Oct. 1 is a big milestone for the Affordable Care Act. That’s when open enrollment begins for the ‘‘marketplaces,’’ the insurance exchanges where individuals... The insurance exchanges are coming –– but what will that mean?

Renard Murray

Oct. 1 is a big milestone for the Affordable Care Act.

That’s when open enrollment begins for the ‘‘marketplaces,’’ the insurance exchanges where individuals and small businesses will get health coverage under the 2010 law.

Renard Murray is well aware of the upcoming calendar.

Murray is the regional administrator for the Centers for Medicare & Medicaid Services in both the Atlanta and Dallas (Texas) regions.

He will be in charge of the federally run insurance marketplace in Georgia and six other states in the Southeast. And Murray, who hails from Louisiana, will be working with the exchanges in the Dallas region, which consists of Texas, New Mexico, Louisiana, Arkansas and Oklahoma.

Georgia Health News interviewed Murray recently about the planning for the marketplaces, the public perception of the Affordable Care Act (often known as Obamacare), possible problems with its implementation, and the South’s health challenges.

Q: You’re in charge of the exchanges in two regions now?

A: With the Affordable Care Act, it’s basically region-based. So in the Atlanta region, we are running federally facilitated marketplaces in seven of eight states. The executive person in each region is basically running the marketplace for that region –– open enrollment, quality, and its operational components. I’m running the Atlanta region marketplaces.

I’m supporting the Dallas region as well, but not really leading it. It’s still a lot of work.

Texas has the largest number of uninsured among states with federal facilitated marketplaces, and Florida is second. It keeps us busy. But it’s exciting work, because when you think about the mission of getting the uninsured people insurance that they’ve never had before, it’s keeping us excited. Individuals with pre-existing conditions who were denied coverage can now get coverage. That keeps us excited.

Q: Which states in your region are running their own marketplaces?

A: The only one running its own [in the Atlanta region] is Kentucky –– they have a state-based marketplace. We stand ready and available to provide support, assistance, guidance, recommendations to Kentucky as well, even though they’re operating their own marketplace.

Q: And the Dallas region?

A: The only one in the Dallas region running its own marketplace is New Mexico.

Q: How’s the planning for the marketplaces going?

A: It’s going very well. We’re partnering with our federal partners [such as] the Department of Labor, the Department of Education. They have similar interests in getting people insured. There’s overlap.

The Department of Labor operates the COBRA benefit. Individuals are becoming unemployed, but may not afford COBRA coverage, but they qualify for the marketplace. From the federal perspective, we are working with more than a dozen of our federal partners.

We are also working with stakeholder groups –– the hospital associations, the geriatric associations, the various associations that deal with individuals who might be uninsured. We’re trying to get them to understand what the marketplace is.

We are driving people to our website, Healthcare.gov, which has posters, pamphlets, YouTube videos, self-help things –– things that can educate your constituencies in terms of what the marketplace means. We’re developing it in Spanish as well. We want to reach all populations.

Q: Are you working with health insurance companies as well?

A: This is work we recognize we have to do. We haven’t really started engaging insurance companies directly at the regional level. I’m not saying it hasn’t happened nationally at the headquarters level. Here, we have had several conference calls and trainings already, and I’m sure insurance company members have participated.

We’re trying to get people more interested in becoming [insurance] navigators to ask questions and be informed on what the navigators will be doing. We’re giving stakeholders information on what to expect with education, what the marketplace means. We want to make sure that we’re getting it right. We’re asking stakeholders to give us ideas and information that will help us build this correctly.


Q: Will the information technology to launch the marketplaces in October, or definitely by January, be ready?

A: I would say yes. There’s been a lot of work that has been going on with states. There’s been testing in building that [IT] hub. In addition to that, we’re also developing a network of call centers that can help individuals, so a person can call, speak to a counselor who can help them.

I’m pretty confident that our IT infrastructure is going to be pretty solid so that we’ll be able to facilitate marketplace enrollments beginning October 1.

Q: There’s a lot of confusion among consumers about how this marketplace is going to work –– questions such as: Am I eligible for credits? How is this going to help me? Am I going to lose my insurance?

A: Let me use an analogy for you. Fifteen to 20 years ago, we’d go to a travel agent to take a trip. The travel agent would come up with options, you’d pick a flight, you’d go there, you’d have a good time.

The marketplace will be very similar to the transition of moving from travel agents to Travelocity or the other sites [that offer travel assistance via the Internet]. Individuals who would normally go to insurance companies to shop for insurance will go now into a marketplace.

At a one-stop location, they can decide which health plan is the best option for them. Their children can be eligible for CHIP through the marketplace, or Medicaid. Individuals with incomes less than 400 percent of the federal poverty level will also quality for a tax credit.

It sounds like it’s overwhelming, but nonetheless, it puts at the fingertips of consumers the ability to choose a plan that works the best for them. Just like it did for Medicare Part D. There are gold, silver, bronze, platinum plans –– they can choose which coverage is best for them in the marketplace.

It sounds it may be a little bit overwhelming, but they’ll have more ability to manage my own choice health care, instead of going to an agent.

Q: You mentioned Medicare Part D, the prescription drug benefit that debuted in 2006. There were hiccups when that started. Do you anticipate similar glitches?

A: Yes, there were a few hiccups along the way in Part D, but the good thing is we learned a lot of lessons.

We’re applying those lessons to the marketplace . . . We’re looking at our processes now so when people apply October 1, we have procedures and processes already developed [to help them] based on lessons we learned from Part D.

Q: Many of the states in your regions are not expanding Medicaid programs. How much of a problem will that be?

A: Let’s look at it historically. When the law was signed in the ’60s [establishing] Medicaid, several states said, ‘We’re not going to do Medicaid.’ Maybe less than a handful of states said they weren’t going to do it. Here we are [nearly] 50 years later, and we have Medicaid programs in every state. I can’t predict what states will do, [but] Medicaid expansion may follow the same path.

Q: So you believe states will eventually expand their programs?

A; It depends on the Legislature of a state and what they decide to do. I think states will start to re-examine their options, realize the availability of federal funds, and then decide what’s best for the state, based on whatever the governor and Legislature decides to do.

Q: Many critics of the ACA say it’s too costly for states to expand Medicaid.

A: I can’t speculate what a governor is looking at in terms of cost, because what he or she may be using for analysis may be based on some other types of decision points. On the point of reimbursement for Medicaid expansion, all I can tell you is that in the first three years, we’re looking at 100 percent federal reimbursement. The plan has been laid out in terms of Medicaid reimbursement rates for expansion over the next 10 years.

Governors are making a decision based on what he or she anticipates is going to be the growth of cost of the Medicaid program over that time.

Q: Opponents also question whether the federal government can deliver what it’s promising, given the current budget crunch.

A: I’ll use another analogy. You buy a car, you expect it to last five years with a five-year warranty. You have a major breakdown in the fourth year. The warranty is still there; it hasn’t expired. The regulation [says Medicare expansion] will be 90 percent [federally funded] 10 years down the road, and it will be 90 percent.

Q: You’ve heard a lot of criticism of Obamacare. What are the biggest misconceptions about it?

A: The biggest misconception is people basing their comments and decisions on what they’re hearing from a neighbor or someone else who hasn’t read the regulations and doesn’t know what’s going on. I try to debunk the myths and direct people to Healthcare.gov, the official site.

Don’t base what you’re hearing from a media outlet. Base it on what you’re hearing from the federal government. If you have questions, you can contact the Department of Health and Human Services, the Centers for Medicare and Medicaid Services, or if you have a tax question, contact the IRS. . . . We have a team here at CMS that can address those questions.

Healthcare.gov gives information on not just how the marketplace will work but how the Affordable Care Act itself works, how it affects women, affects seniors, affects Asian-Americans . . .

We also have a mobile app, so that individuals can access [the marketplace] from their smartphones, and people can sign up for information. When the marketplace website is launched, you can access it . . . and start the enrollment process.

Q: The states in your region have physician shortages. There are fears that the ACA will aggravate these shortages.

A: I’m not that concerned about that. I hear the comments and the rhetoric about not having access.

Some of the things we’ve done [include] HRSA, with the Medical Service Corps, looking to expand the availability of primary care positions in medically underserved areas.

In Medicaid, we’re reimbursing primary care physicians at the Medicare rate, enhancing more primary care for Medicaid recipients because we tend to have a gap there.

We’re getting more advanced practice nurses out there.

We’ll see a lot of people hopefully accessing primary care, instead of [going] to the ER . . . We’re developing medical homes that will provide primary care and coordinate care. Medicare is developing accountable care organizations. There’s telemedicine.

I think we’re going to have adequate access to services over the next several years.

Q: The South has many health needs and health disparities, along with high poverty and uninsured rates. How important is the ACA in addressing these problems?

A: It’s extremely important. States in the Southeast are among the highest in uninsured rates.

We’re working on other models. There’s a pilot project taking place in Alabama to focus on heart [care]. A lot of people in Alabama have congestive heart failure. African-Americans as well as [Hispanics], we’re targeting those ethnic groups [so they] get more informed about some things that can help prevent heart attacks and strokes.

Q: Do you hope the ACA will help solve these health problems?

A: It’s not going to be solved, but we’re going to make a tremendous dent in it. A lot of the things we’re focusing on, telling African-Americans, Asian-Americans, this is how the ACA can help you to deal with some of the health issues you’re having.

Each state has an office of minority health. There are connections with those state offices. We’re working with them to deal with some of the health disparities.

Q: Anything else you want to emphasize?

A: Even though the marketplace is upon us, we’re still going to administer the Medicare program, the CHIP program, the Medicaid program. We know the natural connections between those programs.

If you walk around the halls at CMS, you’re probably going to see some pretty exhausted people –– they’re doing both things at once. Nevertheless, we’re excited about the work coming from the Affordable Care Act.


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Andy Miller

Andy Miller is editor and CEO of Georgia Health News

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