LANSING – Michigan’s premiums for health insurance coverage through the federal exchange may be lower than the national average, but sign-ups have been “modest,” says Rick Murdock, executive director of the Michigan Association of Health Plans, due to factors such as the fierce advocacy on both sides of the Affordable Care Act, the state deciding to expand Medicaid, and lack of public awareness.

“Where we’re starting up is a good sign on the price side and that should have some impact on the budget decisions,” Murdock said. “The challenge now is: Are people actually going to enroll? That’s really the challenge of health care, and it’s information we don’t really know yet.”

Murdock said his members certainly signal the existence an interest in the matter – they’re contacting others, doing research and asking questions – and the modest enrollment so far is not exactly surprising.

In fact, it’s about par with a survey the association did in January and July in which only about 30 percent of people indicated they were comfortable making such a big decision online, presumably with little to no input from others. The greater majority of people signaled an interest in talking to a professional agent, a “navigator” such persons are formally known, or getting recommendations from friends and family.

“(People) have until January, and really until March, until any penalty can be applied,” Mr. Murdock said. “Our activity right now is simply awareness.”

And in the thick of things, the state decided to expand and reform Medicaid to more than 400,000 individuals.

“If that wouldn’t have taken place, we would’ve had several hundred thousand individuals seeking insurance on the exchange rather than through Medicaid,” Murdock said.

Of course, the Affordable Care Act has been under major scrutiny. Some in Congress have repeatedly and unsuccessfully tried to defund the act. That controversy, combined with waiting to implement some provisions of the act and then having technical glitches present on Day 1, have certainly made it more difficult to have a smooth implementation, he said.

“It’s made implementation more difficult than it has to be,” Murdock said, noting the state “missed an opportunity to control our own destiny” by defaulting into a predominately federally-run exchange rather than a state-administered exchange.

The Michigan Republican Party has begun distributing articles from around the country about the technological problems in the exchanges. One firm, CNBC reported, found 99.6 percent of visitors to the heathcare.gov website did not enroll in a plan.

Other states that are rolling out their exchanges on their own seem to be having an easier time doing it, Mr. Murdock said, but fortunately Michigan did maintain the ability to make choices about the essential benefit package, and Insurance and Financial Services Director Kevin Clinton managed the selection process well, Murdock said.

For the most part, he said members have reported the technical glitches and server overload that plagued the first day of the federal exchange rollout have “calmed down quite a bit” and folks are using alternate sources to get their insurance.

But the legislative communication may not be over just yet.

“What we need is some focused activity on cost elements … and issues on transparency for providers of health plans,” Murdock said, also noting expanded primary care access and updating the Insurance Code.

“We believe that there’s still a need for further insurance code reform to bring everything in alignment nationally, and with what’s going on here in Michigan,” he said. “The state could take some action to eliminate some of the redundancy requirements (and) limitation requirements that are no longer necessary.”

Some legislation (SB 627 ) has been introduced in the Senate by Sen. Joe Hune (R-Hamburg Township) with regard to cost controls, but Murdock said that is essentially a small slice of the pie. Sen. James Marleau (R-Lake Orion) will be the go-to person when it comes to legislation on better access to primary care and updating code, Murdock said.

“On the regulatory side, there’s simply a need for more awareness too,” he said. “When we chose not to become a state administered exchange, we defaulted back to the federal government on all that information. I think it’s worthwhile for folks to take another look on whether Michigan should run its own exchange.”

But, he said, he recognizes an election is forthcoming for legislators and, given making such a switch could take between 12 and 18 months, such a change would not happen overnight.

“I’m a realist,” he said. “It would be a tough road to move that type of legislation.”

The Senate passed a state-run exchange in 2011, but the House declined to take up the legislation. Then the House earlier this year passed legislation for a state-federal partnership on an exchange that the Senate similarly refused to take up.

Michigan Consumers for Healthcare has set up a website to help people navigate the ACA and coverage options, and others are in the process of doing the same.

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