WA: Kreidler Explains Decisions Regarding Exchange Plans

Below is a statement from Washington State Insurance Commissioner Mike Kreidler released on August 8, 2013, outlining the reasons that the applications for five carriers were not approved by the OIC for the Exchange:

I’m very pleased with the 31 plans we approved for the Exchange – they’re quality plans with good benefits. More people will be able to get covered than ever before and the plans are higher quality and offer better value. Many people will qualify for subsidies to help with the costs.

Unfortunately, not all of the insurers who applied were approved. Some of the plans were new to the commercial market and it’s a big challenge to meet the criteria to enter that market.

For more than a year, we went to great lengths to help these companies succeed. We held dozens of meetings and discussions with their staff and CEOs. We held 14 webinars, starting as early as June 2012, to help them get through this process.  Our staff worked until midnight on the final night to give the carriers every possible minute, but in some cases, they didn’t succeed.

Examples of specific problems include:

*     Molina – Didn’t allow adequate access to certain providers such as HIV/AIDs specialists and proctologists. It also had no approved retail pharmacy.

*     Coordinated Care Company – Had no pediatric hospital in its network and no approved vision network.

*     Community Health Plan of Washington -Couldn’t adjust its benefits to meet the new cost-sharing requirements. It also required people – even those living in an urban area – to drive more than 47 miles to see a cardiologist and 123 miles to see a gastroenterologist.

*     Kaiser – Had several Health Savings Account (HSA) plans that didn’t meet the federal requirements of an HSA.

*     Moda – Wanted to charge the same rates for plans with different benefits.

I fully support competition in the market, but it’s also my responsibility to make sure that plans sold in Washington state comply with state and federal law. It’s also critical that if consumers buy a plan, they’re actually able to use the benefits they’re promised.

While I wish all of the companies who applied had succeeded, I had to hold everyone to the same standards. I remain optimistic about next year, when I fully expect more insurers to apply and more to succeed.

It’s also important to remember that the market is bigger than just the Exchange. There are dozens more plans that have been filed for sale outside the Exchange and they’ll have to meet the same quality standards.

Washington has a vibrant health insurance market today and it will continue to have one in 2014.