Former HealthCare.Gov CMO Josh Peck Launches Get America Covered to Fill ACA Marketing Gap

Josh Peck – Get America Covered

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Mark Masselli: This is Conversations on Healthcare , I am Mark Masselli.

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Well Margaret, the Senate has launched another attempt to find ways to
dismantle the Affordable Care Act , they put a provision in their tax overhaul bill that
would eliminate the individual mandate which requires Americans to carry health
insurance or pay a tax penalty , t he GOP leadership are calling this a windfall for
Americans but it's really not that simpl e .

Margaret Flinter: And while the removal of the individual mandate would indeed save
tax dollars and that's an estimated $300 billion , there's a reason an estimated 13 million
fewer people would have health insurance within 10 years of eliminating the mandate
and that would indeed save the government some substantial money but only because
they would no longer be covering subsidies for people buying insurance on the
exchanges .

Mark Masselli: The elimination of individual mandate would essentially entice younger
healthier people to stay out of the insurance pool leaving older sicker people in the
coverage pool and that would ultimately mean much higher rates for everyone .

Margaret Flinter: But Se nate Republicans have a narrow margin to get their version
passed all it takes is a couple of Nos among the GOP and the bill will not clear the
chamber .

Mark Masselli: In the meantime Margaret we ’ re the midst of open enrollment and the
ACA is still the l aw of the land and that leads us to our guest today.

Margaret Flinter: Joshua P eck is the Cofounder of Get Covered America , a nonprofit
organization that's made up of former employees of the Centers for Medicare and
Medicaid Services especially targeting parts of the country where there has been
political resistance to the Affordable Care Act.

Mark Masselli: Looking forward to th at conversation Margaret and hearing more about
Get Covered America .

Margaret Flinter: And Lori Robertson will stop by, the Managing Editor of
FactCheck.org , but no matter what the topic, you can hear all of our shows by going to
chcradio.com.

Mark Masselli: And as always if you have comments, please email us at
[email protected] or find us on Facebook or Twitter; we love hearing from you.

Josh Peck – Get America Covered

Margaret Flinter: We will get to our interview with Dr. Joshua Peck in just a moment.

Mark Masselli: But first here ’s 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 healthcare headlines. $504 billion
per year , that's the calculated annual toll of the opioid epidemic in this country for 2015
alone . The Council of Economic Advisers just released a report detailing the scope of
the economic impact from the opioid epidemic recalculating earlier estimates after
taking into account nonfatal costs of opioid misuse disorder including healthcare cost ,
treatment for substance use and criminal justice and incarceration costs as well as lost
productivity , b ased on the new findings the council is doing economic analysis of
potential interventions to the crisis . While Pres. Trump has declared the opioid crisis an
emergency , he has issued no new funding for confronting the problem as of yet .

Meanwhile the Centers for Medicare and Medicaid Services is moving ahead with plans
to attempt to curtail opioid abuse among Medicare recipie nts as well as dual eligible
seniors of rules of restrict special enrollment for the Medicare Part D program and would
also allow plans to set up a drug management program for members deemed to be at
risk for opioid abuse disorder t hose plans could limit members ’ access to coverage for
opioids to a narrow list of prescribers or pharmacies .

Meanwhile Purdue Pharma makers of OxyContin being sued by a number of states
municipalities for allegedly pushing the highly addictive narcotic on unsuspecting
cl inicians and patients , attorneys general alliance states are moving ahead with lawsuits
to recoup losses incurred from the high cost of treating those suffering from addiction
citing the company's aggressive marketing tactics as the primary force behind th e ris e in
opioid abuse and overdose deaths , 60,000 Americans overdosed in 2016 alone .
Purdue is reportedly considering a global settlement that would cover all the state and
county governments who filed suit that’s avoiding added scrutiny should those cas es go
to trial .

Seniors in the US seem to be the poor relations when compared to their counterparts in
10 other wealthy nations in fact they rank last in overall outcomes and experience with
the health care system . The Commonwealth Fund's 20th international health policy
survey revealed that compared all the other countries which have some form of
universal health coverage for citizens US seniors don't gain that cover age until the age
of 65 . The study is showing , they were far more likely to forgo medical tests or

Josh Peck – Get America Covered

medications because they simply couldn't afford them here , conversely in the UK ,
France, Norway and Sweden 5% or fewer seniors reported skipping needed care due to
cost concerns . I am Marianne O'Hare with these healthcare headlin es.

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Mark Masselli: We are speaking today with Joshua Peck, Cofounder of Get America
Covered , a nonprofit entity dedicated to helping Americans gain health insurance
coverage under the Affordable Care Act . Prior to starting this agency , Mr. Peck served
as Chief Marketing Officer for the Center for Consumer Information Insurance Oversight
and the Office of Communications at the Centers for Medicare and Medicaid Services
where he was responsible for the enrollment and retention of healthca re.gov
consumers . Previously he was a senior advisor to CMS and served as deputy director
of the New Media at the DNC , he earned his bachelors in education from Brandeis .
Josh, welcome to Conversations on Healthcare .

Joshua Peck: Thanks so much for havi ng me.

Mark Masselli: Yeah. Well we seem to find ourselves in the midst of really new kind of
open enrollment for insurance coverage under the Affordable Care Act open enrollment
began November 1 on the federal exchange healthcare.gov as well as on a ha ndful of
state exchanges . But there's a new twist this year the enrollment period was cut in half
by the current administration and the marketing funds and navigation supports which
we've all come to rely on have all been but eliminated under the current administration ,
and you ran the marketing strategy for healthcare.gov prior to the new administration
help them understand the complexities of that marketing strategy across the country
and why are these recent developments so concerning to you ?

Joshua Pe ck: So the most important thing to keep in mind is that outreach is proven so
we have years of testing that has shown that television ads reminding people about
deadlines, that they work, w e know which of these kind s of outreach together can enroll
differ ent types of consumers . So when the Trump Administration announced that they
were cutting the outreach budget by 90% , it had a direct and quantifiable impact on
what enrollment was going to look like this year . Approximately 1.1 million fewer people
would get enrolled by early next year as a result of this cut to outreach and you know
open enrollment period has been shortened this year from 90 days to 45 days and
moving that final deadline to a brand - new day it create s consume r confusion because
they're not sure when the deadline is , and when you pair that with cut to outreach it
really sort of makes the problem even worse .

Josh Peck – Get America Covered

Margaret Flinter: Well Josh, there had been so many policy challenges to the health
law but with all th ese challenges we have the latest attempt , the Senate's tax reform bill
that would eliminate the ACA's individual mandate requiring Americans to have health
coverage or pay a penalty , help us understand from your perspective what this latest
legislative at tack on the Affordable Care Act might mean and how do you think it's going
to play out ?

Joshua Peck: Well I mean this is an attempt to de stab i l ize the market, when you reduce
the number of people who are enrolling in coverage the individual mandate plays
especially important role in making sure that the people who are enrolling in insurance
are representative of society as a whole . We know that when people understand s the
role that the mandate plays in getting balance group of people to enroll and the fa ct that
it makes premiums lower for everyone there's widespread support for it. So what we
are seeing is very specific attempts to undermine the ACA using that particular provision
to do it and the consequences based on that the CBO’s estimates would be r eally really
devastating.

Mark Masselli: Josh you know I think back to the passage of Medicare and Medicaid in
the 60s and there were many substantive changes that got made over the decades but I
know we had Andy Slavitt who was former CMS acting ad minist rator on the show who I
also understand as part of your Get America Covered , and he discussed why repairs
versus repeal was the best approach . I'm wondering what issues with the health law
could have been remedied with some targeted strategies .

Jos hua Peck: You know I had the pleasure of being a CMS for the 50th anniversary of
Medicare's passage , what's so different of course is that the Affordable Care Act has
been really the target of partisan attack s since they won but that's not something that
Medicare ever experience . I think that there are plenty of opportunities to make
improvements to the Affordable Care Act , so one is increasing the amount of financial
help that ’s available to people so whether that ’s making plans more affordable for lower
income consumers or whether that ’s making plans for middle class consumers who are
just missing the financial help that ’s available currently I'm certainly supportive of that . I
think making sure that Medicaid expansion continues as plan ned, it's really tragic for
people who don't make enough money to qualify for financial help , b ut their state hasn’t
expanded Medicaid to cover them f or people who fall in that gap it creates a pretty
tragic situation . And then the third would be the public option , one of the things we ’ re
seeing in the marketplace is that as insurers are finding their feet we ’ re not seeing as
many people in the marketplace to give consumers all of traces that we would like to
give them so I think the public option is one way to solv e that problem . Outreach plays
a very important role in the running of the federal marketplace what we ’ re seeing with

Josh Peck – Get America Covered

the Trump Administration is that this budget ha s been drastically cut . So one of the
recommendations that I would make would be restorin g that budget and potentially even
increasing it . The California State exchange put out a paper earlier this year suggesting
that the federal exchange was grossly understanding even when we had the full
outreach budget that we did last year to think nothi ng of the cut budget this year.

Margaret Flinter: Well I want to talk about Get America Covered for a moment , you
committed to filling that big messaging void around the country especially in the 39
states that are reliant on the federal exchange . So talk with us about how your team at
Get America Covered is working in the se states and the strategy that you are using to
get the word out .

Joshua Peck: So Lori Lodes, my cofounder when we created Get America Covered ,
first off Lori and I worked at CMS t ogether working on outreach and education for the
last three years s o when we left we took with us the sort of best practices about what
works , what doesn't . Now as a nonprofit with a shoestring budget many of the doors
that would have been open to us whe n we had a $100 million budget are firmly shut so
we are putting together basic information for consumers ; when is the deadline ; how
affordable are plan s. Second , we ’ re working with national and local media to get the
word out , this year that ’s even more important and the Health and Human Services
hasn't been working with media this year almost at all . And we are working with
businesses, with celebrities , with influencers to tap into existing network s share this
information organically . Our biggest challenge going from having sort of the power of
the federal government to help get this message out we recognize d that there are really
significant limit s to the impact we will be able to have in this capacity.

Mark Masselli: We’re speaking to da y with Joshua Peck , Cofounder of Get America
Covered , a nonprofit entity dedicated to helping Americans gain health insurance
coverage under the Affordable Care Act . Josh I really couldn't agree with you more that
outreach and education are so important a nd there's so much about the plans that
consumers are not aware of . And I think one of the big ones is that millions of
consumers will qualify for a significant subsid y and in part because the President has
cut off federal subsidies to insurance companies to help them lower the cost for
consumers , wonder if you could break that down and tell consumers about what other
details like that might be very important for them to understand .

Joshua Peck: So when people are shopping for health insurance on the federal
exchange, we know that the most important factor for them is cost. And it's worth
saying that people often assume even before they look often instead of looking they
assume that health insurance is just too expensive , they assume it cost s hundreds of

Josh Peck – Get America Covered

dollars a month. And the reality is before the ACA that was true , what people don't
always appreciated is that financial help is available if you make as much as $49,000
you are typically eligible for a financial help , a family of four would be typically eligible
for financial help up to about $98,000 . I think last year 8 out of 10 people qualified and
so for the last four years most people have been able to find plans for $75 or less , this
year however because of this shenanigans of the Trum p Administration there is a very
unique phenomenon f or people who receive financial help on average prices are lower
this year . In fact they are the lowest [Inaudible 00:14:19 ] and 4.5 million uninsured
people can find a plan that costs them zero dollars a month .

Mark Masselli: Oh my God.

Joshua Peck: So their monthly premium is zero and many of these are bronze plans so
their deductibles are higher but there's no question the zero dollar plans are a far better
option than being uninsured so large numb ers of people have access to plan s this year
that have very very low dollar monthly premiums.

Margaret Flinter: Well Josh, I think I'd slide in one more for people purchasing
insurance which is that those essential preventive benefits that were wired int o the
Affordable Care Act are available upfront with no co - pays and no deductibles so Josh if
I can , maybe just talk a little more about the social media strategy , you’ve got some real
celebrity power , you’ve got f ormer president Obama , journalist Van Jones , act ors like
Alyssa Milano and Bradley Whitford and others offering their social media platforms to
help spread the word . Talk about the social media strategy that you are deploying as
we enter these final few short weeks of open enrollment .

Joshua Peck: First off I would say our strategy is really born in necessarily we are really
dependent on people who have large following s who are committed and willing to get
the word out . So our national co - chairs Van Jones, Alyssa Milano , Bradley Whitford ,
t hey have all really sort of committed to getting the word out about open enrollment and
so the strategy for us is really looking at these final weeks of open enrollment so last
two weeks and frankly even the last week are just so especially critical for pe ople . So
the plan is to really tap into the network s of these celebrities and influencers to reach
their followers to make sure that the uninsured have this very basic information . The
final deadline to enroll is December 15 and most people can find plans for $75 or less
and of course millions of people qualified this year for a zero dollar monthly premium.

Mark Masselli: So that strategy seems to be working and every day I am sort of listening
to these numbers ab out people who are enrolling I don’t want to low anybody into

Josh Peck – Get America Covered

apathy because it is a short window . But what do you think is driving all these huge
turnouts early on , what ’s your thoughts ?

Joshua Peck: So we are thrilled by the performance we have seen i n the first two
weeks looking at new enrollment cumulatively I think we ’ re up 53% over last year there
is a great demand for health insurance is incredibly strong . I think that one thing that
might explain the numbers is that the availability of these low - cost plan s they I think are
particularly enticing and I think really have the potential to be a game changer this year .
However I think it ’s also worth saying that when it comes to those plan s my chief
concern is that the uninsured are not aware that the y exists but I think one thing that is
very much is likely helping this year, is that. I think the second thing to keep in mind is
that we have a long way to go and it's important that we keep the momentum that we ’ re
seeing up. It ’s also just important t o recognize that the impact of outreach which we
would let off this discussion with you know the sort of recognition that there is a proven
connection between outreach and enrollment s o the proven impact of outreach all
happen s in relatively close proximity to the deadline . And so these first couple of weeks
what we’re likely be seeing is this is a natural demand , but as we get closer to the
deadline those dynamics could change because we know that that's when outreach had
to ge t impact , that’s when people are most likely to respond to it , there are folks who are
certainly not [Inaudible 00:18:12 ].

Margaret Flinter: We have been speaking today was Joshua Peck , Cofounder of Get
America Covered , a nonprofit entity dedicated to he lping Americans gain health
insurance coverage under the Affordable Care Act . You can learn more about their
work by going to getamerica covered.org or follow them on Twitter @ GetUsCovered .
Josh , thanks for the work you do and for joining us on Conversati ons on Healthcare
today.

Joshua Peck: Thanks again for having me.

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Mark Masselli: At Conversations on Healthcare, we want our audi ence to be truly in the
know when it comes to the facts about healthcare 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 le vel of deception in US
politics. Lori what have you got for us this week?

Lori Robertson: President Donald Trump issued an executive order in October related
to the Affordable Care Act . The order instructed the Department of Labor , Health and

Josh Peck – Get America Covered

Human Ser vices and Treasury to consider proposing regulations on Association Health
Plan s short term insurance and employer health reimbursement arrangement . The
order said that those items were alternative to insurance under the Affordable Care Act
that subject t o mandate . The A C A requires insurance on the individual or small group
market to cover certain benefits and limit out - of - pocket cost .

Trump's order also mentioned selling insurance across state lines to “ Facilitate the
purchase of insurance across state lines ” and to develop healthcare at “ Affordable
prices ”. We look ed at the issue of selling policies across state lines before and what
impact it might have on premiums on the individual market s where those without
employer plan s or government plans like M edicaid by their own coverage. If insurance
companies could sell across state lines and state regulators didn’t have to follow ACA
requirements would premium s dropped significantly ? Joseph Antos, a healthcare
expert with the American Enterprise Institute told us that while there could be some
reduction in surers will still be locked into the cost of health services in a given
geographic area s o a cheap plan in an expensive locale would still have to be priced
higher if sold in a high cost area .

Linda Bl u mberg with the Urban Institute said that some people could see a big drop in
premium s if insurers significantly curtailed benefits selling plan s without much insurance
protection to healthy people , but that would also drive up premiums for those w anting
comprehensive insurance and in states that want to have insurance regulation . It's also
unclear how much insurers want to sell plans across state lines , Aetna ’s CEO said
earlier this year that the idea is outdated because insurers now are aligned w ith
networks of providers that they create in certain area .

The American Academy of Actuaries said this year that cost savings from negotiating
provider networks can be larger than savings gleaned from differences in benefit
requirements but it may be dif ficult for insurers entering a new state market to negotiate
with providers . It remains to be seen what the agency secretar ies will propose based
on Trump's executive order . And that’s my fact check for this week, I am Lori Robertson
Managing Editor of F actCheck.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
www.chcradio.com . We will have FactCheck.org's Lori Robertson check it out for you
here on Conversations on Healthcare.

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Josh Peck – Get America Covered

Mark Masselli: Each week Conversations highlights a bright idea about how to make
wellness a part of our communities and everyday lives. Currently some 30 million
Americans have Type II diabetes and that number is expected to climb substantially in
the coming decades p atients who are newly diagnosed often find it difficult to process
the behavioral change required to keep their disease in check . So Amazon the creator
of the interactive voice technol ogy known as Alexa and pharmaceutical entity Merck
teamed up to launch a competition for developers to create a tool using existing
technology that would help folks better manage their diabetes . The winner Sugarpo d
developed by Seattle based startup Wellp epper .

Anne Weiler : We already had interactive care plans for people with TYPE II diabetes
they were mobile so we sat down and brainstorm ed and we came up about 20 different
ideas and what we thought that was the most interesting was this integrated care plan
that included a device which is a voice powered scale and foot scanner that looks for
diabetic foot ulcers. And we thought that the scale was a nice way of fitting into a
routine that someone already had in their day.

Mark Masselli: CEO Anne Weiler says they were intrigued by the opportunit y to
incorporate Alexa's voice technology for coaching purposes along with some simple
technologies that exists including a scale and an image scanner .

Anne Weiler : The three components are voice enabled scale and foot scanner, a
mobile care plan because voice isn’t always the best interface and then a voice
interaction that could happen with any sort of Alexa device.

Mark Masselli: Chief Technology Of ficer Mike Van Snellenberg said creating a u ser -
friendly interface was important and they got great feedback from consumers who said
they quickly adapted to the ir Sugarpod interface .

Mike Van Snellenberg : You need to have very low touch lightweight interaction and
things that don't interfere with a person's life and can kind of gently nudge them in the
right direction . I think voice is a great application for that, it's a devices that lot of people
already have in their homes.

Mark Masselli: While weights are measured in feet photographs Alexa offers
suggestions for weight management diet and exercise goal and other behaviors that will
empower patients to make lasting behavior changes . Sugar pod , a simple constructed
Alexa enabled weight and foot ulcer scanner that empowers new ly diagnosed diabetes
patients to shift their behaviors to better manage their disease leading to better diabetes
management for patients and providers , now that's a bright idea.

Josh Peck – Get America Covered

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Margaret Flinter: This is Conversations on Healthcare, I am Margaret Flinter.
Mark Masselli: And I am Mark Masselli, peace and health.
Conversations on Healthcare, broadcast from the campus of WESU at Wesleyan
University, streaming live at www.wesufm.org and brought to you by the Community
Health Center.