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Biden team’s tightrope: reining in rogue Obamacare agents without slowing enrollment • Oregon Capital Chronicle

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Biden team’s tightrope: reining in rogue Obamacare agents without slowing enrollment • Oregon Capital Chronicle


President Joe Biden counts among his accomplishments the record-high number of people, more than 21 million, who enrolled in Obamacare plans this year. Behind the scenes, however, federal regulators are contending with a problem that affects people’s coverage: rogue brokers who have signed people up for Affordable Care Act plans, or switched them into new ones, without their permission.

Fighting the problem presents tension for the administration: how to thwart the bad actors without affecting ACA sign-ups.

Complaints about these unauthorized changes — which can cause affected policyholders to lose access to medical care, pay higher deductibles or even incur surprise tax bills — rose sharply in recent months, according to brokers who contacted KFF Health News and federal workers who asked not to be identified.

Ronnell Nolan, president and CEO of the trade association Health Agents for America, said her group has suggested to the Centers for Medicare & Medicaid Services that it add two-factor authentication to healthcare.gov or send text alerts to consumers if an agent tries to access their accounts. But the agency told her it doesn’t always have up-to-date contact information.

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“We’ve given them a whole host of ideas,” she said. “They say, ‘Be careful what you wish for.’ But we don’t mind going an extra step if you can stop this fraud and abuse, because clients are being hurt.”

Some consumers are pursued when they respond to misleading social media marketing ads promising government subsidies, but most have no idea how they fell victim to plan-switching. Problems seem concentrated in the 32 states using the federal exchange.

Federal regulators have declined to say how many complaints about unauthorized sign-ups or plan switches they’ve received, or how many insurance agents they’ve sanctioned as a result. But the problem is big enough that CMS says it’s working on technological and regulatory solutions. Affected consumers and agents have filed a civil lawsuit in federal district court in Florida against private-sector firms allegedly involved in unauthorized switching schemes.

Biden has pushed hard to make permanent the enhanced subsidies first put in place during the covid pandemic that, along with other steps including increased federal funding for outreach, helped fuel the strong enrollment growth. Biden contrasts his support for the ACA with the stance of former President Donald Trump, who supported attempts to repeal most of the law and presided over funding cuts and declining enrollment.

Most proposed solutions to the rogue-agent problem involve making it more difficult for agents to access policyholder information or requiring wider use of identity questions tied to enrollees’ credit history. The latter could be stumbling blocks for low-income people or those with limited financial records, said Sabrina Corlette, co-director of the Center on Health Insurance Reforms at Georgetown University.

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“That is the knife edge the administration has to walk,” said Corlette, “protecting consumers from fraudulent behavior while at the same time making sure there aren’t too many barriers.”

Jeff Wu, acting director of the Center for Consumer Information & Insurance Oversight, said in a statement that the agency is evaluating options on such factors as how effective they would be, their impact on consumers’ ability to enroll, and how fast they could be implemented.

The agency is also working closely, he wrote, with insurance companies, state insurance departments, and law enforcement “so that agents violating CMS rules or committing fraud face consequences.” And it is reaching out to states that run their own ACA markets for ideas.

That’s because Washington, D.C., and the 18 states that run their own ACA marketplaces have reported far fewer complaints about unauthorized enrollment and plan-switching. Most include layers of security in addition to those the federal marketplace has in place — some use two-factor authentication — before agents can access policyholder information.

California, for example, allows consumers to designate an agent and to “log in and add or remove an agent at will,” said Robert Kingston, interim director of outreach and sales for Covered California, the state’s ACA marketplace. The state can also send consumers a one-time passcode to share with an agent of their choice. Consumers in Colorado and Pennsylvania can similarly designate specific agents to access their accounts.

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By contrast, agents can more easily access policyholder information when using private-sector websites that link them to the federal ACA market — all they need is a person’s name, date of birth, and state of residence — to enroll them or switch their coverage.

CMS has approved dozens of such “enhanced direct enrollment” websites run by private companies, which are designed to make it easier and faster for agents certified to offer insurance through healthcare.gov.

Rules went into effect last June requiring agents to get written or recorded consent from clients before enrolling them or changing their coverage, but brokers say they’re rarely asked to produce the documentation. If CMS makes changes to healthcare.gov — such as adding passcodes, as California has — it would need to require all alternative-enrollment partners to do the same.

The largest is San Francisco-based HealthSherpa, which assisted 52% of active enrollments nationally for this year, said CEO George Kalogeropoulos.

The company has a 10-person fraud investigation team, he said, which has seen “a significant spike in concerns about unauthorized switching.” They report problems to state insurance departments, insurance carriers, and federal regulators “and refer consumers to advocates on our team to make sure their plans are corrected.”

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Solutions must be “targeted,” he said. “The issue with some of the solutions proposed is it negatively impacts the ability of all consumers to get enrolled.”

Most people who sign up for ACA plans are aided by agents or platforms like HealthSherpa, rather than doing it themselves or seeking help from nonprofit organizations. Brokers don’t charge consumers; instead, they receive commissions from insurers participating in state and federal marketplaces for each person they enroll in a plan.

While California officials say their additional layers of authentication have not noticeably affected enrollment numbers, the state’s recent enrollment growth has been slower than in states served by healthcare.gov.

Still, Covered California’s Kingston pointed to a decreased number of uninsured people in the state. In 2014, when much of the ACA was implemented, 12.5% of Californians were uninsured, falling to 6.5% in 2022, according to data compiled by KFF. That year, the share of people uninsured nationwide was 8%.

Corlette said insurers have a role to play, as do states and CMS.

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“Are there algorithms that can say, ‘This is a broker with outlier behavior’?” Insurance companies could then withhold commissions “until they can figure it out,” she said.

Kelley Schultz, vice president of commercial policy at AHIP, the trade association for large insurance companies, said sharing more information from the government marketplace about which policies are being switched could help insurers spot patterns.

CMS could also set limits on plan switches, as there is generally no legitimate need for multiple changes in a given month, Schultz said.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

 

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Oregon

Power shutoffs banned during extreme summer heat in Oregon

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Power shutoffs banned during extreme summer heat in Oregon


The Oregon Public Utility Commission has approved temporary rules to protect low-income residential customers from power disconnections during high summer heat.

The ban starts this month and runs through October and is meant to ensure Oregonians – including those who rely on medical devices – can safely cope with extreme temperatures. The protections stem from a bill passed in 2021, dubbed the Energy Affordability Act, which required the commission to adopt measures to reduce the burden of high electricity costs for Oregonians.

Under the new rules, all investor-owned electric utilities – Portland General Electric, PacifiCorp and Idaho Power – are prohibited from disconnecting service due to non-payment during major heat waves.

The rules apply when the National Weather Service or another local jurisdiction issues a heat advisory or extreme heat watch or warning or when a local air quality alert is issued.

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Customers also are protected in the 24 hours before a qualifying hot spell and in the 48 hours after. They’re also protected 24 hours after an air quality alert has been issued.

Customers whose utility services were disconnected up to seven days before a heat event can request to be reconnected without delay once the extreme weather begins.

Typically, utilities can charge a reconnection fee and require customers to pay at least a portion of their past due bills before reconnecting them. But the new rules waive upfront reconnection fees for medical certificate account holders and discount program participants earning less than 10% of state median income. (Once the heat wave is over, customers are still responsible for paying their past due bills and reconnection fees).

The new rules also require utilities to inform customers about the protections so they can quickly get service reconnected.

The commission is poised to adopt permanent rules by the end of next year.

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Customer advocates hailed the rules in the wake of the state’s first high heat event earlier this week.

“This past weekend, we saw record-breaking heat that threatened the health and safety of our seniors, neighbors with disabilities, and families. These new protections mean that no one will be left at home in danger without electricity simply because their energy bills are too expensive,” said Charlotte Shuff, a spokesperson for the Oregon Citizens’ Utility Board, a nonprofit organization that advocates for utility customers and supported the measures.

— Gosia Wozniacka covers environmental justice, climate change, the clean energy transition and other environmental issues. Reach her at gwozniacka@oregonian.com or 971-421-3154.



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Could Trump deploy Oregon National Guard if immigration protests escalate?

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Could Trump deploy Oregon National Guard if immigration protests escalate?


PORTLAND Ore. (KPTV) – If protests break out in Oregon in response to federal immigration raids, President Donald Trump could legally mobilize the state’s National Guard, like he has done recently in Los Angeles.

Federal law grants the president authority to federalize a state’s National Guard under Title 10 of the U.S. Code, Section 12406, in situations of “insurrection, invasion, or rebellion,” or when it becomes “impracticable” to enforce federal law by regular means. In such a scenario, Guard troops are placed under federal control, though their roles would be largely restricted to protecting federal personnel or property. They would not be allowed to arrest civilians due to the Posse Comitatus Act, which prohibits the use of federal military forces in domestic law enforcement.

This means, that if Trump evoked this authority during immigration-related unrest, Oregon’s Guard troops could not act as police officers.

The president also has access to the Insurrection Act, a more sweeping statue that allows deployment of active-duty military or federalized Guard troops without a governor’s consent.

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While this law has rarely been used, it could theoretically be used if civil disorder severely threatened federal operations.

There have been ICE protests in Portland recently, but they have been largely peaceful.

On Monday, during a press conference, Gov. Tina Kotek indicated she would push back against any such actions.

She described Guard troops being federalized in California as, “an alarming disregard for the safety of Americans and their ability to govern themselves.”

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“The president’s unlawful actions undermine our local authorities, who should be able to do their jobs without a federal intervention escalating and inflaming the situation,” said Kotek.

So, Trump has the authority, but his power is limited for how Guard troops can enforce the law. Any attempt to deploy the Guard to quell protests would also likely be met with lawsuits from the state of Oregon.



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How three innings dictated FSU baseballs loss to Oregon State in Corvallis super regional

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How three innings dictated FSU baseballs loss to Oregon State in Corvallis super regional


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Florida State baseball’s season ended in heartbreak after Oregon State beat the Seminoles 14-10 in the winner-take-all game three of the Corvallis Super Regional.

Nearly 3,000 miles away from home, the No. 9-seeded Seminoles (42-16) battled No. 8-seeded Oregon State with a berth to the College World Series in Omaha on the line. In a series between two college baseball heavyweights, the Beavers emerged victorious, while FSU begins its journey back to Tallahassee with questions of what could have been.

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Over the 28 innings played at Goss Stadium, three innings seemingly were the difference in the series.

FSU gave up 16 runs over three crucial, season-defining innings in the super regional, and that proved to be the difference between a second consecutive trip to Omaha for the first time in over two decades and a heartbreaking flight home to Tallahassee for the Seminoles.

“They played better than we did. I felt like there were three innings, the ninth (game one), the first, and the third (game three) that we could not escape,” FSU head coach Link Jarrett told reporters postgame. “The game revolves around the big inning, and those three were the difference in this series.”

The ninth inning of game one handed Oregon State control of the series

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It looked like the Seminoles had sealed a game one victory, leading Oregon State 4-1 going into the ninth with a red-hot Joe Charles on the mound on Friday night.

Fears of a leadoff double leading to a rally seemed to shrink after two quick outs recorded by Charles. However, a five-pitch walk and a pair of singles later dramatically loaded the bases and loosened the Seminoles’ grasp on a victory.

Charles faced Jacob Kreig, who was 1-for-3 with a double to that point of the game, and the first pitch he delivered ran to the backstop and scored a Beaver runner from third base.

The resilient Charles battled back and worked into a 2-2 count, and down to their final strike, Kreig launched a two-run single to tie the game, swinging momentum in favor of the Beavers. The hit ultimately forced extra innings, and after the Seminoles went down 1-2-3 in the top of the 10th, Oregon State walked it off to snatch a game one victory, and more importantly, control of the series.

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Since the NCAA implemented super regionals in 1999, the winners of game one of the best-of-three series had gone on to win the series 158 of 200 times, a 79% win rate.

Two home run filled innings ended FSU’s season in Corvallis

The Seminoles tested the odds with a 3-1 win on Saturday, anchored by quality pitching from Jamie Arnold and Peyton Prescott to force a winner-takes-all game.

With all to play for in game three, it looked like the Seminoles had made an early statement of intent as Max Williams launched a two-run home run in the top of the first on Sunday to give FSU a quick 2-0 lead.

Coming off a career-high eight innings pitched vs. Mississippi State, Wes Mendes toed the rubber with hopes of delivering something similar in Corvallis.

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However, five hits, two home runs and seven runs later, Mendes exited the game after less than an inning pitched, and a touchdown allowed in the first inning. For the second time in the series, the Beavers had snatched away the momentum from FSU in dramatic fashion.

“This was built around stating pitching, and Wes had been fighting an illness this week, the travel, and the different allergy stuff that’s going on out here for him, he didn’t look like it was as good as I’ve seen it,” Jarrett said.

“You have to have command of secondary pitch. We were trying to get him through it to see if he can find one of the secondary pitches, and you have an all-right-handed lineup. It seemed like if he could get that changeup going, that changeup’s pretty good. But they were on it, and we could not get out of it. That was damage.”

While jarring, a 7-2 lead didn’t feel insurmountable for the Seminoles, and a second inning Chase Williams home run proved FSU wasn’t going to roll over without landing a few counter blows.

But after delivering a staggering right hook in the first inning, the Beavers landed a knockout punch in the third with six runs scored, including a grand slam and a two-run home run to put the game out of FSU’s reach, despite their best comeback efforts.

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The Beavers hit four home runs in the two innings, and scored six runs with two outs, with 11 of the 14 runs the team scored coming on the long ball.

The two innings counteracted what was FSU’s best offensive performance of the weekend as the Seminoles outhit their opponent 17-12, and scored runs in all but three innings, and held Oregon State scoreless after the fourth.

And FSU wasn’t without its opportunities to tie the game, as 10 runners were left on base, including two innings that ended with the bases loaded.

Ultimately, missed opportunities and three innings of poor pitch execution out of the 28 innings played in the series sent the Seminoles home, and not to Omaha.

“We fought, we had chances, believe it or not. This game, you could have looked up, and this thing could have been 14-14, and still going,” Jarrett said. “But some of the at-bats, some of those moments, we needed to do a little bit more, and we needed a crooked number.”

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“And we were scoring… but we needed that big blow, that big one, and we didn’t get it.”

Liam Rooney covers Florida State athletics for the Tallahassee Democrat. Contact him via email at LRooney@gannett.com or on Twitter @__liamrooney



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