If states like California and New Mexico have success with the launch of their health insurance marketplaces on Tuesday, GetInsured.com will be able to claim a share of the credit.
California's CoveredCA portal is based in part on software obtained from GetInsured, which operates a private health insurance exchange that markets directly to consumers. The state's prime contractor, Accenture, has customized and adapted that software to meet the state's needs, and GetInsured has also been providing updates to order.
In New Mexico, which made a late decision to pursue setting up a state-based health insurance exchange, GetInsured is acting as a cloud services provider, delivering one component of the exchange: A service to assist small businesses who want to provide their employees with access to private insurance.
For now, New Mexico is defaulting to offering an exchange operated by the federal government for use by individuals, although the plan is to take control of that also at the state level, with GetInsured positioned to pick up that additional business. Mississippi, which has so far refused to play any active role in fielding these Obamacare marketplaces, is also talking with GetInsured as a cloud provider that would allow it to deliver something relatively quickly.
"We've brought the whole concept of SaaS to health insurance exchanges," CEO Chini Krishnan said, referring to the software-as-a-service model of cloud software delivery pioneered by companies like Salesforce.com. Because California was one of the first states to commit to creating a health insurance exchange, GetInsured's contract with the state was based on delivering binary software, he said. "Since then, the insight and learnings we have had have convinced us that SaaS was the way to go."
The cloud approach particularly paid off for New Mexico's service for small businesses, Krishnan said. "The contract was awarded less than four and a half months ago, and already the state is live. That's the advantage of having the assets, having cooked software ready to deploy," he said.
"Our company was really founded to provide an Expedia-like experience for shopping for healthcare," Krishan said. To book a flight online, you can say you want to travel from San Francisco to Miami on a morning flight, non-stop, and get back a list of options. In health insurance, the equivalent is asking for a plan that includes your current doctor, with a deductible under $200 and a premium of less than $400 per month. "That's the thing we founded the company to solve, and it turns out to be a non-trivial problem."
Under the Affordable Care Act, a.k.a. Obamacare, every U.S. citizen who lacks healthcare is supposed to have an opportunity to purchase it starting Oct. 1 under terms of guaranteed coverage, with no denials or inflation of rates for preexisting medical conditions. Now that everyone has the opportunity to obtain insurance, those who fail to do so will be subject to tax penalties, as part of a system designed to compel the young and healthy to participate in the system, compensating for the insurance risks of the old and sick.
GetInsured.com markets directly to consumers, in addition to powering state exchanges.
Providing an online shopping experience is only one component of setting up an exchange, and the overall success of these programs might depend just as much on call centers and social service agencies helping consumers understand what their options are. Still, the information technology challenges of coordinating with hundreds of insurers, confirming eligibility and calculating discounts are immense. We already know Tuesday's launch will be marred by glitches and functions that aren't working yet. In fact, the Small Business Health Options Program (SHOP) that New Mexico is ready to launch using GetInsured's software is one of the pieces the federal government now says will not go live on the exchanges it is facilitating until November. Through that program, businesses with fewer than 50 employees can select an assortment of plans to offer to their employees and decide how much they are willing to pay toward coverage, rather than creating a traditional employer-sponsored health plan.
New Mexico can be confident that its SHOP program will launch on schedule because it's already had a "soft launch" to about 100 small businesses that have been testing it, said Deane Waldman, a physician and board member of the New Mexico Health Insurance Exchange (NMHIX). Waldman is a harsh critic of Obamacare who nevertheless sees an opportunity to do something positive for his state through NMHIX.
"What we're doing or trying to do with NMHIX is bring as much of market forces as we can into our exchange," Waldman said. Adapting an existing private health insurance exchange such as GetInsured to meet the state's needs was consistent with that philosophy, he said. "That's part of the reason we liked them -- they're out in the commercial world and dammit we should be able to leverage their success in the commercial world."
President Obama certainly promotes the program as using free market forces to drive down the cost of health insurance, Waldman said, but the program meddles too much with the market for his taste, while "spending money the U.S. can't afford" on health insurance subsidies.
Waldman was appointed to NMHIX, a quasi-public agency, by Gov. Susana Martinez, a Republican who has bucked the trend in her party by also agreeing to an expansion of Medicaid under ACA. Regardless of politics, if an exchange system is going to be implemented, it makes sense for the state to capture a share of the jobs that will be created to serve the exchanges and to address local concerns like the need of 14 different Native American tribes that will be eligible for services, Waldman said.
"If we just left them to the feds, I think they'd be lost in the shuffle." Together with the Medicaid expansion, the result will be "a large influx of dollars into the state, which will be good for New Mexico, even though I personally think it's bad for our country."
In Mississippi, insurance commissioner Mike Chaney is trying to establish at least a SHOP exchange for businesses in partnership with GetInsured, even though Gov. Phil Bryant, a fellow Republican, has blocked all efforts to establish a state exchange for individuals.