STATE Insurance Commissioner Mike Kreidler has ruled that the health-insurance plans of five companies didn’t pass muster by the July 31 deadline to be included in the new Washington Health Benefit Exchange.
Authorized by the federal Affordable Care Act, the state-created exchange is expected to open Oct. 1 for coverage in 2014. Kreidler’s ruling limits the Exchange to the three principal companies already in the outside market for individual coverage — an unhappy result that should be changed.
“We are making history here,” said Dorothy Teeter, director of the Washington State Health Care Authority. “We need to ensure the broadest choice of plans for the people of this state.”
Kreidler should push back on the federal government to secure a few more weeks so that some of the five rejected companies, or all of them, can be brought into the market for 2014.
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Kreidler did approve 31 offerings of Premera, Regence and Group Health and their affiliates. But three is a thin number, and in 19 of the 39 counties, the only offerings will be from Premera or its affiliate, Lifewise. That Premera offers coverage in these rural counties is commendable, but one player does not make a competitive market.
The main reason Kreidler gave for rejecting applicants was that they had not created a full provider network. He said Coordinated Care had no pediatric hospital in its network, that Community Health Plan of Washington didn’t have enough cardiologists and gastroenterologists and that Molina Healthcare didn’t have an approved retail pharmacy.
These are problems that can be worked out.
Community Health Plan, for example, is new to the commercial market but is a successful provider under Medicaid, Medicare and state programs. It applied to offer coverage in 26 counties where it has member clinics. It disagrees that its network is inadequate and has filed an appeal with the insurance commissioner.
Competition requires competitors. More applicants will have to be brought to “yes,” either now or a year from now.
Better to do it now.