Health exchange ready for 3rd go-round

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It’s survived an IT meltdown and attempts to kill it in the Legislature. It’s now facing the loss of two insurance carriers and an effort to constitutionally ban it.

But leaders of the Silver State Health Insurance Exchange said they’re optimistic about their effort to get more Nevadans covered during a three-month enrollment period starting Nov. 1, bolstered by a relatively smooth process last year.

“It was a vote of confidence,” exchange director Bruce Gilbert said about the 73,000 or so people who signed up last time for insurance plans, many of them taxpayer-subsidized. That was roughly double the number who signed up in the rocky first enrollment period. “We’re in a position to build on that.”

Nevada’s shift to the Affordable Care Act has been a mixed bag.

On one hand, hundreds of thousands of people have taken advantage of Gov. Brian Sandoval’s decision to expand Medicaid eligibility, a trend that’s largely responsible for the state’s uninsured rate tumbling from 20 percent in 2013 to 15.7 percent in 2014, according to a Gallup poll.

Democratic Sen. Harry Reid pointed to a study that said the number of Nevada children without health insurance dropped from 15 percent to 9.3 percent in the course of a year.

“One time we were the most underinsured state in the country for health insurance,” Reid said Thursday in a Senate floor speech that praised Sandoval but panned his fellow Republicans who seek to repeal the federal health law. “It is yet further proof that the Affordable Care Act is working in Nevada and all across America.”

Other elements of the president’s signature health care overhaul have struggled. The Nevada health co-op, which offered plans on the exchange and was created to compete with private insurers, is closing down at the end of the year due to high costs and lackluster enrollment that have plagued many co-ops in other states.

Nearly 17,000 people were enrolled in the co-op at the end of 2014 and will need to find other plans. With another carrier, Assurant, leaving exchanges all over the country, consumers in Nevada can now choose from only four carriers on the exchange.

The Obama administration also laid out modest projections for growth this year through exchanges. Health and Human Services Secretary Sylvia M. Burwell said it’s been getting more difficult to sign people up since much of the “low-hanging fruit” has already been picked — residents eligible for Medicaid and those easier to reach are already signed up.

That leaves people who are on tight incomes and find coverage unaffordable, even with the subsidies, or who are unaware or confused about how to qualify for or keep coverage.

Gilbert said the exchange is responding by shifting its tactics. In the first year, billboards along the road trumpeted the broad message that everybody needs insurance, and outreach included vast health fairs and two brick-and-mortar enrollment “stores” cropped up in years past.

But with the understanding that much of the population has insurance through an employer or Medicaid, the exchange is taking a more targeted approach. One ad aimed at “young invincibles,” who don’t see a need for insurance because they’re healthy, features a barista who concludes it’s time to grow up and take responsibility for herself by getting insured.

The exchange has also taken a networking approach, leveraging existing relationships with insurance brokers and community members to widen its footprint. In one example, it’s working through tribal leaders to enroll members who may have coverage through the federal Indian Health Services program but struggle with high out-of-pocket costs that aren’t included in those plans.

Gilbert said the exchange’s toughest days are behind it and trust is being restored, although it still has critics.

Lawmakers briefly considered a bill this spring to repeal the exchange before letting it die. Republican former U.S. Senate candidate Sharron Angle has proposed a ballot measure to do the same thing, though it’s still in its infancy.

“I’m sort of flattered,” Gilbert joked. “It’s not a bad thing for us. It forces us to make our case.”


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