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Indy Q&A: Exchange director Heather Korbulic talks ACA lawsuit, open enrollment during a pandemic

Megan Messerly
Megan Messerly
Health Care
An Ipad with showing the health link website

As open enrollment kicked off on Nevada’s health insurance exchange earlier this month, the U.S. Supreme Court heard oral arguments in a case challenging the constitutionality of the law on which the exchange was built, the Affordable Care Act.

Though the court likely won’t rule on the case, California v. Texas, for several months, a majority of justices during oral arguments indicated they may be leaning towards finding only one portion of the federal health care law — the mandate requiring individuals to purchase health insurance — unconstitutional while leaving the rest of the law intact. That group of five justices includes three liberal justices and two conservative ones.

Heather Korbulic, the executive director of Nevada’s health insurance exchange, said the hearing came as a “sigh of relief” for her and the heads of other state exchanges around the country, though she noted that it’s too early to know for certain which way the court will rule.

“I think it’s cautious optimism,” Korbulic said, “and it’s very unique to see Supreme Court justices show their cards in the manner in which they did during the hearing.”

In the meantime, enrollment continues on the health insurance exchange until Jan. 15, with five health insurance companies offering 50 plans for purchase, nearly double the number of plans available last year. Korbulic is urging people to take advantage of the open enrollment period to get covered amid the ongoing coronavirus pandemic.

“If you are taking a risk with your health in terms of going without insurance, you're also taking a really significant financial risk,” she said.

Korbulic spoke about all of this and more in an interview with The Nevada Independent last week. The following has been edited for clarity and length.

To start off, let’s talk a little bit about open enrollment. What plans are available to folks this year and what’s changed from last year?

This year we have two new carriers that have joined the exchange, and that is Friday Health Plans and SelectHealth. SelectHealth is only in the Vegas area and Friday Health Plans has joined every one of our rating areas, so they are statewide. They're joining Health Plan of Nevada, SilverSummit, and Anthem who are returning this plan year. So between all of them, we have five carriers, and we've almost doubled our plans from the previous year. We have 50 plans available this year and last year we had about 27.

The rate increases this year are about 4.2 percent, which is relatively stable, and most importantly, consumers who get subsidies, or who get financial assistance, don't see really any impact from those rate increases because their subsidy increases as the rate increases, too.

Numbers-wise, how is open enrollment going so far?

We haven't released any of our numbers yet, but from what I can see, we're looking to be doing equally as well, if not slightly better, than in previous years, which does sort of surprise me just in terms of the noise factor of the elections sucking all the air out of the room in terms of getting attention to the exchange in our open enrollment period. So that does bode well.

I think we know there are a lot of Nevadans who have lost their jobs and who have lost access to those health plans through their employer, and so we've been doing a lot of targeted outreach to those folks to make sure that they understand open enrollment exists, preparing them for when they fall off of their COBRA plans or when they're no longer paying for COBRA and then really working on through DETR [the Department of Employment, Training and Rehabilitation] and the Division of Welfare and Supportive Services to get the word out to people who may not be eligible for Medicaid much longer or who have lost their jobs about open enrollment and getting connected right now.

What has enrollment on the exchange during the pandemic looked like this year generally?

Before I say much more about just this last year, I think it's safe to put out there that there has never been a normal or stable year of enrollment on the exchange. Every year the Affordable Care Act has had some kind of drama or trauma, and this year is no different, really.

What we've seen throughout the last eight months of the pandemic is an increase in special enrollment periods. People are taking advantage of the fact that you can get enrolled within 60 days of a qualifying life event. In general, most of those qualifying life events have been losing their employer-sponsored coverage. We also saw an uptick of about 6,000 new enrollments, when we had an emergency special enrollment period just related to the pandemic.

We also are a fully autonomous state-based exchange this year, which means we have the ability to do that emergency special enrollment period and we also have the ability to do what our board has decided to do for this open enrollment, which is to extend our open enrollment period by an additional 30 days. So our enrollment period will run from November 1 through January 15, whereas is stopping their enrollment on December 15. 

All of that and the competition that we've added to the marketplace this year really does contribute to a very opportune moment for Nevada consumers to get connected to plans that have subsidies that make them affordable, and the qualifications of being under an ACA plan makes those plans very comprehensive. 

Turning to the Supreme Court case, you’ve been emphasizing the point that, whatever happens, people should still feel comfortable enrolling in plans because you’re not expecting a decision in that case to have any impact on this upcoming plan year. Is that right?

It's an interesting dynamic because, on the one hand, absolutely, the impact of having a repeal of the Affordable Care Act is and could be equivalent to chaos in our health care systems at the state level and at a national level, and there are a lot of significant consequences should the ACA be overturned, and then when you put that in the context of the fact that we have a national public health crisis and a national economic crisis happening, the compounding factor of chaos just gets worse. 

At the same time, my job is to also make sure that Nevadans understand and that plan year 2021 is happening and there are better deals for them, there are more carriers, there are more opportunities, and that pandemics are a very bad time to be uninsured. You absolutely should be getting coverage from comprehensive health insurance that will cover the diagnostics and the treatment of COVID and not be duped or fooled into purchasing a plan that isn't as comprehensive and could potentially leave you on the hook for a lot of medical bills.

During oral arguments in the Supreme Court case last week, it seemed like justices, both some of those that would be considered liberal and more conservative justices were leaning against throwing out the entire Affordable Care Act. What is the chatter in the world of state exchanges? 

I think, in general, there is a bit of a sigh of relief, but if 2020 has taught us anything it’s to not really put all your eggs in one basket, and so I think it's cautious optimism, and it is very unique to see Supreme Court justices show their cards in the manner in which they did during that hearing, with some of the more conservative justices being very focused on the matter of severability, and the conversation about Congress's intent was extremely interesting. In terms of how I feel and how my colleagues feel across the country, it is to feel very optimistic.

Back in 2017, when Congress made the decision to zero out the individual mandate penalty, there was a lot of concern that doing that would lead many people to not want to get covered. But it seems like over the last couple of years, that hasn’t played out in the way many expected it to. Is that a fair assessment? 

I think that's absolutely fair. I was one of those people banging the pot and pan saying I think this is going to be a real problem if we don't have a penalty, and I'm happy to say that I was proven wrong. I think what happened over the first several years of the Affordable Care Act is that we started building momentum with folks realizing how important it is to have that comprehensive coverage and really there was no there is no going back for those folks. They're not being motivated by a penalty as much as they are by the benefits that are provided under their plans.

If the Supreme Court makes the decision to just strike down the individual mandate penalty and leave the rest of the Affordable Care Act standing, would there be any measurable change to the exchange in Nevada?

No, none that I could anticipate. I don't see there being any changes in the approach that we have, nor do I see there being any changes in state statute or really manifesting any consequences at the federal level, either, to be honest.

If the Supreme Court rules in a broader fashion and strikes down the entire Affordable Care Act as unconstitutional, do you have any sense of what that would mean for Nevada?

That's a question that I have asked every single person who pays attention in this space, because, of course, that is something I am desperate to know. But I think in terms of when they'll make a decision, it'll be sometime in the middle of 2021, June or July, of next year, and in general, the Supreme Court may decide on the ruling of law, but they don't decide on the mechanisms on which to unwind. So it is likely that the court would potentially decide to repeal, or whatever the word is that we want to use here, the Affordable Care Act and then kick it to lower courts for a determination on how to implement those changes and working through the timeline. I do think that would take quite a bit of time, and that's why I feel confident saying I don't think there are any consequences that can be expected even if the worst case scenario plays out for plan year 2021.

Tying things up, we’re in the middle of a global pandemic and there is a risk to not having health insurance and falling ill, whether it’s with COVID or any other health issue that might normally come up. Why is it extra important that folks get insured this year?

If COVID has taught us anything as a state it is that health is wealth. I think at least every Nevada now must know somebody who got sick with the coronavirus and got very, very ill if not knowing someone who has passed away. If you are taking a risk with your health in terms of going without insurance, you're also taking a really significant financial risk, because having to go to the doctor alone can be very expensive when you're sick, but going to the doctor or going to the hospital and having extended stay is, I mean, bankruptcy-level expensive. 

Most importantly, we need to encourage our loved ones and our family members who are uninsured or underinsured in these plans that are not as comprehensive to get connected with a plan on Nevada Health Link because there are consequences to all of our public safety. When you don't have insurance you are less likely to be willing to go to the doctor and to get treatment, which means if we have people who are sick with the coronavirus in the community who are uninsured and unwilling to get treatment as a result of that they could be much more likely to be spreading that throughout the community, and that is deeply concerning to me.


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