for America Inc., who says she’s “elated” someone is reporting about it.

“The fact the study focuses on the state run exchanges helps to bring the importance of the agent/broker to the forefront,” she says. “In comparison to the federally funded exchanges, in which accountability and receiving correct data is in short demand, state run exchanges have a financial desire to succeed and they realize the absolute necessity of bringing ‘experts’ to the table.”

Improving the relationship

The Institute identified several barriers that impeded broker involvement with the exchanges, and industry experts agree improvements will need to be made to strengthen the relationship between brokers and the marketplaces.

First and foremost, brokers agree, the marketplaces’ information technology systems will need to be improved. Many brokers found the eligibility and enrollment technologies clunky, time consuming, and in some cases impossible to use.

In addition to the time consuming nature of the process, Barkett of Towers Watson says their brokers found data was getting lost throughout the transaction and in many cases an agent would not get compensated for their work.

Brokers also identified issues with call centers, calling them “horrendous” and “a useless interaction.” Barkett says brokers found the call centers “frustrating,” that the system was “amateurish.”

Brokers suggest the marketplaces adopt easy-to-use, online broker directories to help consumers identify a nearby participating broker.

HAFA’s Nolan agrees and questions the lack of such a resource to date, “I believe an easy to use directory should be a consumer issue. Not giving a consumer an easy access directory to an expert, who is knowledgeable, insured and free, but driving consumers to entities without the same expertise should be examined.”

Many brokers also told the Institute improved and online training for enrollment procedures would be helpful, as well as broker-facing portals that include the same functionality they find on insurers’ sites for managing their business. Such a system would allow brokers to track their clients as a group, see when payments are made, send communication to clients and easily perform customer management tasks.

In short, Nolan says, the marketplaces need to “realize the agent community is part of the solution and not the problem. We absolutely work with the poor, we are multi-lingual and we work in rural areas. We are real people, with real issues and real solutions.”

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