Saturday Short Cuts

The Washington Health Benefit Exchange and Healthplanfinder, the state’s marketplace and website where people can buy individual and subsidized health insurance under health reform, have gone through some big changes lately.

Most important to consumers, Healthplanfinder is no longer the portal through which customers pay their insurance premiums.

On Tuesday, the organization announced that starting Sept. 24, Qualified Health Plan and Qualified Dental Plan customers will be required to pay their monthly premiums directly to their insurance companies, and the site will no longer accept those payments after Sept. 23.

The change mirrors a stop-gap measure put in place last year after problems plagued the site’s payment mechanism.

...Onizuka’s departure is another major shift. He was the exchange’s first and only CEO, overseeing the development and opening of the marketplace when the Affordable Care Act went into effect in October 2013, but announced early this month that his last day will be Aug. 28.

With a tax credit available under the ACA for small businesses purchasing health insurance through what were called SHOP (Small Business Health Options Program) exchanges, the report was bullish on the future.  In California, for example, as many as 456,500 small businesses of 25 or fewer employees would be eligible – using 2010 data from the depths of the recession.

So what happened?  As of April 2015, only 2,607 businesses had obtained insurance through the Covered California exchange – representing 17,308 lives altogether in a state of over 38 million.

In Washington, where the 2011 SBA report had found 110,000 small businesses could obtain the tax credit, 115 had by a July 16, 2015 report – representing 600 lives in a state with over 7 million residents.  Only one insurer offers coverage statewide.

National data is elusive, as the federal government hasn't broken out enrollment for the 33 SHOP exchanges it runs, but the most recent (November 2014) report by the General Accounting Office found only 76,000 lives covered through the 18 (counting the District of Columbia) state-run SHOP exchanges – almost half were in Vermont alone.

76K SHOP enrollees nationally in 2014 is a little misleading, because the program wasn't even operating in about 40 states; the technical problems at the October 2013 website launch meant that Healthcare.Gov didn't even activate the SHOP program their first year, nor was it operational in a few of the state-based exchanges.

However, total national enrollment in SHOP is only up to around 200,000 at most this year even with all 50 states (+DC) running full steam...and a good 15,000 of those are Congressional Staffers legally required to use the DC SHOP exchange. Unless the SHOP program is seriously retooled, it might be for the best to let it drop, not because it's terrible but because it might just not be necessary at all.

Sign-up season for President Barack Obama's health care law doesn't start for another couple of months, but the next few days are crucial for hundreds of thousands of customers at risk of losing financial aid when they renew coverage for 2016.

Call them tardy tax filers: an estimated 1.8 million households that got subsidies for their premiums last year but failed to file a 2014 tax return as required by the law, or left out key IRS paperwork.

Because of coordination issues between the IRS and marketplaces like, consumers who keep procrastinating into the fall are taking chances with their financial aid, according to insurers and the tax agency. That means, for example, that someone who's been paying a monthly premium of $90 could suddenly get hit with a bill for $360.

This is the official story behind the Investor's Business Daily op-ed which I roundly trashed the other day. It's not that any of the factual information presented is false, it's just that none of it is particularly surprising or reflects badly on the ACA, making their attack kind of stupid on the face of it.

Nevada Health CO-OP is shutting down by Jan. 1, the not-for-profit health plan announced Wednesday. It is now the third co-op to fold, and data suggest it's possible other co-ops may follow suit.

“The majority of them are still reporting losses,” said Sally Rosen, assistant vice president at ratings agency A.M. Best Co., which has tracked the financial performance of co-ops. “There is some concern about them.”

The closure in Nevada also reinforces how difficult it is for new insurers to enter a marketplace that is dominated by large carriers with noticeable brands and footprints, such as local Blue Cross and Blue Shield plans and national giants like Aetna and Anthem.

Bigger might be better, but it can also be pricier—at least when it comes to Obamacare.

A new analysis found that the largest insurer in each of the states served by raised their prices in 2015 much more sharply—by an average of 10 full percentage points—than smaller competitors on that federal Obamacare marketplace.

Those steeper price hikes for monthly premiums didn't seem warranted by the level of health claims made by customers of those bigger plans, according to the study published in the journal Technology Science, by Harvard University's Institute for Quantitative Social Science.

They also stand in contrast to the belief that economies of scale will result in lower prices.

...The insurance comparison company found that in a dozen major counties across the U.S., a popular kind of health insurance plan tends to be significantly more expensive—by an average of 12 percent—when offered by health-care providers such as hospitals, as opposed to traditional insurers.


...In the same vein, the findings published in Technology Science by Harvard's Grace Gee and co-author Eugene Wang suggest that "the largest on-exchange issuers may be in a better position to practice anti-competitive pricing compared to their same-state counterparts," according to the study.

"This really raises questions about the recent Anthem, Cigna and Humana mergers," she said.

..."On average, the largest issuers raised rates by 23.9 percent, while the other issuers only raised rates by 13.7 percent," the authors wrote.

Corporate America stands to save trillions of dollars by pushing workers and retirees off company-sponsored health plans onto less costly insurance exchanges, and household names from General Electric (GE - Get Report) to IBM  (IBM - Get Report) and Wal-Mart Stores (WMT - Get Report) are on the cutting edge of the shift.

GE alone reported saving $3.3 billion by moving retired production workers to a private exchange, where they will join salaried retirees, according to a quarterly filing last month. The Fairfield, Conn.-based company had already reported $832 million in savings on retiree health benefits in 2012 and $586 million in 2014.

"We are in a transitional period," Thomas Kochan, a professor of employment policy at the Massachusetts Institute of Technology, said in an interview. "U.S. corporations would save an aggregate $3.25 trillion by moving their employees and retirees to private exchanges."

I admit to being a little unclear as to just what any of this has to do with the ACA itself, which actually requres corporations to provide health insurance coverage for their full-time employees, but I'm sure someone will explain it to me:

Many employers have already moved, or are considering moving, retirees under 65 from sponsored plans to defined contributions that could be used in federal or state Affordable Care Act exchanges, according to a Kaiser Family Foundation report last year. "Observers predict this will be a major trend going forward and in some cases see the ACA marketplaces as further displacing employer-provided coverage," author Frank McArdle said in the report.

  • Louisiana Republican Rep. Charles Boustany's legislation, the Small Business Healthcare Relief Act, which would allow small business to continue reimbursing employee health coverage via health reimbursement accounts.
  • The Restoring Access to Medication Act, which repeals an ACA provision that banned the use of flexible spending accounts to purchase over-the-counter drugs
  • The Protecting Affordable Coverage For Employees bill, which blocks the expansion of the small business market to groups with up to 100 employees
  • Legislation to repeal the provision requiring certain large employers to automatically enroll workers into health plans.
  • The Commonsense Reporting and Verification Act, sponsored by Reps. Diane Black (R-KY) and Mike Thompson (D-CA) that would streamline employer reporting requirements.
  • The Simplifying Technical Aspects Regarding Seasonality (STARS) Act, which clarifies the definition of seasonal employment under the ACA's employer mandate provision.

The Associated Press is accusing the HHS inspector general of misstating the Arizona insurance co-op's enrollment numbers in a recent report, saying it missed one of two annual reports filed to the National Association of Insurance Commissioners.

Meritus insured 2,662 people in its HMO in addition to the 869 people enrolled in a PPO, the AP said. The IG only included the PPO number in its report. The federal audit also said Meritus lost $7.2 million last year, while the AP found it actually lost $16.6 million between the two plans.

MNsure is opening a temporary special enrollment period for Minnesotans who were enrolled in Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage, but were not given enough information about the other choices offered through the exchange.

The COBRA special enrollment period began Monday and runs through Oct. 15. Anyone who meets three criteria are encouraged to contact MNsure. Those include enrollment in COBRA in the past 18 months, current enrollment in COBRA or enrollment that ended before or during the SEP, and failing to enroll in a QHP through MNsure since being offered COBRA coverage. MNsure will verify applicants' eligibility before coverage goes into effect.