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Thursday, January 22, 2015

Welcome to Day 1 of Health Action!

Health Action 2015
Thursday, January 22, 2015

5:00 p.m.Marketplace Enrollment Update

Kevin Counihan, Director and Marketplace Chief Executive Officer, Center for Consumer Information and Insurance Oversight, Centers for Medicare and Medicaid Services
William A. Hazel, Jr., Secretary of Health and Human Resources, Commonwealth of Virginia
Mila Kofman, Executive Director, District of Columbia Health Benefit Exchange Authority
Catherine Teare, Senior Program Officer, California Healthcare Foundation

With three weeks until the end of open enrollment, one thing that distinguishes this period from last year’s is the lack of news. Things have been going pretty well. 

Kevin Counihan of CMS noted that he’s grateful for the work of everyone at the conference: “This audience represents our salesforce.”

Counihan ran down the improvements CMS made to Healthcare.gov: reduced number of screens required to enroll from 76 down to 16, the site is warmer, fonts are bigger. “We’re learning.“

He noted that plan choice is something that has to be considered, as Healthcare.gov has 20 percent more plans this year. Are we offering too much choice? They’re trying to figure out the right balance. 

Counihan said that this remains a 5-year implementation: “In a couple years, things are going to feel rote. “

Mila Kofman, Executive Director, District of Columbia Health Benefit Exchange Authority

More than 75,000 people have enrolled though DC Health Link in private health plans or Medicaid.  Number of uninsured dropped by 43 percent in DC Health Link’s first year of operation. 

We have lots of choices. Always struggling to figure out if it’s too many. Biggest category of enrollment is in bronze plans.

Ground game relies on partnerships with community health centers, businesses, and more. 

William A. Hazel, Jr., Secretary of Health and Human Resources, Commonwealth of Virginia

We had a more than 60 percent increase in applications for Medicaid. Big surprise. 

So far, we have enrolled more than 360,000. Don’t know yet how many of those are renewals. The big problem for us is the looming Supreme Court case, King v. Burwell.

Catherine Teare, Senior Program Officer, California Healthcare Foundation

In collaboration with RWJF, California Healthcare Foundation is doing real-time user testing of people applying for health coverage. Teare shared audio clips of questions from a variety of consumers trying to enroll in coverage. 

This research is ongoing and will share detailed findings after the close of open enrollment. 

This kind of research about consumer experience is important for the marketplaces to be sustainable or efficient.

Rachel Klein: It’s time to have the conversation about the consumer experience. What are the most important ways to improve the experience?

Teare says that the “pain points” in the enrollment process continue to be: Plan selection, household size, trust in the product.

DC has a very sophisticated ground game to reach the hard-to-reach consumers. 

Counihan stressed that being an assister is a 12-month-a year role. 

He also wondered: How can we educate consumers more so they can make better plan selections? It is really thorny under any circumstances. 

A lot of people want to know if their provider is in the plan they’re looking at. That’s difficult. 

DC’s Kofman flagged the huge problem of inaccurate provider directories: 

“Provider directories are a problem=garbage in, garbage out.  We have to do better.“ 

Counihan: People want something that they can understand and afford with comprehensive coverage. I’m more optimistic that those tools are becoming available. 

We notice sometimes that people are enrolling in plans that are more expensive than they should be. Which gets back to consumer education. 

Would be great if foundations would look at what consumers choose and help provide some tools to state exchanges to help them. 

Tax time: another big test is how consumers navigate the process.

Counihan answered a question about outreach to non-English speaking populations. One-size-fits-all approach just doesn’t work in communication. You have to be tailored and work with community leaders and orgs. Bottom up, not top down. Have customer service reps that are bilingual. 

Teare noted that it’s important to have an eye to different educational needs. Newer immigrants may need education around how to use health insurance. 

In DC, diverse assister groups reflect the diversity of population. 

3:30 p.m.Outreach and Policy Tips for Reaching and Enrolling Diverse Populations 

Ambar Calvillo, Enroll America
Karl Cooper, American Association on Health and Disability, project manager 
Lindsay Nelson, Kentucky Primary Care Association
Oliver Vera, Oregon Healthy Kids 

We just heard from four champions for enrollment who convened to discuss outreach and policy tips for reaching and enrolling diverse populations. 

The key is to get creative in your approach, agreed the panelists. Karl Cooper, the project manager for the American Association on Health and Disability, knows firsthand how important it is for disabled consumers to get the answers they need. Even though he works in the field, he still had trouble getting the answers he needed on the Maryland health insurance exchange when shopped for coverage. 

“And I knew the right questions to ask,” Cooper said. “You can only imagine how hard it would be for a consumer who doesn’t know what to ask.” 

That’s why he created a Health Insurance Jeopardy game, because, “as with the actual Jeopardy, it’s not about the answer, it’s about asking the right question.” 

Lindsay Nelson of the Kentucky Primary Care Association is working to target outreach and enrollment efforts to those who are incarcerated. 

“We know they are getting left behind,” said Nelson, “and we saw the large potential impact to the cost of care, the benefits of Medicaid expansion, and the need for immediate care as soon as they are released, particularly those with mental health and substance abuse issues.” 

Ambar Calvillo, the National Director of Stakeholder Engagement for Enroll America, knows the importance of maximizing your time and resources to reach pockets of the uninsured. 

“There’s this myth that young adults are hard to reach,” said Calvillo. “That’s a total myth we need to debunk.” 

Calvillo and her team have spent a lot of time talking to young adults about plan selection, answering frequently asked questions (for instance, clearing up misconceptions about birth control), and sharing that financial assistance is available. She shared that a lot of young adults begin the application online but finish the application with in-person assistance. 

Healthy Kids Program Manager Oliver Vera has his own set of challenges in reaching Spanish-speaking populations. He emphasized the most important lesson for advocacy organizations is to translate materials so that they are linguistically and culturally appropriate. That means “no Google translator,” said Vera. 

Vera encouraged groups to establish a translating and review process to ensure accuracy. This includes involving community partners, stakeholders, and clients in the reviewing process, and really listening to their feedback. It builds trust, he said. Vera even said he has his mother read over some of his materials because he knows if she can understand it, any of his “hard-to-reach” populations will get it. 

Calvillo underscored the importance of giving these “hard-to-reach” populations a voice. 

“We need to give these populations a voice at the table,” Calvillo said. “We sit in a room talking about them, but they’re not even there. Forming a task force is an idea. Instead of just working with the organizations who work with these groups, we really need to give them a seat at the table.” 

2:15 p.m.Health Reform 2.0: A Call to Action

Ron Pollack, Executive Director, Families USA
Dr. Reed Tuckson, Managing Director, Tuckson Health Connections

In honor of Dr. Martin Luther King Jr. Day earlier this week, Ron opened the lunch plenary with a very personal reflection on the civil rights movement. He concluded:

“Dr. King’s movement taught us that, in social movements, there’s no such thing as final victories, and there’ no such thing as final defeats.“

How does this relate to health care? Ron noted that, because of the ACA, more Americans than ever have a legal right to health care. But making this a living reality remains a huge challenge.

Ron then listed many of the challenges that remain: the high cost of health coverage, the lack of dental coverage for adults, and others.

“The quest for affordable health coverage didn’t start with the Affordable Care Act, and it doesn’t end with the Affordable Care Act.”

Ron explained that Families USA produced Health Reform 2.0 to advance these goals:

  1. Secure health coverage for all
  2. Ensure that health coverage means access to needed care
  3. Transform our health care system
  4. Reduce health care costs and make care affordable

Why should we all support these goals? Ron listed four reasons that advocates could use to engage consumers and policymakers:

  1. If we continue to have higher costs, what does it do to our wages? We suppress wages.
  2. If we don't deal with costs, it'll crowd out education for our kids.
  3. High costs pressure other programs like Medicaid and Medicare.
  4. If we don't see relief, premiums will rise, deductibles will rise, and coverage and care will be in jeopardy.

Dr. Reed Tuckson, Managing Director, Tuckson Health Connections

Dr. Tuckson, a leader in health system transformation, wanted to engage the audience of advocates to work to improve the whole health system:

“I’m so glad to hear you still have fire in the belly, that you still have energy, because there is a lot of work to be done. “

If you care about expanding access, he said, then you have to deal with the issue of rising costs, of suboptimal quality, and prevention. These are the issues that consumer and patient advocates must begin discussing.

The bottom line, said Tuckson, is that health advocates must be part of the debates and efforts to change the following aspects of the health care system:

  • Health care price and quality
  • Transparency
  • Improving prevention

On prevention, Tuckson warned that there’s going to be a “tsunami of preventable chronic illness” affecting the health system.

“A gazillion people are going to be really sick and live forever. You cannot medicalize your way out of a preventable problem like this. If you don’t fight it, you cannot deal with [health] access issue. “

After a fast-moving and energetic presentation in which Tuckson succinctly diagnosed what’s ailing the U.S. health system, he concluded with an apology for adding to the agenda of the advocates in the room. But he encouraged them to pay attention to innovations in health care and be part of the decisions that affect patients. 

12:45 p.m.Senator Elizabeth Warren

The room greeted Senator Elizabeth Warren with a rousing standing ovation. Warren began by talking about how impressive it is that U.S. health care costs are slowing:

“We already brought health insurance to 10 million more people, yet our total [health] spending is less than if we’d done nothing at all.”

Then she called for advocates to join her in a campaign to pass legislation funding medical research. Access to health care is only half the battle, said Warren. The other half is advancing our ability to improve health itself.

To that end, next week, Warren will introduce a new law: the Medical Innovation Act. It would substantially increase funding for NIH -- without increasing taxes or diverting money from other programs. Blockbuster drug companies that face penalties for committing fraud would have to give money to NIH.

“This isn’t a tax. It’s simply a condition of settling to avoid a trial in a case of wrongdoing. It’s like a swear jar. Whenever a huge drug company gets caught breaking the law and wants off the hook, it has to put money in the jar to keep funding the next generation of medical research.”

11 a.m.Opening Plenary: 20 Years of Progress, New Ground to Plow

Sylvia Mathews Burwell, Secretary, U.S. Department of Health and Human Services
Representative G. K. Butterfield (D-NC)
Alan Weil, Editor-in-Chief, Health Affairs

During this morning’s plenary, a packed room of health advocates heard about where we’ve been in the past two decades of health advocacy and the challenges ahead.

The editor of Health Affairs, Alan Weil, shared a list of the achievements in the movement for quality and affordable health care that constitute “real progress,” a nod to our conference theme “Building Real Progress.” Facts like:

“20 years ago, 1 out of 7 Americans was without health insurance. Now it’s 1 in 9. Still too high, but improving. That is real progress. The share of poor kids without coverage has been cut by 2/3. That is real progress.”

Weil also issued a call to action to health advocates, exhorting them to “focus on delivery and payment reform as much as you focus on [health] coverage.” Chief among the reasons he gave for why they should pay attention to health care delivery reform and payment reform was that, if they are not involved and representing the concerns of society’s most vulnerable, those concerns won’t be represented. The conversation about these reforms is already happening and will be dominated by   voices representing older and middle-class consumers if advocates don’t join in.

Following Weil was Congressman G.K. Butterfield, D-NC, who is the chair of the Congressional Black Caucus and the founder of the Medicaid Expansion Caucus. As someone involved in the drafting of the Affordable Care Act, Rep. Butterfield spoke eloquently of the need to expand Medicaid to low- and middle-income Americans under the ACA: 

“People are dying in North Carolina and other states because some are ‘playing politics’ by stopping Medicaid expansions.” 

HHS Secretary Sylvia Mathews Burwell reviewed some of the early achievements of the ACA, including the fact that the number of people who forgo health care because they cannot afford it is declining. She announced that, as of yesterday, more than 7.1 million people have signed up for health coverage or renewed.

Burwell closed by thanking the room, filled with people who were directly involved in passing the ACA and in helping to make it benefit as many as possible:'

“It’s because of you and your colleagues that this law is working and millions of Americans have financial security and health security.”

7 a.m.—Good morning and welcome to Health Action 2015. We’re starting off the day with networking breakfasts. (You’ll notice lots of opportunities this year for networking, something that attendees have consistently told us they value highly about our conference.)

In addition to relevant and thoughtful workshops, today we’re looking forward to hearing from leading lights in health policy: HHS Secretary Sylvia Burwell, Congressman G.K. Butterfield, and Senator Elizabeth Warren.

Then it’s on to breakout sessions where you’ll have a hard time choosing between all the fascinating topics.

Finally, the day ends with, what else? Networking!