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As the administration works toward fixing healthcare.gov, there is another crucial part of the health insurance marketplace enrollments that hasn’t received a lot of attention – navigators. As it was widely expected, navigators have played a large role in helping people enroll. With the system experiencing issues, more people than expected have turned to the navigators for help.

Unfortunately for the navigators, there were some unforeseen issues that are hampering the ability of the navigators to do their job.

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After a rough start, healthcare.gov (the Federally Facilitated Marketplace) is beginning to experience a bit of a recovery. Although the launch was plagued with system crashes, non-availability and incorrect subsidy calculations, things are finally starting to look up.

According to the government, millions of enrollments were expected in the initial stages of the health reform rollout. Projections indicated that nearly half a million enrollments were expected within the first 30 days. However, enrollments were a lot lower than the projections. The problem was not limited to the site usability; it was also about the data that was being sent by the system. Several health plans experienced incorrect enrollments, missing information and individuals enrolling in multiple plans. The end result was incorrect data in the system and failed enrollments.  On the other hand, the states that opted to run their own exchanges were performing better but still dealing with less than expected enrollments.

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The health insurance marketplaces are being setup to provide consumers with more options and more choices. The online marketplaces are intended to bring together insurance carriers and promote competition with the aim of driving costs down. When the insurance marketplace goes live on October 1, consumers will be able to choose from a variety of carriers and find a plan that fits their needs and budget. However, Hawaii residents will be dealing a less choice on the Hawaiian marketplace.

The Hawaii health insurance exchange, Hawaii Health Connector, will open with two carriers, Hawaii Medical Service Association and Kaiser Permanente Hawaii. There is some concern that with only two carriers, there will be a spike in rates once the marketplace launches.  There are multiple reasons for this worrying lack of competition in the state.

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Colorado’s health insurance marketplace, Connect for Health Colorado, is schedule and Colorado knows what’s coming on the October 1 launch – a deluge of new enrollments. Colorado is expecting about 150,000 residents to sign up for health insurance coverage during the first enrollment period. Some number crunching reveals a strenuous task – Colorado officials will have to enroll 800 applicants a day in the first six month enrollment period to meet this new demand for health insurance.

Surprisingly, this is just a glimpse into the mammoth task that awaits the state health insurance marketplace of Colorado. It is expected that this number will continue to multiply. Therefore, it becomes necessary for Colorado to devise a strategy and implement against the plan in order to control and handle this huge influx of enrollments. Fortunately, Colorado does have a plan.

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With the health insurance marketplace rollout deadlines nearing, New Mexico received a $18.6M federal grant for marketing and outreach to help market the New Mexico Health Insurance Exchange.

The current state of affairs at New Mexico health insurance marketplace shows us some important numbers and facts that are going to influence the health of the exchange once it goes live.

•    New Mexico expects to enroll about 80,000 uninsured citizens by next year and hopes to increase this number to 211,000 by 2020.

•    The current setup of New Mexico Health Insurance Marketplace is a hybrid model. They are using the Federally Facilitated Marketplace for individuals but will use a state-based exchange for businesses.

•    The entire success of this scheme depends upon reaching the uninsured and getting them to enroll into the health insurance system. About 400,000 potential customers, which comprise of individuals and businesses, are they key here.

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Direct Enrollment gives payers the ability to offer consumers a one stop shop when shopping for health insurance plans – allowing them to check for subsidies and enroll without ever leaving the payer site.

Retaining Customers through Direct Enrollment

From the perspective of the insurance carriers, things look rosy. Insurance carriers can now focus on enhancing the online consumer experience as the impending problem of consumers jumping from payers sites to the Federally Facilitated Marketplace (FFM) has been nullified. Naturally, a potential customer getting all the necessary information in a simplified, intuitive portal wouldn’t want to be redirected to another portal. With a streamlined enrollment process, fundamental subsidy application and ancillary plans bundled, the majority of consumers should not jump off the payer’s site.

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Vermont Health Connect, Vermont’s health insurance marketplace, has taken a step further in its implementation of health exchange by revealing the Affordable Care Act compliant insurance rates. The analysis and implementation of these new health insurance rates reveal a substantial reduction in the premiums payable by lower income groups due to tax subsidies and ACA benefits.

The high and middle income groups are put at a disadvantage with the implementation of these rates. In January, when these premiums go live on the Vermont health marketplace, these groups will not experience any substantial improvements over the premiums they are currently paying. Green Mountain Care Board, the state’s largest insurer, maintained that high and middle income groups won’t experience any noticeable change in their premiums while lower and moderate groups, on the other hand, will find increased benefits and subsidies. A combination of state health subsidies and federal tax credits will make life a little easier for these groups by significantly lowering the health insurance costs.

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Insurers are still trying to decipher which end of the consumer spectrum will yield greater and sustained profitability. General wisdom says that the medium- and high-income consumers will drive profits in the health insurance marketplace but the reality might be very different! This post puts forth a slightly different spin on the general perception.

Health Status vs Income Levels
Profitability in the post-exchange market is more likely to be linked to health status rather than income levels. This excludes people in and around the poverty index since they are predominantly covered by Medicaid. However, lower-income people who may or may not be healthier than their higher-income equals could constitute the bigger buying section in late 2013 and 2014.

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According to the Bureau of Labor Statistics, between 2003 & 2011, the healthcare sector created 2.67 million jobs. In comparison, rest of the U.S. economy added 850,000 jobs.

This post discusses how the Affordable Care Act (ACA) is positively impacting the American economy, particularly in the healthcare sector, and why this trend will continue.

The Affordable Care Act seeks to make healthcare more affordable, streamlined and consumer-focused. However, the reforms have had another impact—job creation in the healthcare sector and related industries. As more people gain health insurance and patient care becomes more comprehensive, there will be a direct increase in demand, and jobs, across:
•    Real Estate: Clinical facilities
•    Manufacturing: Medical equipment, drugs
•    Industry personnel: Healthcare IT professionals

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The buzz around big data has brought health industry watchers and senior decision makers to an astute conclusion – big data is valuable and useful. The McKinsey Global Institute has unveiled that big data is capable of generating $300 billion in value every year, if tapped correctly. It can be a means to reduce the U.S. healthcare expenditure by about 8 percent—a huge number, considering the magnitude of the expenditure.

However, there are certain challenges associated with big data that are holding health insurance carriers from effectively utilizing it. Big data is:

•    Huge: The volume of big data is one of the biggest hurdles in its implementation and utilization. It has been estimated that big data is about 152 Exabytes, that’s billions of gigabytes. Furthermore, it is expected to grow exponentially to 40 times its current number by 2020.

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