Open enrollment started in Rhode Island on November 15, but while most states were only allowing one month for people to complete their enrollment in time for a January 1 effective date, residents in Rhode Island have an additional week. In Rhode Island, you can renew or enroll anytime until December 23 and your coverage will be in force January 1.
In the first week of open enrollment, HealthSource RI (the state-run exchange) had processed 1,850 renewals and signed up 319 new enrollees. It’s a good start, and was about where the exchange expected to be after a week. But that left them one month – November 23 to December 23 – to renew coverage for more than 24,000 existing enrollees in order to prevent a lapse in coverage on January 1.
The state-run exchange, HealthSource RI, is operating two walk-in enrollment centers – one in Warwick and one in Providence – during the current open enrollment period, and residents can get in-person enrollment help at either one. The exchange has about 200 navigators working in their call center and walk-in locations, and have about 150 of them available during all open hours, which is double the staffing they had last year.
New plans, benchmark prices lower in 2015
The high-performing HealthSource RI exchange is offering 20 plans from three carriers in 2015, up from two last year. And there shouldn’t be much in the way of rate shock for existing exchange enrollees: Blue Cross Blue Shield of Rhode Island (which garnered 97 percent of the the exchange’s enrollees during the 2014 open enrollment period) is raising its base rate for individual plans by just 4.5 percent (although BCBS of RI had requested a rate hike of 8.9 percent, the final approved rate increase was just 4.5 percent).
Neighborhood Health Plan of Rhode Island (which enrolled the remaining 3 percent of the people who signed up during the first open enrollment) is decreasing its base rate by 7.3 percent. Between the two carriers, the weighted average rate increase is about 4.3 percent.
United Healthcare is joining the exchange for the first time, which will further help to increase competition and hold down rates in future years (United has participated in the RI SHOP exchange in 2014, offering small business plans, but is offering both small business and individual plans for 2015).
And for people who had the benchmark plan (second lowest-cost silver plan) in 2014 and are willing to switch to the new benchmark plan in 2015, premiums will be an average of nearly 11 percent lower in 2015, according to an analysis by the NY Times and confirmed by another analysis done by the Kaiser Family Foundation.
The modest overall rate increases are especially good news given that 2014 rates in Rhode Island were a little higher than the national average. In RI, the lowest cost bronze plan averages $264/month in 2014, versus a national average of $249.
Consumers who are dissatisfied with their health plan can contact HealthSourceRI and report the problem. The exchange is tracking that information to give consumers another source of data. HealthSourceRI directed Christine Ferguson explains that this is part of their fundamental believe that “…competition drives innovation, price, and quality”
2014 enrollees need to re-enroll for 2015
Health Source RI is not utilizing automatic renewals for 2015. They are undertaking a comprehensive outreach program to let current enrollees know how the renewal process will work, and advising them to contact the call center or use the exchange website to see the plans and prices available for 2015 and complete their renewals or policy changes during open enrollment.
Current enrollees who do not renew their coverage or select a new plan by December 23 will be without coverage as of January 1, as 2014 plans will terminate on December 31 if they are not renewed by the policy-holders. You can still enroll after December 23 (anytime up until February 15), but you’ll have a gap in coverage in Rhode Island if your enrollment is submitted after December 23.
If your application is submitted between December 24 and January 23, the effective date will be February 1. Applications submitted between January 24 and February 15 will have a March 1 effective date.
Health Source RI 2014 enrollment
As of August 2, Health Source RI had a total of 26,686 enrollments in private plans, and premiums had been paid for 25,892 of those plans – a 97 percent payment rate. Another 70,243 people had enrolled in the expanded Medicaid program through Health Source RI by mid-April, but Medicaid enrollment continues year-round, so it’s likely that number has continued to climb.
By October 4, the total number of people enrolled in private plans was 26,245. Based on the August numbers, it’s likely that this latest figure is for paid-up policies, but ACAsignups explains that it’s not entirely clear. Total enrollment remained steady in the fall, and was at about 26,300 as of November 1. This is more than twice as many people as the federal government had projected for RI.
The total private plan enrollment in Rhode Island during the first open enrollment period represented 40.6 percent of the eligible population, which was the third highest percentage in the country (trailing only Vermont and California).
Also as of August 2, the Rhode Island SHOP exchange had 258 enrolled small businesses with paid-up plans. Those plans were covering a total of 1,821 people (1,091 employees plus their dependents). By November 1, total SHOP enrollment had grown to about 2,400 people (the highest per-capita SHOP enrollment in the nation). Small businesses can enroll in plans anytime during the year.
RI lawmakers have been considering how to fund HealthSourceRI’s annual budget, starting in fiscal year 2016 when federal funds are used up. In some states, a per-member fee is being assessed, but RI’s small population (and correspondingly small enrollment total) would result in very high per-member fees if the exchanged were to rely solely on that method of funding.
The total HealthSource RI budget for the 2016 fiscal year that begins July 1, 2015 is projected to be $27.68 million. And while the federal government funded the exchange in the first two fiscal years, federal funding is expected to be only a little over $9 million in the upcoming fiscal year. That’s left the exchange asking the state to help with $14.5 million in funding, and it’s still unclear whether the funding request will be fulfilled.
In a letter to outgoing Governor Chafee that was sent with the exchange’s funding request, HealthSource RI director Christine Ferguson pointed out that the exchange used up considerable amounts of its initial federal funding helping the state to fix enrollment systems that are used not just for Medicaid, but also for other state-run assistance programs.
Future switch to Healthcare.gov?
As a result, lawmakers have been considering other options, including the possibility of switching to the federally facilitated marketplace (FFM). A bipartisan bill (H7817) introduced in the Rhode Island House of Representatives in March would have eliminated the state-run exchange at the end of 2014 and switched operations over to Healthcare.gov instead. At the end of May, a committee recommended that the bill be held for further study, but it may be taken up again in 2015.
Governor Lincoln Chafee (who was first a Republican, then an Independent, then a Democrat), did not run for re-election in 2014, and will be replaced in January by Governor-elect Gina Raimondo, also a Democrat. Prior to the election, Raimondo had said that her plan would be to keep the exchange but with a lowered budget (this is in opposition to the other candidates who had said they would either support switching to HealthCare.gov or working with Massachusetts to form a regional exchange).
If it had passed, this bill would have made RI the first state to give up a successful exchange and switch to an FFM (other states – Oregon and Nevada – have made the switch, but they had floundering state-run exchanges). The economies of scale that go along with relying on the FFM are significant: during the 2014 open enrollment period, the average cost-per-enrollee in the FFM was $647, while in RI it was $1,615.
But it’s certainly not a clear decision. Betsy Stubblefield Loucks, director of Health RIght, makes a good case for why the exchange should remain state-run, including one very important point that transcends the budget concerns: we don’t yet know how the Supreme Court is going to rule next June on the King v. Burwell case. If they rule that subsidies are not allowed in the federally-run exchanges, states like Rhode Island that established their own exchanges will be the only ones where subsidies remain legal.
Or create a new state regulatory agency?
And another bill, known as the HealthRIght Bill (H7819) would create a Rhode Island Healthcare Authority that would consolidate all of the insurance regulatory function that is currently spread across several agencies. The bill would also require that all insurance in Rhode Island be purchased via HealthSource RI. H7819 was considered by a House Committee in mid-June, and has been held for further study.
H7819 is being heralded by some as a progressive step, and by others as a government boondoggle. Either way, it would put much more control in the hands of state government than H7817, which would eliminate HealthSource RI and turn the exchange over to HHS.
No grandmothered plans
RI joined several other states in rejecting President Obama’s November 2013 policy cancellation “fix” that would have allowed existing plans to extend into 2014. Insureds in RI who received cancellation notices last fall had to enroll in a new ACA-compliant plan to replace their old coverage.
Health Source RI history
Gov. Chafee established the Rhode Island Health Benefits Exchange through an executive order in 2011. The state submitted a blueprint for a state-run exchange to the U.S. Department of Health and Human Services (HHS) and received conditional approval in December 2012. The state exchange was re-branded as Health Source RI in July 2013.
Chafee’s executive order established the exchange with the executive branch of state government and set up a 13-member board of directors. The board receives input from the Expert Advisory Committee (which includes representatives of insurance brokers, insurers and medical providers) and the Rhode Island Healthcare Reform Commission (which includes more than 200 stakeholders).
The Commission was established by Chafee in early 2011 and charged with implementing health care reform in the state. The Commission includes multiple workgroups that study and provide recommendations on various aspects of exchange operations.
According to the state about 126,000 people in Rhode Island were uninsured prior to 2014 — approximately 12 percent of the population. Between policies available on the exchange and through increased Medicaid enrollment, RI hopes to achieve near universal coverage. However, the state has not set a target date for reaching that goal.
Rhode Island’s exchange is one of only five in the country that did not offer any plans in 2014 that specifically excluded abortion coverage. This has caused some controversy with a local Catholic Bishop, and in neighboring Connecticut the exchange recently started offering four plans without abortion coverage. HealthSource RI director Ferguson said in late November that the exchange is working with the federal government to provide a multi-state plan that doesn’t cover abortion.
Contact the Rhode Island exchange
Health Source RI
More Rhode Island health insurance exchange links
State Exchange Profile: Rhode Island
The Henry J. Kaiser Family Foundation overview of Rhode Island’s
progress toward creating a state health insurance exchange.
Health Care Advocate, Office of the Attorney General
Serves all consumer and health care professionals with health-related problems.
Rhode Island Consumer Assistance Program
Assists people insured by private health plans, Medicaid, or other plans in resolving problems pertaining to their health coverage; assists uninsured residents with access to care.
(401) 462-9520 / firstname.lastname@example.org