Agents and Brokers are Key to Exchange Sustainability

In-person assistance is an important resource under the Affordable Care Act. With low levels of health literacy and numeracy, a complicated system of subsidies, and many people enrolling in private insurance coverage for the first time ever, expert help can ensure that consumers fully understand the enrollment process and select the best coverage for them.

The ACA set aside millions of dollars for in-person assistance, with the Department of Health and Human Services providing many Navigator grants to states over the past few years. Few states built an in-person assistance apparatus from scratch, with most relying on community groups who had previous experience with social service programs.

Other vital resources for shoppers are health insurance agents and brokers, also known as producers, who have been fixtures of the private health insurance landscape for many years. Their business model is typically based on commissions from insurance carriers, who pass those costs onto consumers in the form of higher premiums. But there’s no question that agents and brokers play a valuable role, especially now with uncertainty surrounding new Navigator grant funding. Some state exchanges did a better job than others engaging the producer community, as this recent report funded by RWJF shows (an overview is available here).

The State Network has observed many benefits from exchanges building strong institutional relationships with agents and brokers. That’s why we funded the development of two pilot programs, in Illinois and Minnesota, to deepen producer engagement.

In Illinois, Wakely Consulting Group helped Get Covered Illinois establish a Producer Program, with the exchange providing co-branded marketing support in exchange for enrollment commitments. The program also ensures producers are equipped to handle Medicaid inquiries, which historically have not been a focus of their business. Last month, the Chicago Tribune described the growing role that producers are playing in ACA enrollment, highlighting the partnership with GCI.

Wakely also worked with Minnesota on a lead agency program. The state exchange, MNsure, is working with six lead agencies, which offer enrollment assistance to anyone walking through their doors, whether they are eligible for Qualified Health Plans or public programs like Medical Assistance and MinnesotaCare. Already, the lead agencies have increased their QHP enrollment over 14 times last year’s numbers.

Ideally, these pilot programs will expand to other states and help ensure that a robust enrollment infrastructure lives beyond the federal funding of in-person assistance. Some states, where agents and brokers are not active in the individual market, may want to consider bringing them into the fold. Integrating producers into the ACA’s plan enrollment and renewal process, familiarizing them with public insurance programs, and generally helping them grow comfortable with the health law will go a long way toward stabilizing the exchanges for years to come.