In a tense meeting Wednesday in a packed hotel conference room, the Washington Health Exchange Board voted to hold off on certifying health plans that can be sold inside the state’s new online insurance exchange, which is to open for business Oct. 1.
The move by the board, a nine-member group that oversees the exchange, centered on applications of five insurance companies that were rejected from offering plans in the exchange, a key element of the Affordable Care Act, or Obamacare.
Despite warnings from state Insurance Commissioner Mike Kreidler against a delay, board members said they wanted
to give those companies more time to demonstrate they can meet the standard for offering a health plan on the exchange. They also said they wanted to ensure there was adequate choice and competition among the plans offered through the exchange.
The board had been expected to formally certify 31 health plans from four insurers for the state-run exchange, called the Washington Healthplanfinder. Kreidler’s office approved the four companies’ plans last month.
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But the board decided to delay that action, until next week at the earliest.
Kreidler warned that postponing certification could affect the state’s ability to get Healthplanfinder up and running on time.
“The problem is, we’re really pushed against timelines,” Kreidler said.
States that are running their own exchanges — as Washington is — face an Aug. 31 deadline to submit information on the plans they have certified to the U.S. Department of Health and Human Services. Wednesday’s board action makes it unlikely the state will make that deadline.
Kreidler also noted that delaying certification would be unfair to the four insurers whose plans were approved.
“The four carriers put a lot of work into this,” Kreidler told the board. “Let’s not hold the sword of Damocles over their heads at this point.”
are BridgeSpan Health Company (an affiliate of Cambia Health Solutions, the parent company of Regence BlueShield), Group Health Cooperative, Premera Blue Cross and its subsidiary, Lifewise Health Plan.
Kreidler said his decision to approve some carriers’ plans and reject others was based on each company’s ability to meet certain criteria, such as having an adequate network of care providers.
“The plans that were rejected were rejected for substantial reasons, I can assure you,” he told the board.
But board members said they were not prepared to certify any plan until they could understand why proposals of the five other companies had been rejected.
The rejected carriers are Kaiser Foundation Health Plan of the Northwest, Moda Health Plan (formerly ODS Health), and three Medicaid plans: Coordinated Care Health, a subsidiary of Centene Corp.; Molina Healthcare of Washington; and Community Health Plan of Washington.
“I’m not comfortable signing off on the qualified health plans until we know why we denied others,” said Phil Dyer, a board member and a senior vice president at Kibble & Prentice/USI.
Board members expressed concern that rejecting those carriers would limit choice and reduce competition.
Member Don Conant noted that Lifewise, one of the four approved carriers, is a subsidiary of Premera, another approved carrier.
“I’m choosing to see these as one carrier,” said Conant, general manager at Valley Nut and Bolt in Olympia and an assistant professor in the School of Business at St. Martin’s University. “It’s sort of a choice without a distinction.”
The board’s concerns were amplified during the meeting’s public-comment period, when representatives of some of the rejected carriers made their case.
Three rejected carriers have already filed formal appeals. Two of the Medicaid plans, Coordinated Care Health and Community Health Plan of Washington, have separate hearings before an administrative-law judge next week.
The issue of Medicaid patients also played into the board’s thinking.
The concern is that if Medicaid patients’ income rises above eligibility, they cannot stay in their Medicaid plan and would need to seek coverage from another insurer, which could disrupt their care.
Meanwhile, exchange officials are requesting that HHS extend its Aug. 31 deadline for submitting plan information, said Michael Marchand, communications director of the Washington Health Benefit Exchange, which will administer the exchange.
Marchand said the delay wouldn’t put at risk the exchange’s ability to open for enrollment Oct. 1.
Amy Snow Landa is a freelance writer in Seattle. This story was produced through a partnership with Kaiser Health News, an editorially independent part of the Kaiser Family Foundation, a health-policy research and communication organization that is not affiliated with Kaiser Permanente.