Welcome to Health Reform Watch, Sarah Kliff’s regular look at how the Affordable Care Act is changing the American health-care system — and being changed by it. You can reach Sarah with questions, comments and suggestions here. Check back every Monday, Wednesday and Friday afternoon for the latest edition, and read previous columns here.
Days until the health insurance marketplaces launch: 57.
The health insurance marketplaces launch eight weeks from Tuesday, and Health and Human Services Secretary Kathleen Sebelius would like you to know that her agency is "on target and ready to flip the switch on October 1."
"We know there's still work to do," Sebelius told reporters Monday afternoon. "We knew all along that Washington couldn't do this alone. That was never the plan. The plan was to build a network in every state to help spread the word and make sure their communities are enrolled."
Sebelius spent about a half-hour earlier Monday answering a wide range of questions from reporters, mostly on the launch of the marketplaces, whether her department would be ready and what to expect in coming weeks. These are the points that stood out to me as the most interesting.
1. Health and Human Services is trying to protect Obamacare outreach from sequester cuts.
The agency lost $15.5 billion due to the automatic budget cuts, but has tried to shield efforts to promote enrollment from those reductions. While the sequester has made travel "more complicated," Sebelius did not say that it has limited efforts.
"This has been a significant priority area so we're finding ways to limit other kinds of administrative costs [like] fewer conferences, looking at printing costs and other areas," she said. The agency is "making sure I can travel and that people who need to do outreach can travel is a critical part of bringing attention and particularly the states where we'll be running the federally-facilitated marketplaces."
2. Wanted: A blockbuster movie budget.
The White House has long expressed frustration with Congress' decision not to provide funding for Obamacare outreach. That means that, right now, the administration is working with a budget it wished would be larger, as it tries to sign seven million people up for health insurance coverage.
"We won't have the kind of resources that Apple had when it rolled out the iPhone and iPad," Sebelius said. "We'd love to have the money a movie studio has when its about to launch a new hit."
In lieu of that, Sebelius said her agency is "going to be using all the resources we have and identifying all the partners eager for this to happen."
3. Lots of people can actually start their Obamacare application right now. Americans cannot enroll in new health insurance options until Oct.1. What they can do, starting today, is create an account with the federally-run marketplaces. "What we're trying to do is ramp up the outreach and action items so we don't peak too soon," Sebelius said. "The goal, frankly, of having My Account launch in August is eight weeks from tomorrow is October 1. We want to put this in focus."
Keep in mind, this is a feature only available in states that opted not to run their own marketplaces. When I try and create an account for the District of Columbia, where I live, I get a note telling me to head over to the DC Health Benefit Exchange.
Beyond creating an account, there's not much to be done at this point. Users won't be able to access sample insurance costs, for example, because of many of the rates haven't been finalized (federal officials say that data will come out in September).
4. Out: Exchanges. In: Obamacare.
Sebelius confirmed that the agency has indeed pivoted away from using the word "exchange" to describe the new Web sites that will launch Oct. 1. "What we found as we got closer to developing outreach and marketing materials was it meant very little in English and less in Spanish," she said. "No one knew what we were talking about." So, now the Web sites are marketplaces.
Pressed on whether she likes the term Obamacare, Sebelius said: "I think I'm happy to talk about whatever terminology people understand to mean getting millions of Americans affordable coverage. If that what Obamacare means to people, I'm all for it."
Asked about efforts to dissuade young adults from enrolling in Obamacare, Sebelius described such work as "dismal."
"I think its a pretty dismal effort underway," she says. Moreover, Sebelius expects these counter-enrollment efforts to be overwhelmed by all the insurance companies, hospitals and non-profits encouraging young adults to sign up.
"We're going to do our best outreach to this group," she says. "We know a lot of young adults don't have health insurance as their top priority and reaching that group is a challenge. I do know that the target population is front and center on insurance companies' target lists." Insurance plans want to sign up young adults for the same reason that the White House wants them to enroll: Their lower health care costs would likely lower the cost of premiums. Lower premiums, from an insurers' perspective, means an easier sell.
KLIFF NOTES: Top health policy reads from around the Web.
Aetna calls it quits on the Maryland health exchange. "In an August 1 letter sent to the Maryland Department of Insurance, Aetna said the state's requirement for rate reductions off its proposed prices would lead it to operate at a loss. The rate reductions include products from Aetna and Coventry Health Care, which it bought this spring. 'Unfortunately, we believe the modifications to the rates filed by Aetna and Coventry would not allow us to collect enough premiums to cover the cost of the plans, including the medical network and service expectations of our customers,' Aetna said in the letter to insurance commissioner Therese Goldsmith." Caroline Humber in Reuters.
Contractors see big money to be made in the marketplaces. "Companies from Adobe to Maximus are looking to work that will involve first-hand interaction with citizens, meaning they must prepare to combat misinformation and boil down complex decisions. 'Within the last three to six months, a lot of attention has shifted to driving awareness, outreach to the citizens and various communities ... to drive participation to the exchanges.'" Marjorie Censer in the Washington Post.
Obamacare is increasing pressure on public unions. "Cities and towns across the country are pushing municipal unions to accept cheaper health benefits in anticipation of a component of the Affordable Care Act that will tax expensive plans starting in 2018. Cities including New York and Boston, and school districts from Westchester County, N.Y., to Orange County, Calif., are warning unions that if they cannot figure out how to rein in health care costs now, the price when the tax goes into effect will be steep, threatening raises and even jobs." Kate Taylor in the New York Times.