Reform Update: Exchange preparedness varies in GOP-led states

Even as HHS touts broad consumer choice and lower-than-expected premiums for health plans in health insurance exchanges across the country, officials in Republican-led states with federally facilitated exchanges report widely varying levels of competition and preparedness in advance of the Oct. 1 start of open enrollment.

With many Republican leaders in these states opposed to the healthcare reform law and the exchanges, some of these states have been more willing to participate in exchange implementation than others. And that could affect preparedness and enrollment.

In Indiana, four insurers—MDWise, Coordinated Care, Physicians Health Plan of Northern Indiana and Anthem—will offer plans on the state exchange, pending final HHS approval, said Dennis Rosebrough, a spokesman for the state's department of insurance. But 31 of the state's 92 counties will have offerings from only one of those insurers. Thirty-five counties will have offerings from two issuers.

Seventeen insurers in Indiana's individual market have exited since March 2010 because HHS refused to exempt insurers from the Patient Protection and Affordable Care Act's medical-loss ratio rule through 2014, Rosebrough said. Stephen Robertson, the state's insurance commissioner, had told HHS that not granting the exemption would severely limit consumer choice of health plans. HHS replied that it did not find a reasonable likelihood that the medical-loss ratio would destabilize the state's insurance market.

In Florida, 11 insurers, including Cigna and Humana, have sought qualified health plan certification. Twenty-one of the state's 67 counties, however, will have only one company offering health plans on the individual market, according to the state's office of insurance regulation.

Molina Healthcare, a Long Beach, Calif.-based managed care insurer operating in Florida, will offer plans in only three heavily populated South Florida counties—Miami-Dade, Broward and Palm Beach—with plans to expand to other counties in 2015, said Steve Snider, Molina's director for membership growth.

He predicted a slow start for the state's exchange, hindered in part by a lack of political support for the healthcare reform law. “I think it will build momentum as people get less afraid and grasp it for what it is,” Snider said.

Florida Blue, on the other hand, will offer plans in all the state's counties, said Mark Wright, a company spokesman. The company has ramped up its outreach efforts with retail centers in strip malls where consumers can seek out information, he added.

Some smaller health plans are viewing the opening of the exchange as a way to boost membership in states dominated by larger carriers. They'll be listed side by side with the giants on the insurance exchange's website and may offer lower premiums.

“We're excited about it,” said Jessica Self, a compliance coordinator at Vantage Health Plan, a small insurer based in Monroe, La., which is one of four insurers expected to offer plans on Louisiana's federally facilitated exchange. “We see this as a real opportunity.”

Michigan, which is partnering with HHS to run its state exchange, will offer plans from 13 insurers, including Blue Cross and Blue Shield of Michigan. The Blues plan will offer insurance options in all of the state's 83 counties.

“I think we're one of the more competitive states in terms of offerings,” said Terry Burke, Blue Cross and Blue Shield's vice president for individual business. “Michigan had a pretty solid response from carriers.”

Michigan's department of insurance and financial services is still compiling county-by-county offerings, said spokesman Caleb Buhs. The department also has focused on providing support to consumers seeking information about their options.

“We've been preparing for this for years,” Buhs said. “We have extra staff, additional phone lines—everything we need. We're trying to get ready for as many scenarios as we can, but we can only do so much. Most of it is out of our hands.”

Other states with federally run exchanges are taking a much more hands-off approach. In most of those states, Republican governors and state legislators have strongly opposed Obamacare and the exchange. In some, they have prohibited involvement of state officials in exchange implementation and have put up barriers to enrollment activities.

Alabama, for instance, will forward all questions to HHS related to the state exchange and the three health plans expected to compete on it, said Mark Fowler, government relations manager for the state's insurance department.

“If it is related to an issue we would normally deal with, we will field those calls,” Fowler said. “Any questions specifically related to the exchanges we will forward to the federal government.”

Joel Ario, managing director at Manatt Health Solutions and former director of the office of health insurance exchanges at HHS, said states' level of consumer assistance will have some effect on enrollment. But he predicted it would be “generally at the margins since everyone will have access to the online site and call-center services.”

“More (assistance) is better, though, especially in year one,” Ario said.

With insurers assembling narrow networks of providers to keep costs down in plans they sell in the new insurance exchanges, some controversy is erupting in Missouri over a major player that's left out of one plan. Anthem Blue Cross and Blue Shield has omitted BJC HealthCare from its exchange plans, and patient advocates are saying that will be a barrier for many patients, reports Kaiser Health News. BJC—which operates 13 hospitals, including 1,305-bed Barnes-Jewish Hospital—is the biggest system in the region. “Unfortunately, we were not able to reach an agreement with BJC,” an Anthem spokeswoman told Kaiser. Andrea Routh, executive director of the Missouri Health Advocacy Alliance, called BJC's exclusion “a major concern,” arguing in particular that BJC's St. Louis Children's Hospital is an “essential community provider.”

Sweden-based security-guard firm Securitas plans to pull the plug on its “mini-med” health plans and send 1,200 U.S. employees to the new health insurance marketplaces established under the Patient Protection and Affordable Care Act, the Wall Street Journal reported Thursday. Mini-med plans allow employers to offer coverage with low premiums but cap benefits. Though some mini-med plans capped payouts to as little as a few thousand dollars, Securitas employees paid $100 a month for a plan with a $50,000 annual cap or $125 a month a plan with a $100,000 annual cap, the newspaper reported. Annual caps are eliminated under the Affordable Care Act. The law's penalty for medium and large employers that don't offer affordable and adequate coverage, meanwhile, was delayed until 2015.

UCLA Medical Group and Humboldt Del Norte IPA, an independent practice association in Northern California, joined the large and growing ranks of providers in Anthem Blue Cross' accountable care contracts. The WellPoint subsidiary said some consumers buying coverage in the state's health insurance exchange will have access to UCLA's ACO. The nine other California provider organizations in Anthem's ACO program, launched in 2011, include Cedars-Sinai Medical Care Foundation, Sharp Community Medical Group and HealthCare Partners (a division of DaVita HealthCare Partners).

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