Covered California, the new health insurance exchange in California has begun agent training. Kudos to them because they have accomplished a lot in a very short period of time. With this blog post I hope to give some first hand info and feed back on the training process and on the enrollment procedures and processes.
Overwhelming Agent Interest in Certification
It’s crazy – the state set up a system to train agents and agents responded with overwhelming enthusiasm. According to Chris Patton, VP of sales for Pinnacle TPA (the SHOP plan administrators) the State expected a few thousand agents to apply to become certified. In fact, 14,000 agents registered to become certified Covered California agents. In contrast, only 800 people have applied to become certified enrollment counselors. Clearly, agents will play an important role. Chris made this comment at the LAAHU agent association meeting last week. I was the MC and moderator of the Marketplace Panel Discussion that also included Regina Lightner from L.A. Care Health Plan and Janet Fosdick of Molina HealthCare.
Step 1: Enrollment Training – 8 Hour Course
The first step in the agent training process is to attend an 8 hour live, in-person, class. I attended one of the first agent training classes, September 6, 2013, in Culver City. Over 300 licensed agents attended that training session. To say that I was disappointed would be an understatement. The instructor was terrible – apparently he was a volunteer who told us on many occassions that he had been trained the week before in a 5 day session in Bakersfield. He read slides for 8 hours. He responded to questions with incorrect answers. He talked about himself way too much. I spoke with about 10-12 agents who all complained about the instructor.
Many of us looked forward to the session – especially to learn about Medi-Cal, the California Medicaid system for low income people. We learned next to nothing. Apparently, Covered California hired a separate company that provides insurance license training to train and hire the instructors. What a fiasco. I sent an employee to another Covered California training session on September 13th and the same instructor gave the course. Same dismal results. Ultimately, Covered California must take responsibility for the poor decision of delegating this important job to a company that did such a poor job. The only silver lining was that representatives from Pinnacle TPA also attended the class and they were able to answer questions correctly. Employees from Pinnacle TPA should have taught the course. Strike one for Covered California.
Step 2: 4 hour online course
I am writing this blog post as I wait for the many sections of the online training to load. I have a very fast computer but each section takes a few minutes to load and there are more than 20 sections. Some sections take 5-10 minutes or more to load… it gets frustrating staring at a computer screen while nothing happens, then spinning circles appear on the screen, then blinking dashes appear, sometimes dashes spinning in a circle … a BIG waste of time. As I think about the thousands of agents who are basically donating their time to the government to make their plan work; I wish that the government -or their contractor- had made the system more efficient. I’m about 6 hours into the “4 hour” training and I don’t know how much longer it will take – I have taken two exams so far – two hours and three more tests later; I discovered that these tests are practice and I must take a 75 question test… wow.
To give you a feel for the exam questions, one of them was “On which page does the SHOP application begin?” This seems like a silly question to me. To have this process take so long is especially frustrating because I am VERY knowledgable in health care reform, ACA, ect. I have been reading and writing about is for years (Check out the many articles I’ve written for this blog and for our newsletter) – I’ve attended nearly every webinar that Covered California has hosted; and I watch most of the HBEX board meetings online. I even coordinate, interview and moderate panel discussions on the exchange and health care reform with industry leaders. So, to sit in front of a computer and answer banal questions is frustrating. Strike two for Covered California. Hopefully, someone from Covered California or Pinnacle TPA will read this blog post.
Early Look at Covered California Content
One benefit of the online class is that we finally get to look at the website Covered California has designed to enroll individuals and small groups. Let’s ignore a few oddities such as the web site showing United Health Care (UHC) and Blue Cross Blue Shield (BCBS) as being plan selection options when UHC will not participate in either SHOP or the individual exchange and there is no BCBS in California – here we have, Anthem Blue Cross (a for profit part of Wellpoint) and Blue Shield of California (a California only not-for-profit), not BCBS.
Employer Contribution: The SHOP webpage has a “slider bar” for employers to select the appropriate employer contribution amount. It is always shown as a percentage of the employee (EE) or dependent premium. In the two decades that I have been helping small business owners set up group health plans I have found that most employers want to know the total cost that they must pay every month – this helps them determine whether it is within their budget. It would be better for the employer to have a total dollar amount for the entire group – rather than a percent for an average employee.
Tax Credit Calculation: Another confusing component of the SHOP employer application is that “tax credit” is shown and it appears to be per employee per month – but I’m not sure. They should identify the measurement of the estimated Tax Credit. Another slide refers to a “tax penalty” for a small employer if the coverage is “unaffordable” to an employee. The only penalty that I am aware of is the “shared responsiblity” penalty (recently postponed until 2015) and this penalty only applies to mid-large employers (more than 50 employees.) They should remove this reference to a tax penalty for a small employer.
Online Group App: The major difference with the SHOP application is that it is all online. Currently very few, if any, small groups apply online. Anthem Blue Cross created a small group online application a few years ago but nobody used it. I’m not sure why Covered California thinks that small businesses will embrace an online process with them, but we’ll find out if the strategy is successful.
Federal Data Hub: One thing that may surprise people is that by enrolling in Covered California you agree to have the government cross-check your information with other Federal government agencies such as the IRS to verify the amount you earn and your eligibility for a subsidy; and, Homeland Security to verify legal resident status. The application asks for authorization to cross check data for up to 5 years. This may cause a problem for people concerned about Big Brother checking up on them.
Payment Info Required of Employers before Total Bill Shown: The Covered California web site requires employers who apply for coverage in SHOP to input all of their payment information before they know the total cost for the plans. An employer must input this information before employees select plans – and plan selection impacts the total premium and the employer’s payment. I don’t think that employers will like this. Most consumers want to know their total cost before they agree to pay.
How did you hear about Covered California: This is one of the questions early in the application. A drop down menu appears with pre-selected answers. It strikes me as extremely unusual that “from my insurance agent” is not one of the selection choices. As with MRMIP, I suspect that many people will learn about the subsidies and the new plans from an agent. That should be one of the options.
Covered California has done many things very well. Other things need some improvement. Hopefully, they will read these suggestions and improve their system.