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Oregon health insurance exchange

Cover Oregon transitioning to Healthcare.gov partnership

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  • By
  • healthinsurance.org contributor
  • September 1, 2014

Although the Cover Oregon website has been largely regarded as a technological disaster, things should be much better during the 2015 open enrollment period, when enrollments will be processed through Healthcare.gov.  Despite myriad technological problems, Cover Oregon had still enrolled just over 100,000 people in private plans by August 25 (only about 79,000 of those policies are still active, the rest either didn’t pay their premiums or have cancelled their coverage at some point during the year; significant attrition is always expected in the individual insurance market)  Another 330,000 had enrolled in Medicaid by June (Oregon Health Plan); the majority of them completing their Medicaid enrollment via Cover Oregon.

Although Cover Oregon will be switching to a state-federal partnership exchange (technically a Supported State Based Marketplace, or SSBM) model by the start of the 2015 open enrollment period, the exchange is still working to repair itself.  In mid-June, Cover Oregon announced that they had selected a new executive director, Aaron Patnode.  The hiring of Patnode, who was previously a Kaiser Permanente manager, indicates that the exchange is still thinking long-term, and Patnode’s reputation as a problem solver and “turn-around artist” bodes well for the long-term success of the exchange in a partnership with HHS, or possibly as a fully state-run marketplace in 2016 or beyond.  In addition to Patnode, the state also hired “corporate turnaround expert” Clyde Hamstreet earlier this year in an effort to right the failed exchange.  Hamstreet and two assistants worked throughout the summer and the exchange has spent upwards of $600,000 on their services so far.

Although Healthcare.gov will be handling Oregon’s private plan enrollments for 2015, Cover Oregon will still be involved in Oregon Health Plan Medicaid enrollment.  The exchange confirmed in mid-August that the online application for Oregon Health Plan will be more streamlined and the eligibility determination process will be completely automated by 2015.  But there are still some doubts as to whether the entire process for seamless Medicaid enrollment will be up and running by November.

Oregon has completed the rate review process for 2015.  So although enrollment and 2015 rates will not be available on Healthcare.gov until November 15, Oregon residents can visit oregonhealthrates.org to see detailed information about the rate review process and the average rates for 2015.

Following months of efforts to fix the troubled website, Cover Oregon’s board voted on April 25 to switch to using Healthcare.gov rather than continue to try to repair the existing site.  The Cover Oregon website will still exist, but will redirect visitors to Healthcare.gov.  The SSBM model means that Cover Oregon will be working together with HHS, with the state retaining some functions and Healthcare.gov being utilized to enroll people in private plans through the exchange.  Tina Edlund, Director of the Oregon Health Agency, was selected in early May to lead the transition.

As part of the transition to Healthcare.gov, the 80,000 people who enrolled in private plans through Cover Oregon will have to re-enroll through Healthcare.gov during the 2015 open enrollment.  Not all of the eleven carriers selling products through Cover Oregon have relationships with Healthcare.gov, so there’s still a lot of administrative work to be done before November, when the 2015 open enrollment period begins.  Edlund has put a positive spin on the re-enrollment process, likening it to the annual open enrollment changes/updates for employer insurance.   But there is no doubt that it will be a tough sell for the exchange, especially given how challenging enrollment was through Cover Oregon for many of the people who enrolled for 2014.

Open enrollment for 2015 plans begins on November 15, 2014.  Cover Oregon worked extensively with the Center for Consumer Information and Insurance Oversight (CCIIO) this summer in an effort to be able to start re-enrolling 2014 members on the new Healthcare.gov platform prior to the start of open enrollment, but ultimately that does not look like it will be possible.  Thus, everyone who already purchased private coverage in 2014 will need to re-enroll starting on November 15; they will be enrolling at the same time as everyone signing up for new coverage.

The FBI and federal prosecutors have launched investigations into the failed exchange – which cost $248 million in tax dollars and was never able to enroll any applicants entirely online.  In early June, Governor John Kitzhaber asked Oregon Attorney General Ellen Rosenblum to take legal action against Oracle – the creator of the Cover Oregon website – in order to recover funds spent on the site.  But Oracle is fighting back, saying that officials at Cover Oregon and Oregon Health Authority are to blame for the debacle.  Both sides have sued each other, and the issue was still highly contentious by late August.

On February 18, four and a half months after open enrollment began, Cover Oregon’s website was finally functional enough for insurance agents and navigators to be able to process enrollments start to finish online.  Although the site is still not yet available for the general public to enroll online, the fact that electronic enrollment is possible at all is a huge improvement after months of relying on paper applications.  Oregon lawmakers are calling for an investigation into what went wrong with the exchange and how federal funds were spent along the way, further intensifying the pressure on Cover Oregon’s managers and IT team.

Despite the fact that Cover Oregon was the only exchange relying solely on paper applications for the first four months of open enrollment, its total enrollment numbers are around the middle of the road when compared with enrollment in other states – all of which were using much more efficient online applications for months.

Virtually all of the existing 2013 individual policies in Oregon were eligible for renewal into 2014.  Moda Health Plan Inc. and PacificSource Health Plans allowed existing policies to extend until the end of March.  And seven carriers allowed 2013 policies to be renewed until the end of 2014: Regence BlueCross BlueShield of Oregon, Kaiser Foundation Health Plan of the Northwest, Providence Health Plan, LifeWise Health Plan of Oregon, Health Net Health Plan of Oregon Inc., Time Insurance Co. and John Alden Life Insurance Co.  The renewal of 2013 plans into 2014 gave many Oregon residents in the individual market some breathing room as they wait for Cover Oregon’s website to improve.

The Oregon Medical Insurance Pool – a state run high risk pool – closed at the end of December, but the state implemented a temporary medical insurance program that automatically covered risk pool members who were not able to enroll in an exchange plan with a January 1 effective date.  The temporary plan remained in force until March 31, but ceased operation at that point.  Insureds who were still covered under the temporary program lost their coverage at the end of March, but the risk pool had been working closely with members to get them transitioned to new policies, so there were very few people still on the temporary program at that point.

The Oregon legislature authorized a state-run health insurance exchange in 2011, and the exchange developed a formal business plan, which the Legislature approved in February 2012 as a final go-ahead for the exchange. The U.S. Department of Health and Human Services (HHS) gave conditional approval to Cover Oregon in December 2012. The exchange has a 2014 budget of $105.7 million, which will be covered with federal grant money, and $62.4 million budget in 2015 according to a Cover Oregon spokesperson.

Cover Oregon is overseen by a nine-member board of directors, two of which are non-voting members. The board receives input from the Individual and Employer Consumer Advisory Committee. The 19-member committee holds monthly meetings, which are open to the public. The Consumer Advisory Committee was mandated by the legislation that established the state’s exchange. Committee members are selected by the board and must include individuals or employers who will use the exchange, individuals who will enroll in state medical assistance through the exchange, minority groups, and representatives of organizations that will people purchase insurance through the exchange. All geographic areas of the state must be represented.

Cover Oregon is acting as “active purchaser,” meaning it limits the number of health insurers that can participate in the exchange. Participating insurers are required to offer a bronze, silver and gold plan and have the option to offer additional plans.

According to Kaiser’s State Health Facts, about 17 percent of Oregon’s under-65 population is uninsured. Cover Oregon officials expected about 237,000 people to purchase health insurance through the exchange in 2014.

Contact the Oregon exchange

Cover Oregon
855-CoverOR (855-268-3767)

More Oregon health insurance exchange links

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