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Thursday, January 23, 2014

Live from Health Action 2014...Thursday 1/23/14

From: Kate Blocher
6:00pm

That wraps up the first day of Health Action 2014. Make sure to join us tomorrow morning when we'll hear from Kentucky Governor Steve Beshear about his experiences implementing the Affordable Care Act in Kentucky.


From: Kate Blocher
5:14pm

The final question Claire poses to the panel is how can we best advocate for consumer-friendly policies in our states?

Sabrina begins by noting that although the opportunities to advocate on the federal level are less abundant than in the states, there are still ways you can influence the discussion. For instance, the federal government has been very deferential to states when it comes to issues that their state has traditionally controlled. So get to know your state agencies and work with them to provide the consumer's perspective.

Cindy agrees, it's all about building relationships and providing the consumer perspective. But make sure you're prepared, gather stories, do your research, before you meet with any state agents. And get to understand the process of how policy is developed in your state so you know when it's best to offer your voice. And most importantly, be persistent. Your persistence is why we've been able to get this far.

Anthony follows with emphasizing the need for transparency and allowing everyone to participate in the process. We may not all agree on everything, but we all want the same thing in the end. By being honest and willing to compromise, you're much more likely to reach that goal.


From: Kate Blocher
5:05pm

Claire moves the discussion to network adequacy. She asks the panelist how they are ensuring consumers actually have access to providers that are covered by their newly acquire coverage?

Sabrina begins by noting that this was a strategic decision by insurers to keep prices low, and many states did not have much of a review process when determining what's an adequate network. But things are starting to change. Many state agencies recognize the problem of not being able to find an in-network provider and bills are being introduced in many state houses to address the issues. As advocate, this is where your voice is important. To make sure the consumer perspective is heard.

Anthony responds that we should also look at the problem differently. Will it actually help to have thousands of doctors in your network, but none of them in your area? Networks should be driven by consumer need, where there is a large consumer need there should be more options. In California, they have been determining adequacy not by numbers of providers, but by how long it takes to get an appointment with a provider. If it's over 10 business days, that's not adequate.


From: Kate Blocher
4:50pm

Claire poses the next question to the group: What has been the enrollment experience for consumers so far and how can we improve upon it? For instance, many studies have shown allowing for window-shopping before purchasing a plan greatly improves the consumer experience. How will you improve their experience?

Anthony begins the discussion noting it's important to first get things working before trying to improve the consumer experience. For instance, they had hoped their call-center would only have a wait time of 30 seconds per call, and it is actually 45 minutes. Making that technology work for the consumer will greatly improve their experience.

Cindy follows by noting the importance of giving consumers the confidence to enroll. Make sure they actually feel like it's doable for them and to simplify the process as much as possible. One way they have been doing this in Arkansas is by using a consumer's SNAP (the Supplemental Nutrition Assistance Program) eligibility to determine their Medicaid eligibility. Using this in Arkansas has allowed them to enroll 85,000 Arkansans in their state's private option.

Sabrina agrees that giving consumers confidence is essential, and one way to do that is through education. Many people aren't even aware they're eligible for subsidies, so many avoid enrolling all together. It's also important to do market research to see how consumers are interacting with the marketplaces – find out what's working, what's not, and adjust.


From: Kate Blocher
4:40pm

Claire opens up the discussion by asking the panel what's happening in their state marketplaces now and what do they see happening in the future?

Anthony Wright starts the discussion, "Welcome from California where it's 50 degrees warmer and we have a working website!" But even though things are going well, that does not mean there are not important lessons to be learned for all states.

The main lesson Anthony wants the audience to take away is that their is from extensive planning. They made sure to start working on the IT immediately, and decided to become an active purchaser in order to be able to leverage the bargaining power of the exchange to lower costs and standardize benefits. The result? 500,000 Californians had selected a plan by the December 31 deadline, and by last weekend 625,000 had selected a plan. Combining those who have enrolled through the marketplace and Medi-Cal (California's Medicaid program) - 1.5 million Californians have signed up for new coverage!

Cynthia Crone follows with her experience in Arkansas. Half a million Arkansans are uninsured out of a population of just 3 million. And even though the state hasn't expanded Medicaid, they were able to implement a private option where they allow Medicaid eligible consumers between 100-150 percent of the Federal Poverty level to use subsidies to buy coverage through the marketplace.

Finally, Sabrina Corlette offers the national perspective, but first she has some breaking news: the Missouri federal court has struck down the law that severely restricted navigator activity in the state. This is big not only for Missouri but for all the states that are trying to restrict navigators from doing their job.

This decision could not have come at a better time, as Sabrina points out, because moving forward it's going to be all about enrollment in the states. The surge in enrollment we saw in December is expected to continue at the same pace, and it's important to note that a recent study by the Kaiser Family Foundation found that out of the 10 best performing marketplaces, eight of them were state based.


From: Kate Blocher
4:30pm

Day one of Health Action 2014 is wrapping up and it's time for one of the most important conversations of the day - improving the marketplaces for consumers. It's great that we actually have a place where consumers can go to purchase quality, affordable insurance, but it won't mean anything if they can't use it.

Claire McAndrew, Senior Health Policy Analyst at Families USA, opens the discussion by reminding the audience that the race to achieving high quality health care for all Americans is a marathon, and not a sprint. And although we have made great strides in achieving our goals, implementing the Affordable Care Act and seeing its consumer benefits fully realized will not happen in a year, maybe not even five, but it will happen.

One of the biggest roles we as advocates can play to ensure we meet our goal is to continue to work to improve the consumer experience in the marketplaces. The discussion today will focus on how exactly we can work to improve health insurance marketplaces for consumers in the coming year and beyond, from the perspective of both state and national level experts.

The panel includes Anthony Wright, Executive Director Health Access California; Sabrina Corlette, Research Professor and Project Director at the Health Policy Institute at Georgetown University; and Cynthia Crone, Insurance Deputy Commissioner of the Arkansas Health Connector.


From: Carla Uriona
2:15pm 

Next, we're hearing from Antoinette Kraus, a consumer health advocate from the Pennsylvania Health Access Network, the state's largest health coalition.

She talks about how, with a staff of 30 to cover the entire state - capacity is an issue. When the ACA was passed, she and her team had to hit the ground running. "We went to every corner of the state educating people about what health care means. Their challenge? How to increase capacity across Pennsylvania to spread the word. Their response? Train the messenger. In short order, they trained 100 messengers to conduct outreach - doctors, nurses and the public. They got an overwhelming response.

The Coalition also brought certified application counselors on staff to help organizations become certified application counselors (CACs). Because their funding was limited, they worked with local colleges to become certified application counselors. And they launched a CAC and navigator network that meets monthly to share best practices and problem-solve. They launched Ensure Pennsylvania, and are working with Enroll America to spread the word as well.

Rachel Klein is now polling the panelists on how to keep the momentum going for 2014. The panel almost unanimously agrees that emphasizing consumer testimonials (www.mycoveragestory.org) is key to getting the word out. Ramping up advertising campaigns to focus on unreached populations will be key, because it's likely that those who have not yet enrolled are the hardest to reach through traditional advertising and marketing campaigns. As Vanessa Gonzalez-Plumhoff from Planned Parenthood reminds us, "We have to realize that we need to meet the community where they are." And Bill Nold rejoins with "This isn't about us telling you what do, it's about you ways that you can help yourself."


From: Carla Uriona
2:01pm 

Vanessa Gonzalez-Plumhoff, Director of Latino Leadership and Engagement, speaks for Planned Parenthood's multi-pronged enrollment and outreach efforts. She leads with more statistics:

"We are hitting 10,000 doors a day. In two states that we focused on, 55 percent of the people that we touched have started enrollment."

She discusses how their efforts are going in other states and what contributes to their success in outreach. They have a website set up in Spanish and deliver a complete experience in Spanish, not a partial one. All materials are truly bilingual, as are the canvassers. Another good tactic that canvassers use is to provide prospective enrollees with questions in Spanish to ask prospective insurers.

The payoff is huge, she states. "People have cried and hugged our canvassers when they heard from them because, until then, they didn't know what the law meant. The consumer suddenly understands, and it is this one-on-one connection of helping someone change their lives that matters. How many of you have felt this, she asks the audience [most of the members of the audience raise their hands].


From: Carla Uriona
1:40pm 

[Lots of applause for Bill Nold, likely in acknowledgment of Kentucky's success in pursuing a state-based exchange in a Republican-controlled state.

Nold talks about what was responsible for Kentucky's successful rollout of a state-based exchange. The governor's approach has been different, he notes, reminding the audience of Kentucky's health care challenges. When the ACA passed, the governor saw the law as an opportunity to not just to lower costs, but to get the residents of Kentucky in good health. Nold recounts how, when the Supreme Court ruled on the ACA, the governor asked all of his policy staff to do everything they could do to simply improve the health of Kentucky, whether that included establishing a state-based health insurance exchange, expanding Medicaid, or getting grants from the federal government.

"The day after we went live, our website got slammed (our website had never been down though - Nold smiles and continues - it has been a little slow though - Nold features a bigger smile - but we're back on track."

He also cites a few statistics pointing to the success of Kentucky's efforts: As of January 17: 162,000 people have become enrolled in either qualified health plans or Medicaid. Over half a million people have browsed plans on the site. And that's just halfway through the first enrollment period.


From: Carla Uriona
1:15pm 

Dr. Mandy Cohen, an internist and acting director of consumer support for the marketplace at CMS:

(Thanks the advocates for their work in changing the face of health care). She opens her talk with a few statistics. Since the marketplace opened, 6 million people signed up for new coverage. With the young adults who were able to get coverage through their parent's plan, that adds up to 9 million people enrolled in coverage. More than 15 million people have visited the marketplace, 11 million called the call center, and more than 8 million people used the online chat, with more than 20,000 assisters helping with enrollment. Healthcare.gov had some challenges but things are definitely better. "We continue to make progress every day," emphasizes Dr. Cohen. Error rates are down, pages are loading faster, and folks getting through the system. She is enthusiastic about the robust case worker system established for those who are having challenges with the system.

Where to focus in 2014? "This is game time, critical time. You'll see this from the administration and you heard it from Vice President Biden today. We have to raise awareness as much as we possibly can. This doesn't end on March 31. There is lots of work still left to do.

Next up is Bill Nold, the deputy director of the Kentucky Office of Health Benefit Exchange, which established a state-based health insurance exchange.


From: Carla Uriona
12:40pm

Rachel Klein, Families USA's Director of Organizational Strategy, is introducing our first lunchtime plenary panel, "Outreach and Enrollment in the New Coverage Options." She's talking about the theme of our conference - how it's time to make the promise of the Affordable Care Act real in order to ensure that consumers actually get the health care they need.

Rachel is turning to the four panelists and poses the question: how well have we been doing so far in our efforts to spur enrollment and conduct outreach? And what do we need to focus on in 2014? With 68 days left until the end of the initial open enrollment period - it's close - we have about 10 weeks left to benefit from lessons learned and put them into practice.

Our job doesn't end on March 31. Lots of ppl will have special life circumstance that makes them eligible even after that. And after that, there is another second enroll period. So before the next 2014 conference in January, we will have had 2 enrollment periods.


From: Talia Schmidt
10:55am 

Ezra Klein, journalist Washington Post: "How's it going, health care nerds?" Ezra Klein asks a sea of health care advocates.

Klein discusses the Affordable Care Act's far-reaching effects. All of a sudden, people are actually going to the doctor. "And it's not called Obamacare; it's called Aetna or Medicare or Medicaid. They get seen and their lives get better, and it's because of Obamacare."

Right now, the major concern is enrollment, Klein says. Focusing on those who need the most help, and figuring out how they can get access should be our priority as health care advocates.

Americans are buying health insurance in the hopes that it may save their life. Klein touches on the importance of health system improvement. "Our health insurance, for how much it costs us, is not as good as it needs to be." Improving the quality of health care is crucial to effectiveness of the Affordable Care Act.


From: Talia Schmidt
10:35am

Julian Castro, mayor of San Antonio, isn't afraid of a challenge. In Texas, the state with the highest number of uninsured Americans, "there are too many people who have been left behind."

He worries that not enough people are taking advantage of the newfound right to health care. Castro says he's working hard to ensure Texas follows suit with the rest of the country.

"One of the blessings of being mayor is we get to see the people we represent every day," Castro beams. "We go to neighborhood association meetings or PTA meetings, and we get to hear the dreams and the aspirations of the people we represent."

In the field, Castro's hearing that folks are making a choice to see the doctor or pay rent. He finds this heartbreaking, and wishes for a better life for his constituents.

"We have made it our business to make sure the Affordable Care Act succeeds," says Castro. "For the city, it's about ensuring that people have the opportunity to live a good life."


From: Talia Schmidt
10:15am 

The air is crisp as the excitement builds for Vice President Joe Biden to take the stage. Families USA executive director, Ron Pollack, pauses to deliver a statement that will shape the scope of this presentation. "Health care is a right; not just a privilege."

But first, we hear from Kathy Stokes, a single mother of twins and breast cancer survivor. "I lost my appetite, my hair, and at times, my will to keep going," Stokes tells the crowd. "With Obamacare, my insurance company couldn't deny. Without Obamacare, my 2014 would have been a disaster. I am an Obamacare success story."

Now, an enthusiastic Biden takes the stage.

"Even with the Affordable Care Act, it's a rough road," Biden says. "One of the things Ron [Families USA executive director] and I believe is that it's not just about physical coverage; it's about peace of mind."

The notion that health care is a basic human right used to be the eternal struggle. Key leaders in Congress agree on this, Biden says.

"I'm here today because 1) I wanted to come," Biden announces. "2) the president wanted me to, and 3) on behalf of the president and me, we wanted to say, thank you."

Biden emphasizes the tragic effects of high medical bills, the single greatest cause of bankruptcy in America. He underscores the unparalleled significance of advocates knocking on doors, changing people's minds, and arguing on behalf of affordable health care. Without the undying commitment of health care advocates, we wouldn't be here today.

"It's important to remember what the culture was like immediately before the Affordable Care Act passed," Biden reflects. Too many Americans were left in panic when they opened their medical bills. The average cost of one trip to the ER is $1,200 per visit, Biden shares. That adds up to tens of billions of dollars.

"With the cooperation of key players, we could easily cover five million more people, with the stroke of the pen," Biden explains. The energy, the fervor behind this sentiment, leads to a rousing applause by conference goers.

"We will not go back!" Biden exclaims. "America has turned the page. We will not go back to the days before the Affordable Care Act, when pre-existing conditions were not covered, when those suffering from mental illness were left uncovered, when women were covered differently than men, when we kicked young adults off their parents' policies. America will not go back!"

Biden closes his speech by encouraging attendees to keep-and spread-the faith in the Affordable Care Act.


From: Ron Pollack
8:51am 

We're moments away from the start of Health Action 2014 and I'm extremely excited. In just a few minutes, I'm going to get to introduce Vice President Joe Biden to the podium to kick off our 2014 Annual Health Action Conference. It's an amazing feeling to know the Vice President values the work we all do and is willing to come share some of his insights and inspiration on how we can make the health care experience better and more attainable for all Americans.

Welcoming the Vice President is a great honor, but the truth is, I'm just as excited to spend three days with many of the most inspiring and hard-working people from across the country. Health Action is always one of my favorite times of year and it's because there's nothing like being with our advocates, feeling their energy, and learning how we can better work together to make the dream of the Affordable Care Act a reality for all of us.

Health Action 2014 is going to be the best one yet! Ok, I've got to run...I'm off to introduce Vice President Biden...