August 24. 2014 8:23PM

Tom Raffio: Assessing health-care marketplaces


If the Affordable Care Act's Health Insurance Marketplaces were an athletic team, it would have earned the 2014 “Most Improved Team” award — hands down — at the end of season award ceremony. Technological snafus and insufficient system capacity doomed the federal Health Insurance Marketplace to a largely failed rollout in October 2013. In short, it was a lousy start, but you'll see below the progress it made as states, insurance carriers, employers and consumers now begin to look to the 2015 open enrollment period.
Recall that the 2014 open enrollment period was to begin on Oct. 1, 2013, for all the Marketplaces — Individual and SHOP (the Small Business Health Options Program for small employers). Opening Day gave fuel to those opposed to the ACA. It quickly became obvious the federal Marketplace website,, was folding under its own weight.
The website kept crashing, and it took hours (days for some) to review the plan options and complete an enrollment. It took more than a month for the worst of the technological problems to be resolved, and it wasn't until January or so that the Individual Marketplace shopping experience became more user-friendly.
The administration recognized that the SHOP Marketplace was not going to be ready on time so it chose to delay its opening for a year. States and carriers had the option of offering their SHOP plans directly to interested small employers, though few small employers took up this option. The administration's decision late in 2013 to allow more employers to renew their existing medical plans for 2014 (and longer), removed much of the traffic to the SHOP Marketplace for 2014.
The numbers: Approximately 8 million Americans nationwide enrolled in medical coverage through the marketplaces; more than 1 million people enrolled in stand-alone dental benefit plans nationwide. In New Hampshire, more than 40,000 people enrolled in a medical plan offered on the Marketplace — twice as many as expected. Northeast Delta Dental, the only dental carrier offering stand-alone dental plans, enrolled close to 2,000 people. Although the first open enrollment period of this new health and dental insurance market was tumultuous, it is fair to credit the marketplaces for their part in the reduced number of uninsured Americans. According to a national Gallup poll released on Aug. 5, 17.3 percent of U.S. adults reported being without health insurance in 2013; that number has since declined to 13.4 percent in the second quarter of 2014.
How are things shaping up for the 2015 individual and SHOP marketplaces? The federal SHOP marketplace is slated to open this fall for the 2015 open enrollment period, but it will lack some of the planned functions.
Although technological issues persist with the individual marketplace, the new “normal” is that medical plan enrollment can be confirmed in a timely manner, and the necessary information and payment will be properly transferred from to the carrier. Because dental plans are routinely given less attention than medical plans by the federal agency implementing the marketplaces, there remains more to be “fixed” for dental offerings. For example, Northeast Delta Dental continues to push to allow the purchase of a dental plan without the need to buy a medical plan first, something Medicare subscribers want to see.
All of this shows progress, which ACA detractors and supporters needed to see to warrant the effort's great expense. The General Accounting Office analyzed the federally facilitated Marketplace's costs earlier this year and found that “(f)rom September 2011 to February 2014, FFM obligations increased from $56 million to more than $209 million. Similarly, data hub (an FFM system) obligations increased from $30 million to nearly $85 million.”
Two things we can reasonably expect for year two: We will see greater performance in terms of the efficacy of the markeplace's technology and its ease of use. And ensuring Americans are insured will continue to be an expensive effort. Toward that end, as a dental carrier, the mission of which is to advance the oral health and overall wellness of our customers and the general public, we know that people who have insurance are more likely to go to the doctor or dentist and seek treatment before a health condition escalates to one needing more expensive emergency care or more extensive dental work.
The expense incurred to see more Americans insured will return future savings in reduced emergency care costs and future gains from improved overall health.

Tom Raffio is the the CEO of Northeast Delta Dental.