‘Many, many thousands’
In the meantime, GoHealth, like the other licensed exchanges, is assembling a queue of “many, many thousands” of customers who have completed their initial applications and have utilized a GoHealth subsidy estimator on the site. SVP Mahoney said that 52 percent of families initiating applications are eligible for subsidies, a percentage that he believes will be higher once everything starts flowing.
The subsidies are available for those whose Modified Adjusted Gross Income — MAGI, the income tax term for income minus certain deductions — is no more than four times the poverty level. For a single person, this means a top MAGI of about $46,000; for a family of four, it’s up to about $94,000. Subsidies are key: Without a subsidy, a family might pay up to 30 percent of their annual income on premiums alone; with the subsidy, the cost of the second-lowest Silver plan is capped at about 9.5 percent of annual income. The subsidy can also be applied to other metal levels.
HealthCare.gov says it can currently handle 20,000 to 30,000 simultaneous users, which it will boost to 50,000 by the end of November. But even that might be insufficient to handle millions of last-minute enrollees, as the recently extended Dec. 23 deadline approaches for coverage beginning Jan. 1.
The commercial exchanges could provide an essentially unlimited additional load capacity, since they are built to quickly scale. eHealthinsurance.com’s Gibbs, for instance, told VentureBeat that his company’s system is designed to handle ten-fold more than its actual peak load. In fact, he said, “we have the capacity to take all of HealthCare.gov’s traffic by ourselves.”
Besides capacity, there are also several potential other added-values provided by the commercial exchanges. “We like to think of ourselves as HealthCare.gov Plus,” said GoHealth’s Mahoney.
The exchanges are able to handle payments to the insurance companies, something that HealthCare.gov currently has to hand off to insurance companies themselves. And they can offer advice to customers on which plans make the most sense, since most or all of the customer service reps in the commercial exchanges are licensed insurance agents, and thus legally able to provide buying advice.
As ExtendHealth’s Williams pointed out, 2,000 workers at his company’s call center are “licensed agents to help you make your decision.”
A spokesperson for ConnectedHealth.com noted that over 20 million Americans have access to a version of its site through employers, brokers, or payroll companies, adding, “It’s a good bet that many are opting to use a guided experience where they can create personalized recommendations based on their own preference and budget.”
One pending question is whether an exchange’s agents will push plans for which the exchange receives a commission, steering customers to those plans instead of the nonbrokered plans it must also display. The exchanges have every reason to broker all the plans, although it’s not yet clear if all insurance carriers, especially new nonprofit ones like Health Republic in New Jersey, are prepared to meet exchanges’ commissions.
Wanted: Young people
Another difference from HealthCare.gov might be the age of the exchanges’ users. eHealthinsurance.com’s Gibbs told VentureBeat that his company can provide greater access to the user pool that Obamacare most needs to keep premium prices down: young people, whose generally better state of health means they cost the system less than older customers. He said that half of the customers on eHealthinsurance, which has been in this business since 1998, are 30 or younger.
eHealthinsurance, like most other commercial exchanges, also has extensive partnerships with large companies to provide access to plans for their part-time employees, who are often not covered under company plans and have to shop for individual insurance.
This outreach can pull in people with many different profiles and offer them customized service, Gibbs added. “Someone with 130 percent of the poverty level is going to need something different than a millionaire farmer in Iowa,” he added.
ExtendHealth.com is primarily oriented toward providing health insurance plans to part-time/seasonal workers and early retirees who are associated with large enterprises. ExtendHealth’s Williams noted that “a large retailer with 20,000 part-time workers” can direct its employees to federally qualified health plans and subsidies through its ExtendHealth portal.
“The federal government is not expected to be good at forging these kinds of business relationships,” he added.
Nor are the 14 exchanges set up by states. The commercial exchanges are also eager to help enroll customers for the plans on the state exchanges, especially since the state exchanges’ access to the data hub is direct. eHealthinsurance’s Gibbs said that Maryland, Washington, and many other states have agreed in principle to the idea that commercial exchanges will take over some of the load, but the implementation is still underway.
Tim Jost, a law professor at Washington and Lee University who specializes in health care policy, told VentureBeat that the idea of commercial Web brokers enrolling subsidy-eligible customers has been around since the beginning of the Affordable Care Act, and its upcoming implementation “is a big opportunity to get a lot more people enrolled.”
He added that enrollment through the commercial exchanges will likely have the biggest impact “on middle income people who are eligible” for subsidies, rather than the lowest end of the income ladder. But that could dramatically change the income profile of the signups thus far, which have overwhelmingly been for Medicaid for those at or near the poverty level.
When the history of the first two decades of the modern Internet is written, HealthCare.gov may deserve its own chapter. Reportedly near or at the top of the most technically complex Web sites in history, it has also become the lightning rod for the political warfare surrounding health care reform.
While these conditions won’t soon disappear, its current role as the only bridge to subsidized individual and family health insurance in two-thirds of the country is about to change into a bigger marketplace employing a new health care data infrastructure.