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Getting the Word Out (or Not) on the Health Insurance Marketplace

August 16, 2013
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States vary widely in their efforts to educate the public

With open enrollment for the Health Insurance Marketplace set to begin October 1, it’s worth taking a look at how informed the public is on state-operated insurance exchanges. The answer to that depends on the state where you live.

(This is in addition to this week’s reported news that a little-noticed ruling has granted a one-year grace period to some insurers on a mandatory cap on out-of-pocket medical expenses—$6,350 for individuals and $12,700 for families—in 2014. That’s a separate issue, but is relevant in at least one sense: it caught a lot of people by surprise, and is especially unfair to people who are afflicted with serious illnesses such as cancer and rheumatoid arthritis, who must contend with extremely high out-of-pocket costs.)

The Health Insurance Marketplace is an important piece of legislation that will benefit consumers by allowing them different options when selecting a health insurance plan. The question is, how effective will be legislation if many people who can benefit from it are confused about what state-based insurance exchanges are and how they work.

How much confusion? Consider this: according to an April Kaiser Health tracking poll, four in 10 Americans are unaware that the Affordable Care Act is the law of the land and is being implemented; what’s more, six in 10 of those in households making less than $30,000 a year are unable to say if the law is still in force.

Also according to Kaiser, as of May 2, 16 states plus the District of Columbia have declared their intention to establish a state-based Health Insurance Marketplace, and have received conditional approval from the Department of Health and Human Services (HHS). A majority of those states passed legislation authorizing the establishment of a Health Insurance Marketplace. Seven states have opted for a state-federal partnership marketplace, and HHS will take responsibility for states that opt out of either a state-based or state-federal marketplace.

How effective have states been in getting the word out about Health Insurance Marketplaces? The New York Times on August 2 profiled two states, Colorado and Missouri, which is a study in contrasts.

On one extreme is Colorado, which has opted for a state-based marketplace. According to the Times, the state is promoting its Health Insurance Marketplace heavily, with representatives who are traveling throughout the state to explain how it works and to help people—there are about 800,000 uninsured in Colorado—sign up for coverage. The Web portal,, includes a calculator for comparing insurance rates, customer assistance sites, a primer on health insurance, and a buyers’ guide put out by the state Department of Regulatory Agencies.

Missouri represents the other extreme. It is one of 26 states that have defaulted to a federally facilitated marketplace and which, according to the Times, has no official voice for the Health Insurance Marketplace and no board of local advisors. About 850,000 people are uninsured in the state; yet there are also significant obstacles in reaching out to them. For one thing, insurance counselors, or “Navigators,” are required by state law to get licenses before they assist consumers in understanding their health plan options. Also noted by the Times, last November voters approved a ballot measure that prevents the governor and other state officials from establishing or operating a state-based insurance exchange unless authorized by a vote of the people or by the state legislature. The measure also says that state and local officials may not provide assistance or resources to a federal exchange unless the assistance is specifically required by federal law.

Information does exist online. One portal,, provides basic information and news updates, as well as links to the Centers for Medicare & Medicaid Services (CMS) Web site; and community groups have stepped in to fill the information void. Also, CMS has awarded Navigator Grants to two organizations, Primaris Healthcare Business Solutions and the Missouri Alliance of Area Agencies on Aging, to help raise awareness. Still, Missouri public officials have not stepped up, and I think that’s unfair to the citizens in that state. After all, Health Insurance Marketplaces, as part of the Affordable Care Act, are the law of the land, and the people who can benefit have a right to know.