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Colorado Struggles to Educate, Enroll Residents in New Health Insurance Exchange

June 25, 2013 at 12:00 AM EST
Colorado is in the midst of preparing to roll out a new way for residents to get health coverage using an insurance exchange. Health correspondent Betty Ann Bowser reports on the challenges for the state in spreading the word about the program and getting Coloradans to enroll.
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JEFFREY BROWN: Next: spreading the word about the new health reform law.

It’s a crucial challenge for the federal government and states, creating so-called insurance exchanges. Last week, an independent arm of Congress, the Government Accountability Office, reported that work is running behind. Yesterday, HHS Secretary Kathleen Sebelius told reporters she still believes seven million people will enroll in the first year of the program. But she acknowledged, “The most daunting aspect is that people still don’t know enough about what’s going to change in the law, and still have some misinformation.”

NewsHour health correspondent Betty Ann Bowser reports on Colorado’s efforts to tackle the problem.

BETTY ANN BOWSER: The employees at Confluence Kayaks in Denver make it look easy. Their boards and boats seem to slip through the white-water rapids where the Platte and Cherry Creek rivers come together. But no fear is no substitute for insurance when one of them gets hurt.

JOHN KAHN, Confluence Kayaks: I had an employee who was injured last fall in a kayaking accident, and that kind of opened all of our eyes that we’re not invincible and that accidents do happen.

BETTY ANN BOWSER: And it brought home to owner John Kahn how important health insurance can be when something goes wrong in a dangerous business he’s owned for 18 years.

JOHN KAHN: I have a small business with three or four full-time employees, and adding health insurance as a benefit was just kind of cost-prohibitive.

BETTY ANN BOWSER: But now Kahn is hoping he may be able to offer health coverage because Colorado is one of 16 states that’s going to run an insurance exchange. The other states will partner with a federally managed marketplace.

The idea is to get millions of people who currently don’t have health insurance to be able to buy it at affordable prices. The new insurance marketplace, called Connect for Health Colorado, starts enrolling individuals and small businesses on Oct. 1.

JOHN KAHN: I don’t know a whole lot about it. I have definitely gotten health plans quoted from the major health care companies. And I think the exchange might make that easier to compare the plans, but I don’t know a whole lot beyond that.

BETTY ANN BOWSER: And that’s the problem. State internal polling found only 10 percent of Coloradans know about the new marketplace. National surveys mirror similar findings. So health officials all across the country are scrambling for private and federal grants to help get people educated and enrolled.

Under the Affordable Care Act, almost every American must buy health insurance or pay a penalty beginning in 2014.

NARRATOR: At Connect for Health Colorado, you can shop, compare, pick, and purchase the health plan that is right for you.

BETTY ANN BOWSER: Colorado has become the first state to reach out to residents with a $12 million dollar ad campaign.

NARRATOR: Connect for Health Colorado, because when health insurance companies compete, there is only one winner. You.

BETTY ANN BOWSER: Patty Fontneau, the CEO of Connect for Health, knows she has her work cut out for her.

PATTY FONTNEAU, CEO, Connect for Health: It’s really going to be a two-part discussion, which is, what’s going on? What is this? What does the law require? What’s going to be available to me? And then the second is, how do I do it? And how do I get it done? And how do I make sure it’s the best thing for me?

BETTY ANN BOWSER: In addition to advertising, the exchange will spend at least another $12 million dollars trying to reach the public directly using newly hired employees called navigators or guides.

PATTY FONTNEAU: What the health coverage guide will say is, let’s sit down and take a look at the number of plans that are available. Who is your physician? Let’s make sure your physician is in this network. What hospital will you use? What kind of a deductible might be feasible for you and your family? What are the kinds of costs you’re able to pay on a monthly basis?

BETTY ANN BOWSER: That’s not exactly a 10-minute discussion.

PATTY FONTNEAU: We don’t expect it to be a 10-minute discussion. This is — health insurance can be confusing.

JOHN KUENNING, Vice President, Metro Community Provider Network: I think it’s a huge, huge project.

BETTY ANN BOWSER: John Kuenning is vice president of the Metro Community Provider Network, which operates 19 clinics in the Denver area. They serve people who have little or no insurance.

JOHN KUENNING: The numbers we’re hearing are, there are 800,000 uninsured in the state. Probably 600,000 to 700,000 of those will need to be educated by September, so that they can make decisions in October about what to enroll in. I think it’s a monumental task. And I’m not sure how they’re going to pull that off.

BETTY ANN BOWSER: He’s also worried about the confusion and stress that his patients are feeling about the upcoming changes.

MICHELLE BLEDSOE, Colorado: I would love to have more information. Ever since this reform, this health care reform, they keep talking about it, but they don’t ever give us any kind of details of what is going to happen or how it’s going to affect any of us.

BETTY ANN BOWSER: Michelle Bledsoe doesn’t make enough money to afford health insurance and makes too much money to qualify for Medicaid. That’s why she comes to the clinic, where care is offered on a sliding scale.

When the new federal law kicks in next year, many people who come here will likely qualify for a government subsidy that may make coverage affordable; 13 insurance companies have agreed to participate on the Colorado exchange. They will offer more than 240 different plans. Like all the other states, there will be various levels to choose from. In Colorado, a bronze or basic package for a 40-year-old nonsmoker starts at $177 dollars a month.

More generous plans go up from there, silver, $232 dollars, gold, $273 dollars, and the platinum would cost $311 dollars a month for an individual.

MICHELLE BLEDSOE: I think that would be very overwhelming, from not having any kind of choice, just kind of accepting what you can get, to all these random choices. It is overwhelming.

BETTY ANN BOWSER: In order to make the exchange eventually pay for itself, the outgoing insurance commissioner has said the exchange will need to sign up 800 people a day in the first six months.

DEDE DE PERCIN, Colorado Consumer Health Initiative: It is a high number. It’s better than some states, and not as bad as others. But it is a heavy lift. And like I said, I think it’s going to be a process that takes a while.

BETTY ANN BOWSER: Dede de Percin is a health consumer advocate who says it’s unlikely the exchange will meet that target, but thinks over time people will enroll.

DEDE DE PERCIN: I was arguing with somebody about this, and they said, the fines aren’t high enough, people are never going to — and I said, seat belts. And he looked at me. And I was like, I’m 53 years old. My mother just threw her hand across my chest. And the reason why I wear my seat belt now is not because of a fine. It’s because we had that sort of cultural shift.

And you can argue we have had it on other things, like drunk driving. It takes a while, but we get there.

BETTY ANN BOWSER: The cost just to build the ground floor is enormous. Colorado has asked the federal government for $125 million dollars just for the first year-and-a-half. And that’s what has some fiscal conservatives like Dr. Mike Fallon concerned.

A father, emergency room physician, and the Republican-appointed board member to the Colorado exchange, he has serious questions about whether all that federal money is being spent wisely.

DR. MIKE FALLON, Colorado Exchange Board Member: The bigger the thing we make now, the harder it is to sustain. We have to be fiscally independent with no further federal money in another year. And so anything we add now adds future costs, which, if we’re not careful, will raise administrative costs, which, if we’re not careful, will raise the price to the consumer.

And the whole idea of this was to actually bring down the cost of health care and health insurance.

BETTY ANN BOWSER: Colorado exchange officials dismiss such worries and say they are on track for the program to pay for itself this time next year. But — and this is a very big but — they acknowledge this is only going to work if they reach enough people and get them to sign up.

GWEN IFILL: You can find more health care reporting online, from Austin, Texas, where musicians have one less reason to sing the blues. An organization that connects its members with affordable health care is helping artists without insurance. You can watch that report on our home page.