Virginia health insurance exchange
Virginia health insurance exchange
By Louise Norris
July 24, 2014
Total enrollment in Virginia and across the nation has continued to climb in the two months since mid-April (thanks to qualifying events and special open enrollment periods), but HHS has not yet released new enrollment data. 216,356 people had selected a private plan in the Virginia exchange by April 19 – more than double the number who had done so by March 1. The enrollment total included people who signed up after open enrollment ended on March 31, either through a special open enrollment triggered by a qualifying event, or through the extension HHS allowed for people who began their enrollment by the end of March. An additional 48,660 people had been found to be eligible for Medicaid or CHIP by mid-April.
The Virginia Chamber of Commerce announced in early June that it is working with ChamberSolutions to create a new small business private health insurance marketplace called Virginia Benefits Market. It’s unclear when the marketplace will have plans available for purchase, or what sort of coverage will be available, but the Chamber has said that the plans will be available for small businesses that are Chamber members as well as those that are not.
Virginia has not expanded Medicaid (meaning that there are some 400,000 people currently in the coverage gap), but was working out the details of the “Virginia way” that political leaders are offering as an alternative to Medicaid expansion. Newly-inaugurated Governor Terry McAuliffe has said that Medicaid expansion is one of his main priorities, and is considering pushing it through without the support of the state legislature. Public support for Medicaid expansion in Virginia waned in the first few months of 2014 however, and the fate of Medicaid expansion in Virginia is still uncertain.
In early April, the Virginia Senate finance committee approved a state budget that included funding to create a private marketplace (Marketplace Virginia) that would use federal funds to help provide private health insurance to people who would otherwise be covered by Medicaid if the state were to expand the program. But when it came time to vote on the budget, Republicans in the Senate rejected it because of the Marketplace Virginia inclusion, and a stale-mate ensued. A government shut-down was looming if an agreement wasn’t reached before the July 1 start of the new fiscal year. But in early June, Democratic Senator Phillip Puckett resigned, giving the GOP control of the state Senate; the budget quickly passed. Gov. McAuliffe approved the budget on June 20, and the shut-down was averted. But he used his line-item veto powers to remove several Republican additions to the budget that would have blocked Medicaid expansion. Republicans are sure to push back against what they consider an over-reach of executive powers, but McAuliffe has said he will expand Medicaid with or without their support.
Virginia’s exchange is run by HHS, with nine insurers offering a total of 105 different plans. The competition among carriers means that rates are lower than the national average: Across all ages, the average lowest cost bronze plan is $237/month, compared with $249 nationally. Plans in the exchange are sold by Optima Health, Anthem Blue Cross and Blue Shield, CoventryOne, CareFirst BlueChoice, Inc. Innovation Health Insurance Company, CareFirst BlueCross BlueShield, Kaiser Permanente, Aetna and Anthem Health Plans of Virginia.
In early May, insurers in Virginia released their 2015 rates, with rate increases ranging from 3.3 percent to 14.9 percent.
In good news for the exchange, on February 18 a Federal Judge in Virginia rejected the arguments of three Virginia plaintiffs in a lawsuit claiming that subsidies were only to be available in states running their own exchanges. This latest decision comes on the heels of similar rulings on other lawsuits that made the same challenge to the ACA.
Former Virginia Gov. Bob McDonnell, a Republican, opposed the Affordable Care Act. But along with the Republican-controlled General Assembly, he was conflicted as how best to resist the law’s implementation in the state. In a 2011 letter to state legislative leaders, McDonnell wrote of extreme difficulty in determining whether “ceding control of an exchange to the federal government or creating our own is in the Commonwealth’s best interest.” The governor’s and General Assembly’s actions over the next few years reflected their shared reluctance to implement either option.
In August 2010, McDonnell appointed the Health Reform Initiative Advisory Council. The council issued a report in December 2010 and recommended that Virginia implement a state-based exchange.
The Virginia General Assembly passed legislation in 2010 to invalidate the individual mandate of the Affordable Care Act, and the state attorney general filed a lawsuit against Kathleen Sebelius, the secretary of the U.S. Department of Health and Human Services, based on the new law. After a series of legal actions, the state law was ultimately ruled invalid.
In 2011, the General Assembly passed legislation that was supportive of a state-based exchange, and McDonnell signed the bill into law. However, throughout the 2012 session the General Assembly failed to pass additional legislation necessary to move ahead with exchange implementation.
Finally, after President Obama’s re-election, McDonnell notified HHS that Virginia would not proceed with a state-based exchange nor Medicaid expansion. While the norm for the federally operated exchange leaves no role for the state, McDonnell did lobby for oversight of the health plans that will operate on the exchange within the state. HHS approved McDonnell’s request in March 2013, and the federally-run exchange opened for business on October 1 with health plans overseen by the state Division of Insurance.
In January 2014, Governor Terry McAuliffe was inaugurated in Virginia, and unlike McDonnell, McAuliffe is very supportive of the ACA and of Medicaid expansion in Virginia.
According to Kaiser’s State Health Facts, 14 percent of Virginians do not have health insurance.
Virginia health insurance exchange links
Virginia 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.
(877) 310-6560 / firstname.lastname@example.org
State Exchange Profile: Virginia
The Henry J. Kaiser Family Foundation overview of Virginia’s progress toward creating a state health insurance exchange.