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New Mexico health insurance exchange

NM exchange rates decreasing; new carrier and new leadership on board

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  • By
  • healthinsurance.org contributor
  • November 2, 2014

Lower 2015 rates and a new carrier

Open enrollment begins on November 15, and it looks like sticker shock won’t be a problem in New Mexico.  Across the four carriers that participated in the exchange in 2014, the weighted average premium change for 2015 will be a decrease of 1.65 percent.  This is especially good news given that in 2014, the lowest cost bronze plan in the NM exchange averages $217 a month, quite a bit lower than the national average of $249.

Christus Health Plan is also joining the exchange in 2015, bringing the total number of carriers to five. Christus is joining Health Care Service Corporation (Blue Cross and Blue Shield of New Mexico), Molina Healthcare of New Mexico, New Mexico Health Connections and Presbyterian Health Plan.

New leadership and marketing

The New Mexico exchange (NMHIX) will continue to operate as a partnership exchange with the federal government, and will use HealthCare.gov for individual plan enrollments during the upcoming open enrollment.  Small businesses will use the state-run exchange portal.

In late August, NMHIX hired CEO Amy Doud, who came to them from the Idaho exchange that she had run for 15 months (Idaho was a partnership exchange in 2014, but will be a state-run exchange in 2015). Doud’s focus is on working with agents and brokers to drive up enrollment numbers, and much of Idaho’s success during the first open enrollment has been attributed to their strong partnership with agents and brokers.

Just a few weeks before the start of open enrollment, NMHIX hired a new Director of Communications and Outreach.  Linda Wedeen has three decades of experience in marketing and communications in New Mexico.

The exchange is also looking for additional enrollment counselors, and is particularly focused on recruiting enrollment counselors who will be able to reach out to the Native American population in the state.

In the summer of 2013, NMHIX began working with Milwaukee-based marketing firm BVK to market and promote the exchange throughout the state.  In July 2014, the exchange board unanimously voted to renew the BVK contract for $6.2 million.  But in September, NMHIX Chair Dr. J.R. Damron expressed dissatisfaction with the marketing approach, and highlighted recent survey numbers that found the majority of uninsured adults in NM were unaware of the services the exchange provides, and even more had not heard about the exchange on various media sources.

The agreement with BVK was terminated and the marketing contract was put out for bidding in September.  In early October, 18 firms submitted bids; 12 are local New Mexico companies.  BVK did not bid for the new contract, but has said it’s committed to working with the new contractor for a smooth hand-off.

Be Well New Mexico enrollment

Obamacare enrollment in New Mexico has continued during the summer, thanks to qualifying events that trigger special open enrollment periods.  HHS will release the total enrollment increase in November.  But by April 15, 34,966 people had completed their private plan selections through the New Mexico Exchange. 

An additional 30,147 exchange applicants had been found to be eligible for the state’s expanded Medicaid program during open enrollment.  But Medicaid enrollment is year-round, and most eligible residents in New Mexico have enrolled directly with the state’s Medicaid program rather than going through the exchange.  By late September, the total new enrollment in Medicaid had reached 165,000.  That’s 76 percent of the total eligible population, making New Mexico one of the most successful states for Medicaid enrollment. 

New Mexico had the ninth-highest drop in uninsured rate during the first half of 2014.  According to a Gallup poll released in August, the state’s uninsured rate was 20.2 percent in 2013, and had dropped to 15.2 percent by mid-2014.

ACA-created CO-OP doing well

New Mexico Health Connections, one of the four carriers that offered plans in 2014 through NMHIX, is a CO-OP (consumer oriented and operated plan) established with funding provided by the ACA.  By June 2014, New Mexico Health Connections had 9,142 enrollees.  And by the end of September, New Mexico Health Connection’s enrollment was “well past 15,000″ members.  (qualifying events trigger special enrollment periods, so enrollment can continue to increase year-round.  For some health plans, this has been offset by members cancelling their coverage or not paying their premiums – that does not appear to be the case for NMHC).

The CO-OP brought in $10.3 million in premiums during the first six months of 2014, and paid out $9.3 million in claims.  All in all, things look pretty good for the state’s ACA-created CO-OP’s first year.

The ACA’s subsidies

According to a report released by HHS in mid-June, the average after-subsidy premium in the New Mexico exchange is $120/month, significantly higher than the $82/month average across the 36 federally-facilitated marketplaces (FFM).  And only 78% of New Mexico exchange enrollees received subsidies, compared with 87% across all of the FFMs.

The average after-subsidy premium in New Mexico is the fifth highest among the 36 FFMs, but NM Superintendent of Insurance John Franchini attributes that to one of the four carriers in the exchange charging premiums that were 20 to 25 percent higher than the other three carriers.  He didn’t say which carrier it was, but noted that it was a carrier with which people were already familiar, and about a third of the enrollees picked that carrier’s plans, despite the higher premiums.

Since the tax credit subsidies are based on the cost of the second-lowest-price Silver plan, an outlier plan on the high end will mean higher average after-subsidy premiums if a significant number of people choose to apply their subsidy towards the high cost plan instead of selecting a less expensive policy.  Franchini notes that even though $120/month is higher than the average in most of the other FFM states, it’s still far less expensive than people would have been paying prior to the implementation of Obamacare and the premium tax credits.

An expensive exchange

New Mexico’s exchange had the seventh highest cost per enrollee in the nation, coming in at about $6181 per enrollee when total start-up and operating expenses were divided among the 32,062 people who had selected a private plan by the end of March.

However, nearly three thousand more New Mexicans completed their Obamacare enrollment in the first half of April, which brings the total cost per enrollee down to about $5668.  This is still far higher than the national average of $922 though.  The exchange must be financially self-sufficient by 2016 and is still working out the details of how to get there.

A unique exchange design

New Mexico settled on a unique approach to its health insurance marketplace. For individuals seeking health insurance, the state operates Be Well New Mexico in partnership with the federal government. Small businesses use the state-run SHOP exchange.

The state had previously announced that it would run all aspects of the exchange on its own, the exchange board determined in May 2013 that it did not have enough time to get computer systems up and running. (While Utah is also using a hybrid approach, the specifics are different. Utah is leaving the individual exchange exclusively to the federal government and operating the small business exchange on its own.).

Originally New Mexico had planned to have its own individual exchange operational by October 1, 2014, in time for the 2015 open enrollment that begins on November 15.  But ultimately the state decided to continue to use HealthCare.gov for individual plan enrollments in 2015.  General open enrollment doesn’t start again until November 15, but people with qualifying events can enroll during their own special open enrollment window.

Enrollees can also call 1-855-99-NMHIX for personal assistance with individual coverage, and the exchange created a website where consumers can see average prices for individual plans in order to get an idea of what’s available from the five participating insurers without having to access the full services at Healthcare.gov.

The state-run SHOP exchange

By March 18, the state-run SHOP exchange had enrolled 524 people, including 345 employees and 179 of their dependents.  Nearly 1500 small businesses had started their applications in the SHOP exchange by the end of 2013, and several thousand employee names had been entered into the system, so total enrollment is likely to grow substantially over the next several months as employers settle on a plan.  SHOP enrollment runs year-round, so businesses can continue to apply even though the individual open enrollment window has ended.

Establishing the exchange

New Mexico’s path to establishing an exchange was atypical. New Mexico Gov. Susana Martinez, a Republican who opposes the federal health reform law, has been the driving force in establishing an exchange and advocating for the state-run model.

Martinez designated that the Health Insurance Alliance develop the state exchange. The Health Insurance Alliance is a nonprofit association of health plans created by the state Legislature in 1994 to offer health insurance coverage to small employers. Later, the Senate and House both approved a state-run exchange.

New Mexico health insurance exchange links

Be Well New Mexico
For individuals and families (small businesses should contact healthcare.gov)

Guide to the New Mexico Health Insurance Exchange
Includes details about carriers, important dates, eligibility and enrollment information

New Mexico Health Insurance Exchange
Administrative and start-up information

New Mexico Health Insurance Alliance

State Exchange Profile: New Mexico 
The Henry J. Kaiser Family Foundation overview of New Mexico’s progress toward creating a state health insurance exchange.