Kreidler, health insurers reach deal; Exchange options expand

UPDATE (Sept. 4, 2013) — Insurance Commissioner Mike Kreidler has reached a settlement with Molina Healthcare of Washington, Inc. and approved its two plans for sale in Washington’s Health Benefit Exchange, the Washington Healthplanfinder. Consumers in Washington will now have 43 choices in the Exchange when open enrollment begins Oct. 1. Molina’s two plans will be available in three counties: King, Pierce and Spokane. Read more.

OLYMPIA (Aug. 30, 2013) — Insurance Commissioner Mike Kreidler has reached settlements with Community Health Plan of Washington and Kaiser Foundation Health Plan of the Northwest and approved their 10 plans for sale in Washington’s Health Benefit Exchange, the Washington Healthplanfinder.

Consumers in Washington will now have 41 choices in the Exchange when open enrollment begins Oct. 1. Community Health Plan of Washington (CHPW) will have three plans available in 26 counties. Kaiser will offer an additional seven plans in Clark and Cowlitz counties.

Kreidler said the additional 10 plans meet the same high standards held for the other approved companies. They also ensure continuity of care for Medicaid enrollees and create more competition in the marketplace.

The Exchange set an initial July 31 deadline for the Insurance Commissioner’s review and approval of plans for inclusion in the Exchange, where subsidies for health coverage will be offered as part of the federal Affordable Care Act.

“We had 31 health plans approved by the Exchange’s deadline. Washington consumers now have an additional 10 quality plans to choose from,” Kreidler said.  “We took the initial deadline seriously, but we also followed our own legal process and it worked. The Exchange cannot delay any further. It must take action and approve these plans by Sept. 5.”

Sept. 5 is an extended federal deadline granted to Washington’s Exchange to approve plans.

Kreidler said that he made the tough decision to disapprove some plans on July 31 because he did not believe they met rigorous state and federal standards. He said he also knew he would take some heat for standing up for consumer protection.

“I’ve worked for meaningful health reform my entire career,” he said. “I’d much rather face the political fallout that my decision may have caused than know I set consumers up to be harmed in the future by plans that don’t deliver what they promise.”

Four of the five companies that were denied in July – Molina Healthcare of Washington, Inc., Coordinated Care Corporation, Kaiser, and CHPW – appealed Kreidler’s decision. Molina later dropped its appeal, but refilled it last night.

Appealing opened the door to settlement. Kreidler began discussions with only those companies he believed could make the necessary fixes in time before the federal deadline of Sept. 5.

“I knew it would be a serious challenge for both companies and my office to reach a successful settlement, given the time constraints,” Kreidler said.

The agreements required the companies to revisit and fix very specific issues identified by the insurance commissioner’s office during the original review process. Any deviation or omission would have meant failure.

Specifically, CHPW had to agree to drop its proposed two-tier pricing structure.  Its intention was to provide a zero co-payment option at community clinics. Unfortunately, under Washington state law, charging different co-pays for the same type of provider can look like discrimination, steering lower-income residents to only certain providers. CHPW fixed this issue.

The Insurance Commissioner will work with the company over the next year to explore how to help it meet its goals within the law. The revised final plans resulted in a 1 percent to 2 percent rate increase.

Kaiser had to correct its rate information so that it was complete and matched other information it had filed. It also had to ensure that all of its plans it said were compatible with Health Savings Accounts met federal standards.

“I wish I could’ve entered settlement talks with all of the companies that appealed,” Kreidler said.  “Unfortunately, I believed the substantial issues facing Coordinated Care could not be addressed in time to meet the Sept. 5 deadline.”

EDITOR’S NOTE — Commissioner Kreidler has come through again with a win for consumers. The Office of the Insurance Commissioner (OIC) has worked diligently over the last few weeks to ensure additional health carriers met the criteria for offering coverage in Washington State’s Health Insurance Exchange. Additional choice will now be offered in the exchange for low-income and vulnerable populations through the Community Health Plan of Washington (CHPW), as many of these clients’ income fluctuates between eligibility for the Exchange and Medicaid and they will now be able to keep their same provider if enrolled in CHPW. This announcement is also a win for families and individuals in southwest Washington who will now have a choice of insurer options (previously consumers in Clark county only had one carrier choice).

The Exchange Board’s decision to delay the approval of the Qualified Health Plans until next week’s September 4^th meeting was intended to allow for additional time for the OIC to continue its review and approval process. The Board’s decision to delay approval plans was also in recognition of additional time allocated to Washington State by the US Department of Health and Human Services which recognized our state (and others) needed additional time to review plans to ensure adequate choice for consumers. The Board is expected to vote on these plans approved by the OIC at its meeting next Wednesday.