On-the-ground experience and challenges

By Alicia Caramenico

FierceHealthPayer: What does implementing a new insurance marketplace look like from the ground?

Cynthia Crone: In Arkansas, we stand to gain more than most any other state. We have very low per-capita income. We're the second lowest in income and the third worst in health indicators, so that makes our healthcare costs high compared to other states.

And we have a lot of people who are bankrupt because of their debt or they're just absolutely not getting care. So we have 78 percent of our people who would be under 400 percent of the federal poverty level to come in and get a subsidy in the marketplace. And when you talk with them, they are excited, thankful, relieved when they learn what can help and how they subsidies can help them.

We have the private Medicaid option, so that's just be incredible for our lowest income population to be able to come in and get private coverage.

We have had some complaints on the ground, especially in the last few weeks from people whose coverage was not compliant with the Affordable Care Act and who have found out it is going to cost a lot more. But those are far fewer than the ones who are really excited about the potential of getting in.

It's really heartening. But it's also very tough because of we have a lot of political opposition. That is always there; wherever we go, it's always there.

FHP: What do you think of all the controversy surrounding the rocky HealthCare.gov rollout?

Crone: Well I hate it. It's really unfortunate that the website wasn't ready and that just gave more fuel to opposition and more frustration to the consumer.

You know, nothing this big ever happens without some kind of start-up glitches. This is really big change. I think they will eventually get it fixed, and I sure hope it's by Dec. 1 so people can get enrolled in time to have coverage by Jan. 1.

FHP: What challenges has the Arkansas exchange encountered?

Crone: Our top challenge has been the differing political views. That has made it difficult for us to get accurate information out to the public. Our Legislature stopped our outreach and education campaign the day before open enrollment. So our "get enrolled" campaign was never implemented. They felt like it was wasteful spending and we felt like it was an effective outreach campaign.

Our get informed phase that was coming right before enrollment had moved the needle 30 points in three months. We had moved our awareness from 24 percent to 54 percent and we needed to get it to 80 percent. And we felt it was very cost-effective. Overall we would have been spending about $8 million, a 100 percent percent federal dollars. And it would have been an economic benefit to the state of $550 million or more, plus peace of mind for everybody, if we got people enrolled.

But the leading legislators--and we have both a Republican House and Senate--felt otherwise. Of course, it didn't help when HealthCare.gov didn't work as expected. That fueled our opponents and added more frustration for our enrollees. But it's I would say it's been the political opposition that been our biggest challenge.

FHP: How has Arkansas Health Connector overcome those barriers?

Crone: We've just had  lot of consistent and hard work, trying to plan the best possible marketplace and outreach. In the beginning we did state-specific criteria for certifying our plans--we're a partnership state. We took a lot of actions that weren't the federal default. We worked really hard to recruit plans. And we have three carriers in a multi-state and 71 plans.

We really worked to inform Arkansans about their options and responsibilities. We have a speakers' bureau on the ground in all 75 of our counties. When we get out to people, they're always saying "Well, I didn't know that--that sounds pretty good."

We've worked with our different partners--right now when our campaign started, we're working on a grass roots enrollment effort across the state in first part of December--so hospitals, higher ed, our health department, consumer advocacy groups are all coming together to host events.

We had a lot of on-person assisters in Arkansas; we're calling them guides. They've really surprised us with how bright and committed and dedicated they are. So they're working hard to help educate people. And we've had a group that's affiliated with small business administration helping to reach out to small businesses. So we're working to get our closed down website with a link to our department of insurance website so we can at least push minimal information out while our big public space is closed down.

So we've tried to do whatever workaround we can in a short time without expecting to have to switch entire outreach education methods.

FHP: What do you think of all the controversy surrounding the rocky HealthCare.gov rollout?

Crone: Well I hate it. It's really unfortunate that the website wasn't ready and that just gave more fuel to opposition and more frustration to the consumer.

You know, nothing this big ever happens without some kind of start-up glitches. This is really big change. I think they will eventually get it fixed, and I sure hope it's by December 1 so people can get enrolled in time to have coverage by January 1.