Washington health insurance exchange
Washington health insurance exchange
By Louise Norris
July 24, 2014
By June 1, enrollment in private plans through Washington Healthplanfinder had grown to 156,155, or about 32 percent of the state’s eligible population, making Washington’s exchange one of the most successful in the country. In addition to the private plan enrollments, 909,752 people had enrolled in Medicaid through the Washington exchange by mid-April (nearly half of those people were already enrolled previously, but renewed their Medicaid coverage through the exchange), a number that will continue to climb year-round, as there is no open enrollment period for Medicaid. Also by June 1, another 171,286 people had enrolled in private individual plans outside of the exchange in Washington, making the off-exchange market in Washington even more robust than the exchange market (off-exchange plans are all ACA-compliant, but there are no subsidies available to offset the premiums and cost-sharing for off-exchange plans).
Open enrollment for 2014 is over, but enrollment continues to grow both on and off-exchange as a result of qualifying events that trigger special open enrollment periods. The next general open enrollment will begin on November 15, for 2015 policies. In addition to the normal qualifying events, Washington Healthplanfinder has followed suit with HHS and the federally-facilitated marketplaces in allowing residents who are currently enrolled in COBRA to select a marketplace plan instead – with subsidies if eligible. This offer runs until July 1 – after that date, people enrolled in COBRA will have to wait either until general open enrollment in the fall, or until their COBRA is exhausted and a special open enrollment period is triggered.
In May, insurance carriers filed rates for 2015 plans in the individual market in Washington, including plans that will be sold in the exchange as well as off-exchange. For carriers that are selling plans in 2014, the average rate increase for 2015 was 8.25 percent, which is the lowest in seven years. But the two highest rate increases (Group Health Options, at 14.2 percent, and Time Insurance – which has few policies in Washington – at 26 percent) are for plans that are only sold off-exchange. If we look at just the plans that are sold in the exchange, the average rate increase is only 5.4 percent, and includes a rate decrease for Molina Healthcare of Washington.
In addition to lower-than-normal rate increases, the filed rates represent a large increase in the number of plans that will be available next year, both on and off-exchange. If approved by the state, there will be 114 plans in the exchange next year (up from 46 this year) and 119 plans outside the exchange (up from 51 this year).
In Washington, enrollees pay their premiums directly to Washington Healthplanfinder and the exchange then sends the premiums out to each insurer. This is different from the standard billing method used in most other states, where insureds pay their premiums to the carriers after enrolling through the exchange. For the most part, this has worked smoothly in Washington, but a technological invoice problem has impacted roughly 25,000 enrollments (about 15 percent of the total) and has resulted in premiums being paid even though the carrier has no record of the enrollee. As of early June, the exchange was working to fix the problem.
Washington Insurance Commissioner Mike Kreidler and Governor Jay Inslee took a strong progressive stance with regards to consumer protections: existing plans that did not meet ACA standards were cancelled at the end of 2013 and needed to be replaced on January 1 with new, ACA-compliant policies. Following President Obama’s announcement that carriers could extend existing plans into 2014 if states allowed it, Kreidler and Inslee were quick to declare that Washington would not allow non-compliant plans to continue into 2014.
Washington was one of the first states to move ahead with a state-run health insurance marketplace as envisioned by the Affordable Care Act. Former Gov. Chris Gregoire signed legislation creating the state exchange in May 2011. In March 2012 Gregoire signed additional legislation, which further defined how the exchange will be governed and operated.
The Washington Health Care Authority (HCA) helped establish the Washington marketplace. HCA transitioned governing authority to an 11-member board of directors in March 2012. The governor appointed eight voting members and a board chairperson who votes only in if needed to break a tie. In addition, the insurance commissioner and the administrator of the Health Care Authority are non-voting members.
In 2014, eight insurers are selling individual policies through the Washington Healthplanfinder:
- Community Health Plan of Washington
- Group Health Cooperative
- Coordinated Care
- Kaiser Foundation Health Plan of the Northwest
- Molina Healthcare of Washington
- Premera Blue Cross
The carriers are offering a total of 46 individual policy options in 2014, but not all options are available in all counties. Pediatric dental-only coverage is being offered by Delta Dental of Washington, Kaiser Foundation Health Plan of the Northwest, LifeWise, and Premera Blue Cross in all 39 counties.
Four more carriers have submitted plans to join Washington Healthplanfinder for 2015: Moda, Columbia United Providers, Health Alliance Northwest Health Plan, and United Healthcare of Washington. The addition of more carriers and plans demonstrates how successful Washington’s exchange has been in its first year, and the new plans should be beneficial in terms of competition, consumer choice, and rate stabilization.
In March, 2014, Washington legislators tried to pass a bill that would have created much more transparency in the state’s health insurance industry, providing consumers with data on how much insurers are paying for services in each region of the state. It had widespread support, but opposition from Premera Blue Cross – the state’s largest insurer – sank the bill and Washington did not join the 11 other states that have all-payer claims databases.
The federal government is funding the Washington Healthplanfinder in 2014. In 2015, marketplace operations will be funded by the state with $21 million that was previously earmarked for the state’s high-risk insurance pool, which will be operated through the exchange, and with a 2 percent tax on premiums on plans sold through the exchange.
According to the U.S. Department of Health and Human Services (HHS), about 835,000 Washington residents are eligible to use the new marketplace. The Washington insurance commissioner’s office estimates that 477,400 residents will qualify for subsidies, and state set a target of enrolling 130,000 people through the marketplace by Jan. 1 and 280,000 people in 2014. Obviously it fell short of that amount, but enrollment will continue throughout 2014 as a result of qualifying events, and the 2015 open enrollment period begins on November 15, 2014.
Contact the Washington exchange
More Washington State health insurance exchange links
Washington Health Benefit Exchange
Information about marketplace planning and development
State Exchange Profile: Washington
The Henry J. Kaiser Family Foundation overview of Washington’s progress toward creating a state health insurance exchange.