This week, both HHS Secretary Kathleen Sebelius and CCIIO's Gary Cohen were on the Hill before lawmakers at separate hearings. At her hearing before the House Energy and Commerce Subcommittee on Health, Secretary Sebelius faced numerous lines of tough questioning from lawmakers. Of note during her hearing, Sebelius said that the financial management system that would be used to transmit payments to carriers for APTC and CSR would be operating by mid-January. However, the automated system to determine how much carriers should be paid for APTC and CSR, in addition to assessing the 3.5% FFE user fee on carriers, is still being developed. As Secretary Sebelius told lawmakers, payments will “be made in a timely fashion, and they're made in a way that insurers have agreed that works for them. So as the full system is being automated, there is a step in the early months to make sure that the payment to insurers” is made.

Gary Cohen's hearing before the House Small Business Committee had fewer fireworks, but he still faced tough questions over whether the ACA was increasing health insurance costs for small employers. One of the key takeaways from the hearing was even though CCIIO was “the business owner” of the exchanges, including the SHOP, and instrumental in providing regulations and guidance, the agency had little control over the contractors building HealthCare.gov. According to Cohen, the contracts were supervised by people in CMS that were “outside of my organization.”

Also this week, HHS released its enrollment report for October 1 through November 30. According to the report, nearly 260,000 people selected a plan in November, more than double the 106,000 who selected a plan in October. Out of the approximately 366,000 people who have selected a plan since October 1, nearly 228,000 selected a plan in one of the SBEs, while nearly 138,000 selected a plan through the FFE.

Rounding out this week’s federal news, HHS also published an interim final rule to formalize many of the payment and enrollment procedures that will impact QHPs offering plans on the FFE.

In the states on the enrollment end, both Covered California and the Washington Healthplanfinder released detailed enrollment reports for November. In California, like the previous month, just four insurers, Anthem Blue Cross of California, Blue Cross of California, Kaiser Permanente and Health Net, continued to draw the most enrollments. In November alone, 78,377 persons enrolled in private coverage, bringing the total for QHP enrollment to 109,296 since October 1. The report also hinted that December could be a big month for California, with 49,708 persons selecting health plans in the just the first week of December. Paper applications are another reason California's December enrollments could reach a new high. According to the California Association of Health Underwriters, Covered California has reached out to insurance agents and asked them to help enter the paper applications of their clients into the Covered California system. According to reports, Covered California faces a 25,000 backlog of paper applications to process before the December 23 deadline to secure health insurance that begins on January 1. 

This week, there were notable developments for both the New Mexico and Idaho exchanges. In New Mexico, the exchange announced that it had launched its updated SHOP portal, which includes additional financial management tools for employers and an updated brokers portal. The new system also includes upgrades to process and send enrollment information to carriers. Coinciding with the new SHOP portal, the New Mexico exchange kicked off a multi-million dollar ad campaign that includes TV, radio, print ads and social media. Similarly, on December 20 YourHealthIdaho will start its marketing campaign using radio, internet and newspapers. Both marketing campaigns launch just days ahead of a December 23 deadline for customers to enroll in a plan for coverage beginning on January 1.  

To the west, Cover Oregon missed its Monday goal of launching its online enrollment portal for agents and navigators and as of December 10, Cover Oregon now believes its online portal will not be operational until the end of January, 2014. Cover Oregon also disclosed that it had a backlog of 30,000 unprocessed applications from persons seeking coverage beginning on January 1. Roughly half of the unprocessed applications are from people that will qualify for Medicaid and automatically be enrolled, but the other applications for private insurance still require shoppers to select a health plan. In response, Cover Oregon is working with carriers to see which ones can accept applications after the December 23 deadline to select a health plan and is prioritizing applications from current Oregon Medical Insurance Pool enrollees.  

Finally, while many state exchanges are still focused on helping shoppers through the enrollment process for January 1 coverage, all of them are now preparing to report operational and performance data to CMS on an ongoing basis. CMS will use the data provided to perform state-by-state comparisons of exchanges and assist with federal oversight. The level of detail captured by the Performance Metrics and Evaluation Template cannot be understated, as the current draft CMS template has 900 data elements. At a high level, the Silver State Exchange Quality Assurance, Metrics, and Evaluation Plan states that CCIIO’s metrics requirements “break down enrollments at different levels including age, location (urban/rural), FPL, household structure and other demographical information. It also collects information on how many enrollments were completed with assistance by brokers or Enrollment Facilitators.” In addition to federal requirements, the Nevada exchange will also track the enrollments generated by individual Producers, Navigators and Enrollment Assisters, capturing a level of detail that includes the number of persons they helped enroll, the most common plan selection choices of their clients and the top carrier selection.