OIC rules roundly criticized | Oregon looks for partner exchange | Lobbyists grade session a D+

“God is in the detail” is the root phrase which has become “The devil is in the detail.”  So it is with this edition of 5 Things.

Whether you find God or the devil in the detail these days, we can all agree that the details matter today as much as ever.  Just ask the OIC, the Exchange, Oregon Governor Kitzhaber, and the others we’re watching in this edition who find the details a curse as much as a blessing.

DJ 5 things updated

1. OIC network adequacy rule most “intense” in nation

The latest OIC draft rule regarding network adequacy of health plans was released last Thursday.  It is a product of limited stakeholder input, but with extensive consequence for plans and providers alike.

We put together a few posts highlighting the potential impacts on providers, including one specifically discussing what might happen in the rural areas.  But, this rule is a problem for providers and plans alike, with the Association of Washington Health Plans saying this is “by far the most extensive, complex and intense” set of network adequacy rules in the country.

2. Perhaps the most concentrated individual market in US

Washington has generally had a balanced and competitive commercial insurance marketplace, with Regence, Premera, and Group Health battling it out for market share.  With four months of exchange enrollment data in, the Kaiser Family Foundation culled together enrollment data from across the country.  We ran our story on it here.

The bottom line is this:  Washington now has perhaps the most highly concentrated exchange marketplace in the country, where Premera/Lifewise has 62% of members enrolled through Jan 31st.  We could see this coming last summer, based on which plans were approved by the OIC.  Still, seeing it take shape – and thinking about what the implications might be – is a little surprising.


3.  Jeff Roe to take over as CEO of Premera this fall

We were honored to have Jeff Roe on our closing panel at our 2014 State of Reform Health Policy Conference.  He had been named the new President of Premera at that time, with the expectation that he would be named CEO a few months later.  That happened this last week.

So, what does it mean?  An even more invigorated Premera in the marketplace?  Given how active it’s been in Olympia and in the marketplace, that would really be something.

4. Lobbyists give legislature a C- on health policy

Stuart Elway, the dean of the Washington State pollster community, asked the 808 registered lobbyists in Washington State to grade the 2014 legislature.  This was the fifth year he solicited their feedback.

Elway released his results on Tuesday.  According to lobbyists, known in Olympia as the “Third House,” the legislature earned a D+ overall.  They did slightly better on health care policy with a C-.

5. Oregon beginning to discuss using another exchange 

More heads have been rolling in Oregon related to Cover Oregon with the release of findings last week that read like a case study of how to poorly manage a project. With the clock running now ahead of next fall, the board is considering using the federal exchange.  (Maybe give them a call, HealthPlanFinder?)

Governor Kitzhaber is running for re-election to an “historic” fourth term this fall.  But, this Cover Oregon mess has become a credible threat to undermine his campaign.  It would be a tremendous irony if Kitzhaber were to lose in November as a result, in part, of reform’s implementation.  The former ER doc has been a national figure in health reform for almost three decades.