WA: More On The Exchange Board Vote

Exchange Demo MastAt last month’s Exchange Board meeting, there was discussion of the orderly approval process anticipated for August’s Board meeting.  That was before the OIC announced it approved just four of the nine carriers that applied to be on the individual Exchange market.

It was confirmed at today’s Board meeting that three plans have appealed the OIC’s decision: Kaiser, CHPW and Coordinated Care. The hearings are scheduled for next week. Commissioner Kreidler noted that in order for the appeals by Kaiser, CHPW and Coordinated Care to be successful, it would have to be determined that the OIC had incorrectly interpreted state and federal law.

There was significant attention to the looming CCIIO deadline of August 31 and whether it could be extended.  CCIIO will pull the data from SERFF on that date to begin their financial analysis and calculations. The Board would need to have the board certified plans at least two days ahead of that date.

Several Board members were vocal about what they see as a lack of choice for the consumer in the market. Teresa Mosqueda asked Commissioner Kreidler how the Premera and LifeWise networks vary, since LifeWise is a subsidiary of Premera.

Don Conant: Just to be clear, so I understand, the main difference between the two networks is the name. It’s fine if that’s the difference. I don’t have all the information, but what I’m hearing is the difference between the two networks would be the name.

Commissioner Kreidler: I don’t remember offhand. They were approved separately, the degree of overlap. They met all the criteria that was necessary for a network for each plan individually. Because they were separate filings and separately approved.  My assumption is that they were very similar…

Phil Dyer questioned the implications for moving forward with the vote as scheduled.

Phil Dyer: “We’ve got an 800 pound gorilla sitting in the corner. And it’s the denied plans.”

Are we in a position where we’re comfortable  to make decisions on the health and vitality of the exchange on the QHPs we have before us without knowing what the ultimate outcome’s going to be on this kerfluffle? Because I’m not.

I’m thinking as a Board Member of the Exchange that I’m going to look at the whole marketplace and the one tool I have until I get that … is withholding my vote for those that qualify, it’s symbolic, but it’s all I got.

Commissioner Kreidler reiterated that the OIC cannot certify the plans if they do not meet the criteria of state and federal law.

Commissioner Kreidler: In aggregate, some of these plans were probably two months away with all of concerted effort applied to the them to get them through the hoops  it was a matter of some very significant challenges with their networks, their integration of [having] a preferred provider network as opposed to a contracted network there were other problems that were very significant. Everything from not having a pediatric hospital in your network, not having a retail pharmacy network, setting up networks you don’t do overnight. All these plans were notified that they’re not approved. That means they have to start over again with the federal government to get a filing number so that they can start again in order to be considered in some late start. Plus, you have the carriers who were approved, the qualified health plans that we have before us right now, all of whom made significant sacrifices….

We all knew that this first year was going to be bumpy… In this case we had to deal with all of them at one time — we’ve always dealt with one applicant at one time. We condensed that … in a way we’ve never done before in order to have as much time as possible. Clarifications did not come down from the federal government at the end of last year which is what we anticipated, they came later in the spring. Short of saying if you want to have more carriers come through then you better look at a postponement of the ACA in the state of Washington by a couple of months because that’s probably what it would take to make a difference in these plans, in order to have more plans … I can tell you right now, it ain’t going to happen.

Also of note, during public testimony Kaiser offered three choices it sees for the Board:

  1. Hold additional meetings should additional plans be approved
  2. Expressed they do not believe that the Aug 31 deadline is hard and fast, and they believe there is flexibility and have reached out to CCIIO and specifically asked that Richard ask for flexibility with CCIIO
  3. Plans that are in the appeal s process should be considered for approval and that the Board adjust deadlines to the degree they have the authority

They also noted in testimony that Kaiser’s on-Exchange plans have not been rejected by the OIC and they are willing to work with OIC to get them reviewed.

The Board voted to delay the vote for QHP certification in order to see what will become of the appeals.  Stay tuned for the announcement of the next hearing.