Pushback on Medicare Advantage cuts | Oregon’s Senate primary race | The Cover Oregon investigations

The purpose of “5 Things We’re Watching” is to provide a snapshot of things we think are important for senior health care leaders to be aware of.

With less than two weeks left in open enrollment (barring a last-minute extension), Oregon’s exchange continues to face scrutiny from many directions and to serve as reliable campaign fodder, particularly for Republican candidates.

We’re watching Cover Oregon’s ongoing struggles, key political races, and efforts on Capitol Hill to ward off proposed payment reductions for Medicare Advantage plans.

DJ 5 things updated

1. Oregon Democrats join pushback against Medicare Advantage cuts

Both Republicans and Democrats in Oregon’s congressional delegation have joined the insurance industry’s protest against the Obama administration’s proposed rate cuts for Medicare Advantage plans.

Oregon Democrats Bonamici and Schrader are among the 190 House members who sent a letter to CMS last week to protest the proposed reduction.  Forty senators, including Oregon Democrat Jeff Merkley, sent a similar letter last month.  Oregon has one of the largest proportions of Medicare beneficiaries enrolled in MA plans, at 42 percent.

Republicans have already made the proposed MA cuts a campaign issue in some races.  A final ruling from CMS is due by April 7.

2. Wehby, Conger trade accusations over Obamacare

One might expect Republicans vying for Merkley’s Senate seat to save their anti-Obamacare rhetoric for the general election.  But instead the two front-runners have been busy aiming it at each other.

Portland pediatric neurosurgeon Monica Wehby, whose campaign has garnered national attention and raised the most money, points to votes by her opponent, state Rep. Jason Conger, in favor of establishing a state-based exchange in Oregon.  Conger’s campaign is returning fire by running a radio spot accusing Wehby of supporting a bill several years ago that Conger says was similar to Obamacare.

Meanwhile, Merkley has raised far more money than all of the Republican primary candidates combined.

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3. More scrutiny, transitions for Cover Oregon  

Oregon’s troubled exchange has come under scrutiny from several directions in recent weeks.  The GAO has launched a review of Cover Oregon; CMS produced a scathing assessment of the exchange and its contractor Oracle that was leaked to The Oregonian; and the results of an independent audit commissioned by Gov. Kitzhaber are expected soon.

More damaging information could emerge if the OHA’s former chief information officer, Carolyn Lawson, decides to sue the state for wrongful discharge and defamation. Lawson sent a tort claim notice yesterday to state agencies and employees that include Cover Oregon, acting director Bruce Goldberg, and former director Rocky King.

Amid the investigations, criticism and debate, Cover Oregon’s board continues its search for new leadership and a post-Oracle IT strategy that may finally get the exchange fully functioning.

4. Moda Health dominates Cover Oregon sales

Clearly, price matters.  Nearly three-quarters (73%) of Oregonians who purchased private insurance on the exchange through March 6th have chosen a health plan offered by Moda Health, which is charging the lowest premiums.  Kaiser Permanente is running a distant second, at 9.4%.  Moda Health (ODS) is also outpacing the competition in the dental insurance market.

According to Cover Oregon, more than 45,000 Oregonians have signed up for a qualified health plan, including nearly 5,000 who have enrolled through the online portal.  The exchange has taken pains to point out that its enrollment figures put Oregon in the middle of the pack among states running their own exchanges.

5.    Good news for small businesses  

The Obama administration announced last Friday that small businesses can get tax credits without going through health insurance exchanges, as long as the plans are equivalent to health plans offered through an exchange and Oregon applies for permission.  This could be good news for small businesses in Oregon, which still doesn’t have a functioning SHOP exchange.

Meanwhile, Oregon’s Health CO-OP has announced it is slashing rates by 13 percent for its small-group plans outside the exchange, starting April 1. We interviewed Health CO-OP CEO Dr. Ralph Prows to find out how the startup is positioning itself for 2015.