On Tuesday, June 3, at the request of Congressman Sam
Graves, Chairman of the House Committee on Small Business, I had the
opportunity to give my overview of the California SHOP Exchange to the U.S.
Government Accountability Office (GAO).
There seemed to be a certain level of surprise when I
described our experience in the field during both open enrollment and special
open enrollment -- which was markedly different than had been reported by
exchange officials. This was an
important opportunity to again highlight the critical role the licensed agent
plays in finding and enrolling individuals, families and businesses in
affordable public or private health insurance plans.
Wednesday, June 4, marked the sixth quarterly meeting of the
SHOP Advisory Group in Sacramento. Something is definitely up when Peter Lee, executive director of the California Health Benefit Exchange Board, comes in to
open the meeting to talk about the continuing technical problems reportedly
have delayed paying agents who have brought small business groups to the SHOP
exchange.
Six months, 1,233
groups and 8,294 total members into the first year of enrollment and agents
have yet to be paid. Appropriately, Mr.
Lee opened the meeting with a strong “mea culpa” and committed that if
commission payments aren’t forthcoming in short order, estimated commissions
will be sent out and the accounts will be reconciled later. His comments were “on the record”, but they
still lacked the needed “drop dead date”.
If love means never having to say you’re sorry, then agents would like
to feel a little love! I sincerely doubt an apology, however
sincere, is going to serve as legal tender to pay anyone’s rent.
Another core issue for agents is the issue of our licensed
office staff working to help resolve client issues. When Mr. Lee asked for questions, I took the
opportunity to get him on the record about agency staff being able to work with
Covered California service centers on service related issues. CAHU has been battling over this issue with
the Covered California since October of last year. All agrees that the industry standard of permitting
properly identified agency staff to deal with service centers on client-related
issues is appropriate and allowable according to our agent agreements and that
the staff comply with the many personal information handling and privacy
standards set at the state and federal level.
This makes sense for agents and the Exchange—but will mean the most for
our customers –who will get better service as a result.
I so appreciated that other members of the SHOP Advisory
Group jumped in to support agents on this issue, especially Tana Elizondo, an
independent agent from the Central Valley, and David Chase, Chair of the SHOP
Advisory Group and California Outreach Director of the Small Business Majority. Their strong support of our request and that
of the other members of the Advisory Group was very helpful. Just like the commission issue, words are
nice, but let’s get it done!
Covered California/Pinnacle staff reported on the SHOP service center call statistics and it was reported that the average hold time to answer is now 2 minutes and 25 seconds and the abandonment rate is down to 4.6%. Significant progress, I am sure we can all agree. Other recent changes in processing and implementation will go a long way towards continuing to improve the service experience. The most important change is that processing of new cases is being handled entirely on the Pinnacle system and no longer goes through CalHeers. This has resulted in a real time processing window for new cases of approximately 4 days when all information is received and correct. Again, significant improvement.
What I found most interesting are the source statistics of
the new SHOP business. Not surprisingly,
general agents account for 52.65% of the 1,233 cases submitted through
April. Agents direct through SHOP wrote
25% of the cases. What was a surprise is
that 22.4% of the new business being written in the SHOP is Employer Direct. The Employer Direct cases average 3.88 lives
per case. This number includes
dependents, so that means a lot of 2 employee groups. The total lives that have come through this
channel account for 12.8% of the SHOP enrollment.
Another important issue debated was prospect of additional
product offerings for 2015 enrollment as well as alternative benefit design
options such as dual contiguous benefit levels.
The SHOP Advisory Group members were very vocal in their unanimous
support of both issues.
Covered California staff asked for input on allowing
Outreach Grantees and Certified Insurance Agents to work together. The position expressed by the members of the
Advisory Group was overwhelmingly supportive of this policy change.
Hopefully, the onset of summer will melt these ongoing barriers, speed progress at the exchange, and focus light on the fact that Agents are the Answer.
Until Next Time,
Sam