Carlos Carreon | Rossi or Gingrich | Almost $500 per family

Its the end game on the state budget this week, with implications for the Exchange marketplace. And, as goes the Exchange market, so go Medicaid plans with member enrollment moving primarily through that platform.  So, too, go commercial plans generally, with lower performance pressing down on provider rates.

Unlike even a decade ago, these lines of business are increasingly interconnected. It’s what we’re watching this month.

DJ 5 Things Signature

1.  House budget hits Exchange families with $500 annual assessment

Monday’s House budget proposal allocates $110 million for the Health Benefit Exchange. This is down $14 million from its original proposal, and under the Exchange Board’s total request of $127m. Earlier this spring, the Senate’s $85 million proposal led the Exchange Board to approve a placeholder carrier assessment of $13.66 pmpm for 2016, up 225% from the current $4.19 in 2015.

The devil in the details shows this could raise the 2016 carrier assessment to approximately $9.78 per member per month, lower than the placeholder assessment, but still more than double the 2015 level. Put another way, it’s almost $500 per year for a family of four on the Exchange.

2. Hospital and health plan performance in 2014

Health plans and hospitals are heading in opposite directions financially. Updating a previous report, 2014 annual reports for Washington hospitals show they posted a combined margin of over $1 billion last year.

Washington’s health plans, on the other hand, have had a much bumpier ride. After earnings peaked in 2013, Washington’s health plans earned approximately $154 million less in 2014 than the previous year.  These results come despite consistent gains in total revenue for most plans.


3.  Video: Carlos Carreon, Cowlitz County

This week’s “What They’re Watching” feature is Carlos Carreon, Director of Health and Human Services at Cowlitz County. Carreon has his eye on the long game. He thinks it’s time that leaders in health care start talking about issues like big picture community wellness and the growing number of undocumented, Medicaid-eligible populations which have the potential for huge upstream effects.

Carreon says these topics tend to drop off the radar with the conversation focusing on quantifiable issues like direct provision of care. Because preventive measures are not as “seductive,” we kick the can down the road. For more videos that start conversations, check out our entire multi-state interview series.

4.  Budget: Delayed capitulation; Gingrich or Rossi?

With government set to shut down in 6 days without a budget, Monday, House Democrats put forward a budget with no major revenue increases. This sets aside their central position in the budget negotiations of new revenue, the rationale for which they never seemed to explain clearly.  It makes their taking taxes off the table at this hour look like a capitulation that could have come in late April rather than late June.

Whether Democrats or Republicans come out of this brinksmanship the winner or loser largely depends on Sen. Andy Hill and whether he can keep his caucus together.  In the House budget, Senate Republicans have what they asked for: no new taxes, no carbon cap and trade, significant investments in education.

If Hill keeps his caucus together and adopts the House budget (or something close to it), he will be positioned as the next Dino Rossi for a strong run at the Governor’s Mansion. If he can’t, and state government shuts down for the first time, then he will be framed as Newt Gingrich, asking for the moon but failing to claim victory when he got (most of) it.


5.  OIC releases new network adequacy draft

The latest OIC iteration of a draft network maintenance standards rule is out. The two main issues brought up by stakeholders in March were (1) the tight turn around time for submitting documents related to changes impacting networks and (2) OIC asking health plans to perform quality monitoring activities usually reserved for providers. It looks like both of these items haven’t changed much in the new draft. Public comment is open until July 21.