5 Things WA: Individual market, learning from Nevada, North Central

For the first time since March, 2015, we are going to just one edition this month. The June-uary weather – following such a tough winter and spring – has convinced us to get out of town for a bit.  So, less clutter from me for your inbox this month!

1.  Premium increases and the erosion of the individual market

This is not a time in health care where everything is what it seems. Case in point: the individual market.  First, 2 of the 39 counties in Washington will not have individual market insurance coverage for 2018. Second, requested rate increases in the rest of the state range from 9.7% to 38.49%.

Critics will say both are signs of the impending doom of Obamacare, that this is symptomatic of a failed system.  Maybe, but I think this is a reflection of other trends, too, not the least of which is the political environment today.  I lay out three key elements driving these premium increases here.  Some might surprise you.

2.  A solution for this legislature

Nevada is not known for being a hot bed of innovation, but it may have the best idea of the month: letting anyone buy into the Medicaid benefit.  If you’re concerned about no individual plan in a county where commercial insurers have left the market (Klickitat and Grays Harbor), this is a perfect solution.

This is a great idea for legislators representing these counties in this legislative session:  pass a provision that allows individuals in counties with no individual plan to purchase coverage from a Medicaid MCO that serves the county.  The price should be equal to the PMPM the HCA pays the insurer, about $300 per month.

I outline some of the logic and the arguments on both sides here.

3.  North Central Medicaid RFP awarded

Amerigroup, Coordinated Care and Molina have been awarded contracts for financially integrated Medicaid managed care in North Central Washington. This is the second of nine regions to be awarded, but it’s the first where incumbent plans will be cut out of future contracts. I’m told at least one formerly incumbent carrier is readying a legal team for appeal.

The HCA should expect more of that. While the procurement logic of only selecting 2 and at the most 3 plans in a region might make sense, it’s going to mean a severing of plan-provider relationships in many parts of the state, including King County. It might also weaken plans statewide as enrollment is pared back in select regions, essentially undermining part of the 2012 procurement logic of bringing more plan choice to Medicaid.

4.  Impacts of counties fighting integration

One of the various sticking points in the legislature is Medicaid integration. Counties have lobbied Sen. O’Ban to add language to a bi-partisan behavioral health bill that will allow counties to opt-in to Medicaid integration rather than be required to move. Spokane Co, Kitsap Co, and the North Sound BHO have been particularly vocal.  Compromise language creating an “Interlocal Leadership Structure” (pg 10) that the counties will lead, and the HCA will administer, is likely to be in the final language.

The legislative effort may be provoking a local backlash, however. I’m told the North Sound ACH is changing their leadership as a result, and that Spokane area stakeholders are lobbying county electeds directly, working around staff.

5.  A run down of noteworthy items

To bring you up to speed quickly on a few moving parts in Washington State health care, I’ll leave you with this summary of stories at State of Reform.

Regence is celebrating 100 years in Washington State.  Meg Jones has taken on the role of Executive Director of the Association of Washington Health Plans.  Beacon Health Options is 2 for 2 on BH-ASO RFPs. Amerigroup won a TPA RFP from the HCA for foundational community supports (housing, employment).  Providence and Kootenai Health from Northern Idaho have formed a new alliance.  Empire Health Foundation has sued CHS, the former owner of Deaconess and Valley Hospitals in Spokane, for not providing enough charity care, under the terms of its acquisition.