Kevin Counihan, CEO of AccessHealthCT

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Mark Masselli: This is Conversations on Health Care, I am Mark Masselli.

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Well Margaret change is coming to the Department of Health and
Human Services as Secretary Kathleen Sebelius .

Margaret Flinter: Problems with the launch of the federal exchange heathcare.gov have
continue to be attorney issue. But, the President command his secretaries Sebelius for
extraordinary work and noted that despite the miry challenges at the launch of the
website she and her team did manage to turn things around and the number s speak for
themselves . We’ve exceeded the signup goal of seven million and Mark I think it’s
about 7.5 million have signup at last count for insurance.

Mark Masselli: And count ing . She really did over sea a monumental shifting in Health
Care in this country and in spite of the technical challenges she did exceed the
administrations signup goals , President has tapped White House Budget Office Director
Sylvia Mathews Burwell to t ake over the Department of Health and Human Services
pending conformation from the senat e .

Margaret Flinter: She's also held high positions at several foundations in the past
including the Walmart Foundation, it's really thought very highly on most circl es.

Mark Masselli: The change of guard comes at a timely juncture before the mid - term
election kick into high gear the Health Care Law certain to play a central role in the
campaign as it has over the last four or five years.

Margaret Flinter: Well, it will be interesting to see exactly what the picture that is
painted is , you know, not only th at the number of folks who sign up on the exchanges
exceed the administrations expectations but there is another interesting number to
factor in and estimate d 7.8 million Americans gain their health coverage directly through
insurance carriers and that number is a big boom for the insurance industry and think
they will be feeling pretty positive.

Mark Masselli: I think you're right , Margaret, and it turns out mil lions of Americans who
might not have qualified for a tax subsidy on the insurance exchange gain coverage
through private insurers so in all the number of newly covered Americans could be far
more significant than originally thought.

Margaret Flinter: An d it’s important to know , Mark , where the exchanges did function
very well , California and New York are two and ou r home state of Connecticut all are
held up is models of effective state based exchanges and other states may want to
emulate them . Connectic ut in particular are access health Connecticut system is being

adopted by the state or Maryland which had problems from the start and is now
scrapping their system and favor to Connecticut plan that really work very well.

Mark Masselli: Our guest today i s the man behind the curtain, behind the Connecticut
exchange Access Health CT Kevin Counihan , who has a long history in the insurance
exchange arena and can provide some unique insights into what made the Connecticut
exchange work so well and why other st ate s a re looking into adopting our system.

Margaret Flinter: Lori Robertson , Managing Editor of FectCheck.org will be checking in
with another missed statement about Health Care Policy that’s been spoken in the
public domain.

Mark Masselli: But no matt er what the topic you can hear al l of our shows by going to
CHC Radio and a s always if you have comments please email us at CHCRadio.com or
find this Facebook or Twitter because we love hearing from you.

Margaret Flinter: We’ll get to our interview with Kevin Counihan in just a moment.

Mark Masselli: But first here is our producer Marianne O’Hare with this week’s Headline
News.

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Marianne O’Hare: I am Marianne O’Hare with these Health Care Headlines. Sebelius
is out as Secretary of the Departm ent of Health and Human Service , stepping down
from her leadership post after the rocky rollout of the online insurance marketplaces
under the Affordable Care Act. Her resignation was met with praise from President
Obama who said that in spite of the many challenges that the launch of healthcare.gov
h er team manage to turn things around in November and right at the rocking heath care
portal . Sebelius has chosen replacement as S ylvia Mathews Burwell appointed just last
year as the director of White House B udget Office or appointment must passed master
from a senate confirmation hearing.

In a meantime the numbers continue to climb the number of Americans who gained
health coverage under the Affordable Care Act . I mean online exchanges and another
7.8 milli on Americans appear ed to have gain coverage privately through insurance
brokers directly during the open enrolment period, those who founded and qualify for
subsidies were more likely to seek conference of the government run exchanges , a nd
what about the c ost of running those exchanges ? The nonpartis an, Congressional
Budget Office has determine d cost for the continue d implementation and provisions
under the Affordable Care Act are considerably less for the coming years , about 104
billion dollars less over the next 10 year period. The Patient Protection and Affordable
Care Act is expected to cost 36 billion in 2014 that’s five billion less than previously
anticipated . They’re here and they’ re quickly proliferating E - ci garette s that is in th e
trend is di stu rbing , the rapidly expanding E - cigarette market those electronic cigarettes
with a fake light at the end of the tip emitting nicotine vapor into the lungs of those who

inhale with flavors like bubble gum and such , it’s quickly infiltrating a young vulnerab le
population who must have restrict antismok ing laws which do not govern a s latest
smoking fed . Law Makers once again have called for action by the food and drug
administration to regulate the electronic cigarette industry issuing a Congressional
report that showed increase marketing of E - cigarettes directly to youths, so far the
cigarette industry has spent about 60 million dollars and target ed campaigns aimed at
young people with such things as rock concert sponsorships. The study show ed a
direct corre lation between exposures to those ads for E - cigarettes and the number s of
young people who take up actual smoking . I am Marianne O’Hare with this Health Care
Headlines.

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Margaret Flinter: We are speaking today with Kevin Counihan , Chief Executiv e Officer
of the Connecticut Health Insurance Exchange , also known as Access Health CT . One
of the most successful of the 16 set up under the Affordable Care Act . Before Mr.
Counihan was the President of Choice Administrators in California , the nation’s leading
developer of Health Insurance Exchanges , Mr. Counihan served as the Chief Marketing
Officer for the Common Wealth of Massachusetts Health Insurance Connector Authority
where he facilitated the states rollout of near universal coverage in 2006 prior that he
was the senior of VP of the top health plan . Mr. Counihan urges under graduate degree
from the University of Michigan and is MBA and finance from North Western
Universities , Kellogg School of Management . Kevin , welcome to Conversations o n
Health Care .

Kevin Counihan : Thank you , Mark . It’s a pleasure.

Mark Masselli: You know March mad , this is over and I think it’s fair to say Connecticut
one fr ee national championships , the me n and the women and I think on the exchange
site of the Connecticu t Access Health CT. So, tell us what work, what didn’t work?

Kevin Counihan: The things that I think we did recently well was we got a basically
stable system that’s mind numbingly complicated up and running defects had been
corrected so when we flip th e light switch on October 1st we get something where
people could go on to the website , comparison shop they could enroll for coverage and
their eligibility can be established with the insurance companies. We strip back about
30% of our desire d functional ity in order to make sure that we could deliver something
that was less than what we want ed but being done more consistently. So, I think we did
that reasonably well.

I think number two is standardizing plan design s for the three metal tears was extremel y
helpful for consumers because consumers find buying health insurance to be very
confusing and complicated and by freezing the variable around plan design they knew
they were buying the same coverage was extremely helpful to consumers. I think
another el ement that work well was marketing and out reach for example the work that
we did training about a thousand brokers having over 300 personal assist ants, having a

call center which took in 22% of our applications and it was clearly a statewide particular
whe re we are.

Margaret Flinter: Well, Kevin you’ve had such significant experience in this arena
leading up to your time here in Connecticut both in Massachusetts with the 2006 Health
Care Law and then in California with Choice Administrators I would imagin e if you had
chance to see what works on a macro level and a micro level and I think that made it all
the more surprising to me that a s t ate like Massachusetts r a n into so much trouble on
this round why was this so much more complicated th a n want Massachus etts rol l out
back in 2006 and I 'm also going to ask you to explain what you mean by metal tears for
our listeners?

Kevin Counihan: Well, first let me begin with the second questions. So, the metal tears
are which were gold, silver and bronze represent the richness and the extents of the
insurance plans. So, a gold plan is richer and has richer coverage than silver which is
more expensive and richer coverage have been bronze. I think in general the states
that were -- maybe a little ambitious in terms of services that they want ed to provide out
of the gate in general it had a little easier time than those that were a little bit more
ambitious . Then that's just connector actually was a very good example of the policy
principles of Health Reform but the web poll it self was much more like E - health or
relatively simple . When I say relatively because it was still complicated but relatively
simple way for people to shop and compare and to enroll. But it did not have the
complexity of integrated eligibility determinations where by an individual in real - time
could be determine for either Medicaid coverage , subsidy coverage , or un subsidized
commercial coverage. So, those different complexities of the Affordable Care Act really
make it a much different animal th an what the connector had.

Mark Masselli: I like the sort of concept that you start ed off with it’s you noted that the
consumer is that the heart of all these and they find this purchasing process to be
complicated and so your module was to keep thing si mple and certainly there were right
strategic but it also came down to procuring the right technology both the hardware and
software and what let you to developed the system the you way did in Connecticut and
talk to us a little bit about the technology pl atform that you are utilizing .

Kevin Counihan: So, you really hit it , Mark , which is that what really most consumer
activities it’s best to default to simplicity . Now buying health insurance by definition i s
not simple and people to buy health insurance , they tend to be very suspicious of just
about everybody in the value change. If they just don't understand why this should be
as expensive it is but if you can make something as simple as possible and make it us
consumer friendly a s possible it brings m uch more credibility to the purchase in process
and consumer has more trust in what they’re buying if they think they can understand it.
So, it’s important not only from a technology perspective to keep thing simple but also
from a marketing perspective t o keep thing simple. So, that was sort of a module that
we had , so we want ed do fewer things consistently well. And default to those things
that were most valu ed by the customer. So , for example we outsource d and have
outsource d a lot of functionality w hich other state s have not done whether it’s premium

in billing to their consumer whether it’s commission payments to the broker , whether it’s
the call center, whether it’s the vendor for administering small business exchange ,
we’ve outsource d all those th ings to other vendors , because our view is we want to
focus on the thing that makes the most different to the consumer , which is an easy and
satisfying shopping experience . And to that regard the debt around this is encouraging ,
so for example based on th e most recent month s survey of consumers who’ve enrolled
in our platform, we have a 92% overall satisfaction rate but within that 70% of enroll ee
said that they would be either extremely likely or very likely to recommend Access
Health CT to a friend or co lleague , that’s a really critical metric, because that type of
viral marketing or support or reference by a friend or family member goes much further
than any advertisement anyone could run.

Margaret Flinter: Absolutely. Kevin , you reference something t hat I was just about to
ask you about and that’s an area that I think has been fairly confusing perhaps because
of the changes in dates and deadlines around the small business mandate . So as I
understand it now the Affordable Care Act mandate on small bus iness offering coverage
was delayed until 2015 and it will eventually require a companies with more than 50
employees to provide access to insurance coverage for their employees but still quite a
bit a confusion about that so , how have you approach the sma ll business community
and the exchange in Connecticut , have there been viable options for that sector of the
population?

Kevin Counihan: We were one of five states that had a viable small business insurance
exchange up and running on October 1st and we d id it as I said by outsourcing it. We
do get up and running by October 1st. Our enrolment in the small business exchange
has been disappointing to me. Now, clearly the market gets confused every time the
Federal Government for example the first mediate , it all send a message kind of
cascading that this is either not functional or is being deferred or being delayed or but I
think that there’s a whole lot more that we need to do to be more effective in providing
products to small businesses. And we are ve ry close to finishing a new plan to do just
that.

Mark Masselli: We are spe aking today with Kevin Counihan, Chief Executive Officer the
Connecticut Health Insurance Exchange also known as Access Health CT . One of the
most successful of the 16 State base d insurance exchanges set up under the Affordable
Care Act. Kevin , Health Care Law is n't just about providing insurance coverage and
access to care , it's also about improving population health and hard to see the power of
health data and I understand you’ re working on a project with the Robert Wood Johnson
Foundation , follow this newly insured residence so they are key majors so talk to us a
little bit about the key majors you will be looking at in the health data and how do you
see this analysis impacting health and health equity moving forward ?

Kevin Counihan: A point of saying that the Affordable Care Act is more than just about
providing access to insurance is 100% correct. And we are in the final approach of a
finalizing a research vehicle that we ' r e going to be making 3 , 000 phone calls to
residence in our state to assess several things. So, one is going to be insurance status.

So, we need to determine what the impact of the over 200,000 people that we’ve
enrolled has been on the uninsured level in our state. So, the national average of the
uninsured in the countr y i s 18%. And we know that the third of the un insured reside in
three state s , Florida, Texas and California. Now, only one of those states California has
expanded Medica id coverage as we ll as putting up a viable exchange . But in our State
we began with an un insured level of 8% or about 286,000 which again is relatively low.
Now, as low as the 2.8 % of Massachusetts , n o, but no other state is. But, we believe
that we’re going to make a s ignificant in the level of the un insured in our State after
these researched i s done. The second is one the impact and improving knowing the
gap on (inaudible 14:47) . So, for example we know based on other state that it's not
State of Connecticut but not I think that data has been done by State . But there is
roughly 14% disparity in care access in our state between Caucasians and Non -
Caucasian so roughly 90% of Caucasians in Connecticut have routine access to health
insurance coverage where about 76% of Latinos and African - American and other Non -
Caucasians groups do. So, narrowing that 76 to 90 is clearly going to be a major focus
of this research and understanding and eff ectively made any dense in doing just that.

Third is going to be understanding peo ple 's health care knowledge , so for example just
because you've enrolled somebody it doesn’t mean they know how to use the coverage
and a lot of the terms that we all take for granted whether it’s co - pay, deductible
coinsurance all that stuff , the newly in sured don’t take for granted. Not only that they
don't even understand what those terms mean and they find them very confusing. So ,
we want to be able understand in a sense to health insurance literacy. And we want ed
start tracking to see how many peopl e are starting to take advantage of the incentive to
get primary care visits which is you know are free and to incent people to have those
routine checkups that my view and I would be interested in you r folks view as well is
that implementation of this lie s for four to five year process. It’s going to be evaluated
and judge right or wrong you know every single week without a lot of data by the way
but that doesn’t seem to matter th e s e days . But we all have to I think have goals in
mind for what we want to be for example , my goal I would like to see our un insured level
be about 3% in five years. And I think that very tangible and it's very -- very realistic.

Margaret Flinter: Well, I really applaud the focus on making sure that you’re doing a
research ea r ly on because this is a unique moment in history , (inaudible 16:41) give
some of this natural history research when they had their Medicaid Program where
people were as signed on a random basis to see what difference does coverage make
and the fact that yo u’re looking at the patient and the consumer experience and literacy
is really critical so we’ll look forward to those results . And, Kevin , I can’t help to think
that the country certainly is weary of groups that are in conflict with each other and
when w e -- here the state s are beginning to look to each other for help with their best
practices and looking at adopting those best practices versus creating things from the
ground up will all that expense and risk , it’s great to hear that you’re thinking that you
can maybe export the Connecticut exchange , I think you 've refer to as exchange in a
box and you mention ed earlier that at least one state is looking to adopt the software
that you created for the Connecticut exchange and those are the folks and Marylan d .
Tell us about this collaboration and maybe expand this to what you r thoughts are , you

should look around the country with a lot of other states that may decide to do their own
state exchange , what sort of level of collaboration and best practice buildi ng that going
on ?

Kevin Counihan: Well, our experience with this stuff so far is that a lot of it has to do
with pride and ego and we’ve talk to probably six or seven states right now , and this is
all about 2016 . I think , we all feel that we've spoke it 's just with you know you work so
hard on something and when it doesn’t work but you know you take it kind of personally
or you think you know and then somebody else did work building this system in this
application to be frank , Margaret was actually not t hat much fun and our whole team
said if we could have out source d this to another state and used our technology we
would have done it in New York , minute. So ,we have to come with one state as you
said with the State of Maryland and we have a sign deal wit h them , it’s a very
aggressive timeline to get them on November 15th open enrollment thing, they're also
using (inaudible 18:29) which is the same folks that built our system . And we’re helping
them on a variety of different operational and marketing and technical issues and you
know, we are very hopeful that this is going to work.

Mark Masselli: You know o ne of the challenges for exchanges across the country we
are dealing with the foreign language issues , were there any best practices out there for
fol ks who got it right in speaking multiple languages?

Kevin Counihan: From my perspective I think we 're just beginning to compile those best
practices . I think that we’re still learning on this, I think it’s one of the reason that's
going to take several years. We know for example that certain populations are very
suspicious of government because they’re afraid that it might lead to deportation or
other types of things and so there is sort of an institutional or cultural resistance to
several programs. W e’ve learn the importan ce of the family , we know that the average
un insured nurse state is a 39 - year - old Hispanic male living in Bridge p ort. And we know
that the best way to reach that 39 - year - old Hispanic male is through his mother because
the mother ten ds to be extremely influential more than friends . So, there is a lot of
subtlety you know, it’s funny like we’ve got a person on staff that 's dedicated to Hispanic
outreach and she often remind u s that you 're dealing not with one segment community ,
you're dealing with 14 community , and they don’t talk to each other. So, you have to
deal with this communities individually , you have to do it in a way that 's culturally
expectable , usually it's best to be done from the ground up meeting with people that are
i n the community that are known and respected. I think one of the things that we’ve
learn t is the traditional government one size sits all top down approach is really not that
effective anymore . Our community and our country is s o diverse that a bottom up
community based approach is both cheaper and probably were effect ive .

Margaret Flinter: We’ve been speaking today with Kevin Counihan , Chief Executive
Officer the Connecticut Health Insurance Exchange also known as Access Health CT.
You can learn more about their work by going to access health CT.com. Kevin , thank
you for the great job you’ve done and thank you for joining us on Conversations on
Health Care today.

Kevin Counihan: I would like to thank both of you for your tremendous support.

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Mark Masselli : At Conversations on Health Care we want our audience to be truly in,
the know, when it comes to the facts about Health Care reform and policy Lori
Robertson is an award winning journalist and managing editor of FactCheck.org a
nonpartisan, nonprofit consumer advocate for voters that aim to reduce the level of
deception in U.S politics. Lori, what have you got for us this week?

Lori Robertson: Well, President Barrack Obama went too far in saying the Affordable
Care Act meant everybody woul d have basic Health Care. The law doesn’t create a
universal health care system everyone will not have insurance. In fact a 31 million are
expect to remain uninsured according to the nonp artisan congregational budget office.
Obama ma d e the comment and a nnouncing that 7.1 million Americans ha d signup for
insurance on the federal and state marketplaces through March 31st, the end of the
open enrolment period that figure was later updated to 7.5 million. Obama boost to the
progress made but then said that the Affordable Care Act " is making sure that we’re not
the only advance country on earth that doesn’t make sure everybody has basic health
care " . But, under the ACA the US is still one of just a few advance d nations that don’t
have universal coverage . Th e law does greatly reduce the number of uninsured in
United States . The Congressional Budget Office estimates that there will be 25 million
fewer uninsured because of the law as early as 2016. But that still leads 31 million
uninsured , somebody chose to pay the tax penalty rather than buy insurance others will
get an exemption du e to financial hardship o r other reasons , such as qualifying for
Medicaid but living in a state but didn't expand the program. Obama said in his remarks
that the goal that's no A merican to be without health care and that the goal is
achievable, it maybe but not with this law and that’s FactChe c k for this week. I am Lor i
Robertson , Managing Editor on FactChe c k.org.

Margaret Flinter: FactCheck.org is committed to factual accuracy from the country’s
major political players and is a project of the Annenberg Public Policy Center at the
University of Pennsylvania. If you have a fact that you would like checked, email us at
chcradio.com, we will have FactCheck.org’s Lori Robertson che ck it out for you here on
Conversations on Health Care.

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Mark Masselli: Each week, C onversations highlights a bright idea about how to make
wellness a part of our communities and to everyday lives. Much emphasis has been
paid of late to the dang ers of destructed driving , number s of state s have an active laws
banning texting and driving which has le d to a number of traffic death across the
country. But what about distracted walking, a recent in depth study conducted by
safekids.org showed some pr etty start led link statistics , older teens now account for

over half of all pedestrian deaths of children and one of the main cooperates distracted
working.

Kate Carr : So, 25% increase on teen fatalities and that’s what alarm us and we did an
observation al study where we collected data from over 34,000 observation . We saw
that one i n five high school students were distracted by using their mobile device.

Mark Masselli: Kate Carr is President and CEO of safe kid.org . She decided there
need ed to be a cam ping to promote better awareness to reduce the trend and they
created a moment of silence.

Kate Carr : This camping is a reminder to especially teens, there are 50% of the
fatalities put that device down , create a moment of silence when you’re crossing a street
or you’re on a sidewalk or in a parking lot around cars , put you device down.

Mark Masselli: She realize s that kids especially teens will not be separated from their
mobile device but if they could just put them down while walking across the stree t
engage in a moment of silence , the number of teen pedestrian deaths would be greatly
reduced. A simple slogan based campaign to raise awareness about the dangers of
distracted walking that has potential to save the li ves of child pedestrians, now that’s
bright idea.

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Margaret Flinter: This is Conversations on Health Care . I am Margaret Flinter.

Mark Masselli: And I am Mark Mass elli . Peace and health.

(Music)

Conversations on Health Care, broadcast from the campus of WESU at Wesleyan
Unive rsity. Streaming live at www.wesufm.org and brought to you by the Community
Health Centre.