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State, insurers optimistic on health care exchange's Year 2, but increasing costs raise concerns

Donna Frescatore, executive director of New York State

Donna Frescatore, executive director of New York State of Health, speaking in a news conference Wednesday, Nov. 12, 2014, sponsored by the Washington, D.C.-based nonprofit Families USA, said the exchange has done several things to retain enrollees this year and attract the still uninsured: Credit: nystateofhealth.ny.gov

This year should be easier.

That's the message from health officials, brokers, insurers and navigators as Year 2 of the New York State of Health insurance marketplace opens Saturday.

Last year, 960,762 New Yorkers -- including 137,806 Long Islanders -- signed up for health insurance on the exchange by April 15, a number well on the way to the state's goal of 1.1 million enrollees by 2016.

Donna Frescatore, executive director of New York State of Health, speaking in a news conference Wednesday sponsored by the Washington, D.C.-based nonprofit Families USA, said the exchange has done several things to retain enrollees this year and attract the still uninsured:

Customized notices were sent to about 300,000 households statewide last month detailing the costs of premiums for their current health plan and any tax credits for which they might be eligible. Those happy with their plan don't need to do anything to be automatically re-enrolled.

More than 200 call-center staff have been added and wait times reduced to 10 seconds.

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A Spanish-language version of the exchange's website launched Wednesday and materials are now available in 18 languages.

A new anonymous shopping tool has been added to the website that allows people to comparison-shop before having to register.

Frescatore didn't have a number of uninsured she wished to attract to the exchange this year. But the penalty is greater in 2015 for many of the remaining uninsured under the federal Affordable Care Act: 2 percent of yearly household income or $325 per person and $162.50 per child under 18 -- whichever is higher. For those who want coverage to start Jan. 1, the deadline is Dec. 15; enrollment ends Feb. 15.

 

Helping more sign up

Janine Logan, spokeswoman for the Nassau-Suffolk Hospital Council, designated a "navigator" group by the state to help people enroll, said she expected people will still need some help in signing up again if they want to change their plan. "Our goal is that anyone who enrolled last year we hope will come back and enroll again and we want to reach those who are still uninsured," she said.

Statewide, premiums on the exchange are rising an average of 5.7 percent. Among the nine insurance companies doing business on Long Island on the individual and family exchange, rates in the silver plan -- the most popular -- range from an increase of 10.4 percent by Health Republic to a 15.4 percent drop by Affinity.

Although New York's marketplace had far fewer glitches than the federal exchange, healthcare.gov, there were problems, especially early on. Initially the website was slow and people often had to wait for someone to help them on the exchange's call-in center. And when it came to the plans themselves, consumers complained of being assigned primary care doctors they hadn't signed up for, of manifold billing issues and of conflicting answers from insurers.

Doctors complained that they were unsure which insurance plans they were participating in and of losing longtime patients. Insurance companies -- notably Empire BlueCross BlueShield and Health Republic -- contended with backlogs and delays as they struggled to deal with thousands of new customers.

"I would think it has to go better," said Neil Weingarten, vice president of Conference Associates in Patchogue, group insurance administrators of the 2015 sign-up.

Recalling last year, he added, half-joking: "I remember it was terrible. I can't remember why -- it's a dark period."

Health insurers agreed.

"I think it will be smoother than last year," said Alan Murray, chief executive of North Shore-LIJ CareConnect, whose rates on the silver plan are rising less than 0.2 percent. "I think the population is far more aware."

 

Poll: Majority satisfied

Despite the problems, a poll released Monday by the nonprofit New York State Health Foundation of 250 people who had become newly insured with private insurance or Medicaid found that 49 percent were completely satisfied and 43 percent somewhat satisfied with their plans. A majority -- 84 percent -- had used their insurance and 92 percent said they were at least somewhat likely to renew their coverage.

"This is the first time we've asked New Yorkers how they rate their health insurance and it's an enthusiastic thumbs up," said David Sandman, senior vice president of the foundation.

Nevertheless, the survey found that cost is still an issue for many. Thirty-eight percent said they had to stretch their budgets "some" or "a lot" to pay their premiums. Among those with private insurance, that figure rose to 62 percent. Only 27 percent of respondents with private coverage said their monthly premium was "very affordable" compared with 88 percent of Medicaid enrollees.

Cost is an issue for Mary Beth Calamia, 51, a clinical social worker who lives in Holbrook. She said she got a notice that her monthly premium for her Health Republic platinum plan is rising more than $70 a month.

"I'm going to have to completely re-evaluate my options," she said. "The increase is unsustainable."

Beth Drucker, 60, and Louis Drucker, 63, of Centerport said they are not sure whether they will stay with their Empire BlueCross BlueShield silver plan. Beth had to leave her primary care physician of 25 years and wasn't happy with his replacement.

"We really don't know what to do at this point," Louis said. "It was a godsend for us to have affordable health care, but everybody's rates are going up."

 

High deductibles

Monthly premiums are not the only concern. Dr. Christine Doucet, a family practitioner in Patchogue, said many of her patients were initially unaware of the often high deductibles in their plans, which cut down on their visits.

"I felt bad. It's like going to the store and expecting a whole loaf in the grocery bag," Doucet said. "Things need to be more transparent."

And with premium increases, she said, she worries that people won't be able to keep their insurance. "If you believe health care is a basic human right, you have to have something that covers everyone," she said.

Initially, many doctors were uncertain which plans or patients they had. Dr. Raymond Ebarb, immediate past president of the New York State Academy of Family Physicians, said he lost a lot of patients from his West Sayville practice after the exchange opened. But he has gained a lot, too.

And many of the new patients have called to ask if their family members could also come to the practice, he said. "For the first time, we have to put people off," he said.

 

Insurers upbeat

Health insurers said a year's experience has led to some changes.

Health Republic, a new nonprofit cooperative that sold the highest percentage of plans statewide and third-highest on Long Island, said it has gone from 150 to 600 phone lines to handle calls, 93 percent of which are answered in a minute or less.

"We quadrupled staffing in all operational areas," said Debra Friedman, Health Republic's chief executive. "We're poised for another year of extraordinary growth."

Pamela Hassen, chief marketing officer for Fidelis Care, which sold the second-highest percentage of plans statewide and on Long Island, said the insurers -- whose rate on the silver plan for Long Island is rising about 5.5 percent -- now offers its website in Spanish, Chinese and Russian as well as English, and it has tweaked its doctor-search tool.

Mario Schlosser, co-founder of Oscar, whose rates in the silver plan on Long Island are rising 6.3 percent, said the insurer has added several innovations to get people to use their insurance, such as giving people a $20 Amazon gift card to get a flu shot and $60 Amazon gift card to make a wellness visit. "We want to show them the value of staying insured," he said.

Paul Zurlo, senior director of business development for EmblemHealth, whose individual silver plan on Long Island is going up 5.7 percent, said the insurer has also enhanced its website. He said he is confident Emblem is ready for 2015. But he pointed out that the renewal process is still uncharted territory.

"That's going to be new for folks," he said.

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