Nearly 10 percent of the state's residents have no health insurance, and Kevin Counihan and Jason Madrak have a good picture of who they are and even where they live.
But for Counihan, CEO of the state health exchange that will start selling Obamacare coverage on Oct. 1, and Madrak, the marketing chief, knowing details about the nearly 350,000 uninsured people is one thing. Persuading them to enroll in a health plan is something else altogether.
On Monday, the health exchange — called Access Health CT — launches its $15 million public marketing campaign, including TV ads, to reach as many of those uninsured people as possible. The idea is to get at least 100,000 of them to enroll in a health plan for 2014.
This, finally, is the face of federal health reform, not just in our future, but in our face. It is the end result of a volatile national argument that brewed for decades before exploding in the Affordable Care Act of 2010, followed by three years of heated debate about how to make it work.
The kinks are not all ironed out, not in Connecticut or the nation. No one knows how the uninsured public will react to the plans, how much the subsidies will ultimately cost U.S. taxpayers or whether the massive reform will, as promised, lead to affordable care for millions who don't have it now.
But to its credit, Connecticut's health exchange is out in front of Obamacare, with a staff of 42 in a downtown Hartford office building, spending $110 million in federal grant money to make it happen.
"Our mission is very simple," Counihan said. "Improving access, improving transparency of information, improving quality of care."
That may be the first and last time anyone uses the word "simple" to describe anything about the federal health reform that brought us to this point. The outreach effort alone has a multi-pronged strategy to attract the attention of clients, and that's apart from the systems that have been set up to make it all work and the relationships with private insurers whose plans spell the heart of the reform.
The outreach effort includes a physical presence with storefronts and booths at public festivals in the state's poorest cities, where 85 percent of the uninsured reside; a comprehensive, colorful website that's designed to take users step-by-step through a process that's complicated by nature; a network of "assisters" and "navigators" in Connecticut communities who will seek out and enroll people; private insurance brokers, in person and online, who will earn commissions by selling the plans; and community health clinics, the providers on the front lines who see many of the uninsured exactly when they need medical care.
And of course, there is a good, old-fashioned ad campaign with social media, radio, print and TV commercials, which start to air Monday. The ad campaign alone will include a media buy of more than $6 million, about half of that on TV.
The 30-second TV spot has a theme of "Change."
"Now, thanks to Access Health Connecticut, just about everyone can get health insurance," a cheery female voice says over bold words and graphics in the exchange's orange scheme. "No one can be denied due to a pre-existing condition. You may qualify for a discount. ... Change is here."
The ad shows the web site, http://www.AccessHealthCT, but conveying details will be up to the hundreds of people working with enrollees on the ground.
"Any one of these tactics by themselves would be ineffective," Madrak said. "We need all these tactics to work together."
Tough Customers To Reach
It's a concentrated target group of potential enrollees, but a hard one to reach. Many don't speak English as their first language, many have little education and will need hand-holding through a process that can only be made so simple, and many believe that even subsidized health coverage isn't affordable.
Others — typically young males known in the business as "invincibles" — simply don't think they need insurance. And because of new pricing rules, insurers are not allowed to offer as large a discount to young, healthy people buying individual plans as they have until now.
There's a lot of concern about the prices of the plans even though most people without insurance will be eligible for a federal subsidy. With five insurers participating, the most common plans are coming in at an average of about $400 a month (before the subsidy) for individual buyers — with variations based on age.
One problem: Buying health insurance is by nature complex. The exchange is designed to make it as simple as possible, with standardized plans in four levels — platinum, gold, silver and bronze — based on the percent of care they cover. Insurers are allowed to offer two non-standardized plans per level.
Another problem: The penalty for not signing up totals just $95 in the first year.
But if the stick is small, the carrot can be large. A family of four earning as much as four times the poverty rate, or $94,200, would still be eligible for some federal help. The target is for households to pay between 2.5 percent and 9 percent of their income on premiums. For example, a single parent with two children who earns $40,000 a year might pay 6 percent of his or her income, or about $200 a month — while federal credits cover most of the cost.
"We should make a good dent this year in the uninsured," Madrak said. But he added, "This is really a two- or three-year implementation."
No one thinks Access Health CT will sign up anything close to the estimated 344,000 Connecticut residents who don't have insurance this year. The goal is less than half that, including 100,000 in private plans, some individual, some through small business plans; and 30,000 new Medicaid enrollees.
That seems modest, considering that Medicaid eligibility is expanding dramatically for low-income adults with no children. Gov. Dannel P. Malloy proposed to tighten eligibility for working poor parents, sending them to subsidized private plans on the exchange. That would have saved state taxpayers, but advocates won that battle, and the budget for the coming year leaves parents at up to 185 percent of the federal poverty rate on Medicaid.
The goal also seems modest considering that companies with at least 50 employees working at least 30 hours a week must offer health insurance. But, Counihan said, based on federal estimates of likely enrollment, "I think it's an aggressive goal."
Aggressive or modest, Connecticut has some advantages. "We're a small state — we know where the uninsured are," Madrak said.
And, as one of just 14 states running their own exchanges — the rest are relying on the federal government to do the job — Connecticut was able to tailor its own program and received far more money to make it happen.
Behind The Scenes
As the core of health care reform, the exchange system is, by all accounts, a work in progress.
"There are so many dynamics that are happening at the same time, it's going to take a few years for carriers to price plans, come into the market," said Sam Gibbs, president of the government systems unit at the brokerage eHealth Inc., the largest online private exchange.
As the firm that pioneered online exchanges and has signed up 3 million people, about 40 percent of whom had been uninsured, eHealth is trying to take an active role in Obamacare. Private brokers, who receive commissions from insurers, must charge the same rates and must offer every plan on a state exchange, or they can't enroll people.
Private brokers will be especially helpful in working with small businesses, Counihan and Madrak said. Meanwhile, eHealth is trying to take it a step further by lobbying for the right to sign up clients directly on its own website.
"Just because Connecticut has a website and a call center, that doesn't mean people are going to go there," Gibbs said.
"We are very pro-broker," Counihan said. "We view them as trusted advisers."
In another issue, advocacy groups such as the Universal Health Care Foundation of Connecticut lobbied for a bill in the recent legislative session that would have required Access Health CT to actively negotiate with insurers to lower prices. The bill passed in the Senate but died in the House.
Counihan, a veteran of the Massachusetts reform on which the exchange system was modeled, says the debate over active negotiating is based on a misunderstanding. "There is not one state negotiating," he said. At a recent conference of state exchange heads, he asked for a show of hands of how many actively negotiate.
"Nobody raised their hands," he said. "Actuaries don't negotiate, they review."
Access Health CT has hired a consultant to review the prices offered by insurers, and the firm is due to report back on June 26.
The state's network of 14 community health centers, some with more than one location, has a total of 80,000 uninsured people as patients — obviously a key avenue for enrollment. But because the health centers receive money to enroll people in Medicaid, they were not allowed to seek grants to assist Obamacare enrollees in the exchange.
"We were disappointed when we were excluded from the assister applications," said Deb Polun, the government affairs and media relations director for the Community Health Center Association of Connecticut.
That was smoothed over by a $1.5 million federal grant to the health centers to help enroll people in the program, and now Access Health and the centers are working together.
Centrists With a Cause
Counihan is quick to note that polls show Americans are woefully unaware of insurance access reform; and in fact, 12 percent in a recent Kaiser Family Foundation survey thought it has been repealed. All of that gives Access Health CT the chance to tell the story freshly, he said.
The heart of the on-the-ground outreach is a network of 300 assisters, mostly nonprofit groups that are applying for $6,000 grants and will seek out and enroll people. About 600 have applied, and the winning assisters will be named this month.
California's exchange is paying a $63-per-head bounty to assisters for every person enrolled. Some wanted Connecticut to go that route, but, Madrak said, "it wasn't really in the spirit of what we were trying to do here," working with local groups. "They believe in the cause, and they're eager to help."
To help guide the assisters and spread the word broadly, the exchange will give grants to between five and seven "navigator" groups, typically larger, nonprofit agencies.
It is, as Madrak suggested, not just the sale of a service to hundreds of thousands of people, but a cause that will save lives. Critics on the left, who say the exchange system may still be too expensive for many families, and on the right, who say it's socialized medicine that will collapse under its own weight, can now put the details of the debate aside long enough to help get the word out.
"We have the pieces in place to make sure anyone who may want to buy health insurance from the exchange is going to know exactly how and where to do so," said Lt. Gov. Nancy Wyman, co-chairwoman of the exchange board.
Wyman and other board members have delved into details such as making sure there were radio ads produced in Spanish.
"I believe this marketing effort is going to be another example of the great work that is being done to implement what is now the law of the land."
Follow The Haar Report blog at http://www.courant.com/haarCopyright © 2015, CT Now