Insurance Brokers and the ACA: Early Barriers and Options for Expanding Their Role

Insurance Brokers and the ACA: Early Barriers and Options for Expanding Their RoleACA Implementation—Monitoring and TrackingSabrina Corlette, Linda J. Blumberg and Erik WengleFebruary 2015 ACA Implementation—Monitoring and Tracking2INTRODUCTIONIn-person assistance from navigators and other professionals has significantly facilitated individual and family enrollment into the health insurance marketplaces developed under the Affordable Care Act (ACA).1 However, though enrollment in state and federally facilitated marketplaces was at 6.7 million by late 2014 and has exceeded 9.5 million thus far for 2015,2 millions eligible for financial assistance through the marketplaces remain uninsured. As federal and state funding for navigators and other publicly funded assisters decreases in the coming years,3 private insurance brokers and agents (hereafter referred to collectively as brokers) could play an increasingly important role in expanding coverage to the hard-to-reach uninsured and in ensuring that those already enrolled maintain coverage in the future.4 The ACA’s drafters envisioned a continuing, significant role for brokers in the reformed nongroup insurance markets, but circumstances limited their active participation in the first year of marketplace enrollment. This analysis delineates the early barriers to brokers’ full engagement with the marketplaces, highlights the main concerns with their having a more prominent role and offers options for making them more effective in enrolling the uninsured. The information presented in this brief is based upon interviews conducted with stakeholders (e.g., providers, insurers, consumer advocates, navigators, assisters and brokers) in 21 states and the District of Columbia during the first half of 2014: California, Colorado, Connecticut, District of Columbia, Hawaii, Idaho, Kentucky, Maryland, Massachusetts, Minnesota, Nevada, New Mexico, New York, Oregon, Rhode Island, Vermont and Washington (states using state-based Marketplaces [SBMs]), as well as Arkansas, Delaware, Illinois, New Hampshire and West Virginia (states operating in partnership with the federally facilitated marketplace).BARRIERS TO BROKER ENGAGEMENT IN THE HEALTH INSUR ANCE MARKETPLACESAn Evolving Partnership between Marketplaces and BrokersMost broker respondents reported that the marketplaces did little to engage them or to adopt brokers as part of their marketing and enrollment strategy. The broker community was treated as “an afterthought,” a broker in Washington reported, echoing a common theme, and brokers in Minnesota and New Hampshire sensed that state officials preferred to work with navigators for their outreach and enrollment efforts. Brokers in other states took umbrage at what they saw as the marketplaces’ use of negative language to characterize brokers; a broker in Vermont With support from the Robert Wood Johnson Foundation (RWJF), the Urban Institute is undertaking a comprehensive monitoring and tracking project to examine the implementation and effects of the Patient Protection and Affordable Care Act of 2010 (ACA). The project began in May 2011 and will take place over several years. The Urban Institute will document changes to the implementation of national health reform to help states, researchers and policymakers learn from the process as it unfolds. This report is one of a series of papers focusing on particular implementation issues in case study states. Reports that have been prepared as part of this ongoing project can be found at www.rwjf.org and www.healthpolicycenter.org. The quantitative component of the project is producing analyses of the effects of the ACA on coverage, health expenditures, affordability, access and premiums in the states and nationally. For more information about the Robert Wood Johnson Foundation’s work on coverage, visit www.rwjf.org/coverage. ACA Implementation—Monitoring and Tracking3asserted that the SBM’s ultimate goal was to “eliminate the role of brokers.” Despite inauspicious beginnings in many states, as the 2014 open enrollment period progressed and efforts to enroll people intensified, several marketplaces came to recognize the important role brokers were playing. For example, one broker in Vermont reported that the state formed a broker advisory group “late in the game” after “they realized they needed us.” Other SBMs had no choice but to turn to the broker community after problems with information technology (IT) systems rendered online, unassisted enrollment too difficult. Brokers in Nevada, for example, reported that the marketplace initially rolled out without involving their community. But “now that things aren’t going well,” they said, “the Exchange is advising people to go to brokers.” Oregon also came to rely heavily on brokers for enrollment because of a nonfunctioning IT system.Brokers gave several marketplaces accolades for recognizing that brokers could spread the word about marketplace coverage and help people select