Highlights and updates
- Enrollment deadline now the 15th of the month (not the 23rd)
- Open enrollment for 2018 coverage extended to January 15
- All counties will have coverage options in 2018
- Seven insurers will offer plans in 2018
- Half of the proposed 2018 rate hike due to Trump-caused uncertainty
Washington exchange overview
Washington runs its own exchange, Washington Healthplanfinder. Carrier participation in the exchange is robust, with nine insurers offering plans for 2017. The state also has a strong off-exchange market, but subsidies are only available through Washington Healthplanfinder.
Until early 2017, Washington Healthplanfinder was one of three exchanges that allowed QHP enrollments to be completed as late as the 23rd of the month for a first of the following month effective date (the other two are Massachusetts and Rhode Island). But as of April 2017, Washington Healthplanfinder announced that they would be switching to a 15th of the month enrollment deadline, which means they’re now following the same rules that nearly every other state uses. If you enroll in a plan by the 15th of the month, your coverage will start the first of the following month. If you enroll after the 15th, your coverage will start the first of the second following month (note that there are exceptions for certain qualifying events, as is the case nationwide).
open enrollment for 2018 coverage extended until January 15
Nationwide, open enrollment for 2018 coverage is scheduled to begin November 1, 2017, and end December 15, 2017. State-run exchanges have some flexibility with the dates, as HHS revised the scheduled open enrollment period in April 2017 (it had previously been slated to last three months), and acknowledged that state-run exchanges might not be able to make the changes necessary to switch to the new schedule by the fall of 2017.
The state-run exchanges in Colorado, DC, Rhode Island, Minnesota, and Washington have all announced special enrollment periods that will be added after open enrollment ends in order to effectively extend open enrollment beyond mid-December. Washington Healthplanfinder has a web page that states that open enrollment will run until January 15, 2018, and they confirmed by email that they have added a special enrollment period that will run from December 16 to January 15. They are encouraging all applicants to enroll by December 15, however, in order to secure coverage with a January 1 effective date (as noted above, the 15th of the month is now the deadline to get a first of the following month effective date in Washington).
2018: All counties will have coverage options
For 2018, seven insurers have filed on-exchange plans, and every area of the state will have on-exchange options available when open enrollment begins in November. This comes after several weeks of negotiations between state regulators and the insurers — when rates and plans were originally filed, there were only six insurers with on-exchange plans for 2018, and three of the current insurers had indicated their intent to leave the exchange.
Initially, BridgeSpan and Regence BlueShield had both said they would discontinue their exchange participation and would only offer off-exchange plans after 2017. And another exchange insurer, Community Health Plan of Washington, is exiting the individual market altogether.
At that point, no individual market insurers had filed plans for 2018 in Klickitat County or Grays Harbor County. So Washington Insurance Commissioner Mike Kreidler began working with insurers to fill in the bare counties. Kreidler’s first success was in Grays Harbor County; he announced on June 19 that Premera had stepped up and agreed to offer coverage there.
And on June 26, Kreidler announced that two insurance companies had agreed to offer exchange plans in Klickitat County, including BridgeSpan. This is particularly notable given that BridgeSpan had initially intended to exit the Washington exchange altogether at the end of 2017. But thanks to Kreidler’s negotiations, BridgeSpan and Molina both agreed to offer plans in the exchange in Klickitat County in 2018. BridgeSpan will also offer off-exchange plans in Klickitat County.
I spoke with the Washington Office of the Insurance Commissioner about the process they went through to entice insurers into Grays Harbor and Klickitat counties. They described daily phone calls and an unflagging determination on the part of Commissioner Kreidler, and also a commitment on the part of the insurers to serve the people of Washington. They noted that most of the insurers are local/regional carriers that have a long history in Washington. None of the insurers knew where other insurers would opt to participate in 2018 before the rates and plans were initially filed in early June. But once it became apparent that no insurers had filed plans for Grays Harbor and Klickitat counties, there was a commitment on the part of insurers and Commissioner Kreidler’s office to solve the problem.
In a June 8 statement about the shrinking insurer participation and coverage areas, Kreidler stated that
“the uncertainty the Trump administration and the GOP-controlled Congress has sowed for months is sabotaging the progress we’ve made. Their actions, including failing to commit to fund the cost-sharing subsidies, not enforcing the individual mandate, and continuing to push in secret the severely flawed American Health Care Act are eroding confidence health insurers have in the market here and across the nation. These actions only increase premiums and decrease insurer participation.”
Looking ahead to 2018: Washington wants feds to commit to funding CSRs, but rate filings indicate insurers are skittish
The Washington exchange sent a letter to HHS Secretary Tom Price in April, urging him to “take the necessary steps to implement a permanent fix” to the issue surrounding the funding of cost-sharing reductions (CSR). They also asked HHS to consider a national reinsurance program and to adequately enforce the individual mandate — both of which would help to stabilize the individual insurance market.
House Republicans filed a lawsuit (House v. Burwell, now House v. Price) against the Obama Administration in 2014, arguing that the federal funding for CSRs had never been appropriated by Congress, and was being illegally distributed to insurers. A court sided with House Republicans in 2016, but the Obama Administration appealed and the case is still ongoing; CSR funding has continued to flow to insurers across the country, to the tune of $7 billion in 2016 (the lawsuit is currently pended, by agreement of House Republicans and the Trump Administration, until August 2017 — which is after rate filings for 2018 will be complete).
But the Trump Administration has created considerable uncertainty in terms of whether that funding will continue to be provided. Without it, a Kaiser Family Foundation analysis indicates that silver plan premiums in the individual market could increase by 19 percent (in addition to all the other variables that drive price increases), and some insurers would simply decide to exit the exchanges or the full individual market.
Washington has also joined 14 other states and the District of Columbia in filing a motion to intervene in the CSR lawsuit. Washington is arguing — correctly — that a discontinuation of federal funding for cost-sharing reductions would jeopardize the state’s individual market.
2018 rates: 22.3% proposed increase; would be less than half of that without Trump/GOP sabotage
Insurers in Washington had to file rates and plans for 2018 by June 7, 2017. On June 8, Kreidler’s office published a summary of what had been filed (rate filings are available here), and publicized the filing details on June 19. The average proposed rate increase in Washington, before any subsidies are applied, is 22.3 percent. At ACA Signups, Charles Gaba has used the data that Washington insurers provided to break out the portion of the rate increase that’s due to the Trump Administration and GOP sabotage of the individual markets. Without it, the average proposed rate increase in Washington would be 10.6 percent. So more than half of the proposed rate increase in Washington is due to the fact that the Trump Administration hasn’t committed to paying CSRs or enforcing the individual mandate.
For 2018, according to the filings that insurers submitted:
Seven insurers have filed on-exchange plans (here is their proposed county-by-county participation, although it does not include the fact that Premera will offer coverage in Grays Harbor, or that Molina and BridgeSpan will offer coverage in Klickitat County), with the following proposed average rate increases:
- Coordinated Care Corporation (the only insurer that will offer exchange plans in Chelan and Douglas counties): 29.3 percent. Coordinated Care Corp is a Centene Company, and as is the case in several other states, they’re expanding their marketplace coverage area for 2018. Their filing includes two new counties (Columbia and Kittitas counties).
- Kaiser Foundation Health Plan of Washington (also filed off-exchange plans): 12.9 percent
- Kaiser Foundation Health Plan of the Northwest (also filed off-exchange plans): 12.9 percent
- Lifewise Health Plan of Washington: 21.6 percent
- Molina Healthcare of Washington: 38.5 percent
- Premera Blue Cross: 27.7 percent
- BridgeSpan: 23 percent (will offer exchange plans in Klickitat County)
Washington Healthplanfinder has expressed concern about the magnitude of the rate increases, and noted that while 60 percent of exchange enrollees in Washington are eligible for premium subsidies that will offset all or part of the rate increases, the rest of the exchange population — along with everyone who buys off-exchange coverage — will bear the full brunt of the rate hikes for 2018. The exchange reiterated the fact that the uncertainty created by the Trump Administration and Congress is directly harming the individual market.
Four other insurers have filed only off-exchange plans, with the following proposed average rate increases:
- Asuris Northwest Health: 31 percent
- Health Alliance Northwest Plan, Inc.: 14.6 percent
- Regence BlueCross BlueShield of Oregon: 30.9 percent
- Regence BlueShield: 30 percent
Although some insurers have reduced the size of their proposed coverage areas for 2018, only two insurers are completely exiting the individual market: Community Health Plan of Washington and Kaiser Foundation Health Plan of Washington Options (formerly Group Health Options).
Community Health Plan of Washington participates in the exchange in 2017, but only had 60 enrollees as of 2016. Kaiser Foundation Health Plan of Washington Options only offers coverage off-exchange in 2017, in 12 counties.
Regence BlueShield joined the Washington exchange for 2016 and 2017, but will only offer off-exchange plans in 2018. BridgeSpan is also exiting the exchange at the end of 2017.
2017 enrollment: 204k effectuated as of April 2017
By the time 2017 open enrollment ended on January 31, more than 225,000 people had enrolled in private plans (QHPs) through the exchange. The exchange had reported that more than 200,000 people had enrolled during the previous open enrollment period (for 2016 coverage), so the 2017 enrollment represented a 13 percent increase. This is notable, especially given that total enrollment among states using HealthCare.gov was slightly lower in 2017 than it was in 2016 (the Trump Administration reduced advertising for HealthCare.gov in the final week of enrollment, while state-run exchanges like Washington Healthplanfinder were able to continue their advertising efforts as planned).
Enrollments reported at the end of open enrollment included some people who never paid their initial premium to effectuated their coverage. By April 2017, effectuated enrollment in Washington Healthplanfinder QHPs stood at 204,334.
Washington also opted to expand Medicaid under the ACA, and the exchange can enroll people in Medicaid or a private QHP, depending on income. In addition to QHP enrollments, Washington Healthplanfinder had enrolled a total of 1,555,778 people in Apple Health (Medicaid) by February 2017, including renewals (Medicaid enrollment continues year-round). Roughly 600,000 of the Apple Health enrollees are eligible as a result of Medicaid expansion.
Washington’s exchange and the Trump Administration
For the time being, nothing has changed, but there is considerable concern that repealing and replacing the ACA could cause a substantial number of people in Washington to lose their health insurance.
HHS reported that 537,000 people in Washington had gained coverage as a result of the ACA between 2010 and 2015. That number has continued to grow since 2015, particularly in light of the increased enrollment for 2017. In late July, when the Senate voted along party lines to open debate on the health care reform bill, Commissioner Kreidler put out a statement noting that the Senate was “playing with fire” and posing a threat to 700,000 people in Washington who buy their own coverage or receive Medicaid.
But a few days later, the initial push for GOP-led repeal of the ACA stalled when the Senate failed to pass three different versions of the repeal bill that the House had passed in May. But Republicans in Congress are still working to repeal the ACA, and will do so if and when they’re able to muster enough support in the Senate.
2017 rate changes
But overall, the average premium increase in the individual market in Washington was 13.6 percent (nationwide, the average premium increase, before any subsidies are taken into consideration, was about 25 percent). Since the average benchmark premium increase in Washington wasn’t as significant as the average overall premium increase, it was essential for enrollees to shop around during open enrollment, and consider the possibility of switching to a different plan in order to continue to get the best value for 2017.
Since 2014, Washington Healthplanfinder has become more popular with people who don’t qualify for subsidies; 31 percent of the people who enrolled in coverage for 2016 did so without subsidies, up from 18 percent in 2014. As rates increase — both on and off the exchange — the exchange, and its subsidies, become more attractive to more people.
Premera had the largest segment of Washington Healthplanfinder market share in 2016, at 22 percent. And their approved rate increase for 2017 was the highest of any of the state’s plans, at 18.9 percent (a little lower than the 20 percent average increase they had requested).
For 2015, regulators in Washington approved an average rate increase of 1.9 percent; for 2016, the average approved rate increase was 4.2 percent. But regulators said they were not surprised by the higher requested rate hikes for 2017, and the same trend developed in most states.
2017: participating carriers
In 2014, eight insurers offered individual policies through the Washington Healthplanfinder. That grew to ten carriers for 2015 (Columbia United Providers and Moda Health Plan were new to the exchange for 2015, but neither is participating in 2016). For 2016, there were three new carriers that joined the exchange: Health Alliance Northwest, Regence Blue Shield, and UnitedHealthcare of Washington.
Although Moda and Columbia United Providers exited the Washington individual market at the end of 2015, there were still 11 carriers offering individual plans through Washington Healthplanfinder in 2016.
But for 2017, that has declined to nine. Those nine carriers are offering a total of 98 plans through Washington Healthplanfinder. Their 2016 on-exchange enrollment and average approved rate increases are as follows:
- Bridgespan: 5,690 enrollees; 11.9 percent increase (switching to only off-exchange plans for 2018)
- Community Health Plan of Washington: 60 enrollees; 10.6 percent increase (exiting individual market at the end of 2017)
- Coordinated Care: 32,535 enrollees; 7.43 percent increase
- Kaiser Foundation Health Plan of Washington (formerly Group Health Cooperative): 29,272 enrollees; 12.6 percent increase
- Kaiser Foundation Health Plan of the Northwest: 6,822 enrollees; 11.34 percent increase
- LifeWise (a Premera affiliate): 13,173 enrollees; 9.3 percent increase (Lifewise will only offer on-exchange plans in 2017, and is reducing their service area)
- Molina Healthcare of Washington: 22,544 enrollees; 7.35 percent increase
- Premera Blue Cross: 37,104 enrollees; 18.9 percent increase (Premera will only offer on-exchange plans in 2017, and is reducing their service area from 39 counties to 27)
- Regence Blue Shield: 2,022 enrollees; 13.35 percent increase (switching to only off-exchange plans for 2018)
In most cases, the final approved rates vary somewhat from the rate increases the carriers initially proposed.
Numerous carriers across the country exited the exchanges at the end of 2016, and Washington was no exception. Two carriers that offered exchange plans in Washington in 2016 are not participating in 2017:
- Health Alliance Northwest is only offering off-exchange plans for 2017, but only had nine on-exchange enrollees in 2016.
- UnitedHealthcare of Washington exited the exchange and the entire individual market in Washington at the end of 2016, as was the case in most of the states where they offered exchange plans in 2016. United had 2,978 enrollees in the Washington exchange in 2016, or about two percent of the total exchange enrollments.
Plan availability varies from one county to another. LifeWise, Premera, and UnitedHealthcare are the only carriers that offered plans in all 39 counties in Washington in 2016. United exited the individual market altogether at the end of 2016, while Lifewise and Premera have reduced the number of counties where they are offering plans for 2017, and also reduced the number of in-network providers for their plans. This was an effort to move away from fee-for-service payment models and focus instead on value-based care.
Small business coverage – only Kaiser (in two counties) in 2017
Washington Healthplanfinder Business, the state-run SHOP exchange, reported in June 2015 that more than 100 small businesses had enrolled in small group plans for 2015. They also announced that they would make coverage available for businesses with up to 100 employees starting in November 2015. But that changed in October 2015 when President Obama signed HR1624 (the PACE Act) into law. The law repealed the ACA provision that would have expanded the definition of “small group” to include businesses with up to 100 employees. States are free to independently define small groups as businesses with up to 100 employees, but in Washington, Insurance Commissioner Mike Kreidler announced that the state would go along with the PACE Act and continue to define small group plans as those with up to 50 employees.
By March 2016, a total of 174 employers had enrolled in coverage through Washington Healthplanfinder. The plans were covering 606 employees, and 164 dependents. UnitedHealthcare offered small group plans statewide through Washington Healthplanfinder Business in 2016, and Kaiser offered plans in Clark and Cowlitz counties (Moda had planned to offer small business plans state-wide as well, but their last-minute exit from the Washington market at the end of 2015 meant that there was just one state-wide SHOP option in 2016).
And for 2017, United’s exchange exit has left Washington Healthplanfinder’s SHOP exchange limited to only Kaiser, and only in Clark and Cowlitz counties. The state notes however, that there continues to be a robust off-exchange market for small businesses, with 11 insurers offering plans. The small business health insurance tax credit is only available through the exchange. And theoretically, the exchanges provide employee choice for small business enrollees, but that’s of limited value when only one carrier is participating.
Uninsured rate down to 7.3% by 2015
In 2012, the uninsured rate in Washington state was 14.5 percent. According to Washington’s Insurance Commissioner, Mike Kreidler, the uninsured rate had fallen to 7.3 percent by 2015. Only about 522,000 Washington residents were still uninsured in 2015.
Medicaid expansion under the ACA has played a significant role in reducing the number of people without health insurance in the state. 680,000 people have gained access to Medicaid as a result of expansion, although not all of them were uninsured prior to 2014.
Washington Healthplanfinder reported that more than 200,000 people had enrolled in private plans through the exchange by the end of 2016 open enrollment (up from 188,000 as of January 23, and 190,000 as of the middle of the final week of open enrollment). HHS announced that the final enrollment count was 200,691 as of February 1.
To put that number in perspective, 170,101 people enrolled in plans through the exchange during the 2015 open enrollment period (including the special enrollment period in the spring for people who found out they owed a penalty for being uninsured in 2014; if we only consider the open enrollment period, enrollment stood at just under 161,000 during the 2015 open enrollment period), and there were 152,517 people with in-force private plan coverage through Washington’s exchange in October 2015, just prior to the start of the 2016 open enrollment period.
But in 2014 and 2015, Washington Healthplanfinder only included paid enrollments in their total; enrollments that were never paid – and thus never effectuated – weren’t included. For 2016, Washington switched to the method used by most other exchanges, and reported all enrollments including those that had not yet been effectuated with an initial premium payment. This made their enrollment number easier to compare with other exchanges, but harder to make an apples-to-apples comparison between Washington Healthplanfinder’s 2015 and 2016 enrollment data.
Then in June 2016, Washington Healthplanfinder released a detailed enrollment report for the 2016 open enrollment period, and a press release summarizing the details. The exchange reported that 169,182 people had effectuated their coverage (ie, paid the premiums due in order to activate the plan). That’s about an 85 percent effectuation rate, which is similar to what we see across the rest of the country. To compare apples to apples, there were 160,732 effectuated enrollments in the Washington exchange during the 2015 open enrollment period, not counting the tax season special enrollment period that was added that year.
By September 2016, effectuated enrollment had declined slightly, to 166,098. But Apple Health (Medicaid) enrollment had grown to 1,531,402 (including renewals), up from 1,522,342 in March 2016. The exchange notes that prior to 2014, enrollment in Apple Health was a 45 day process. But via Washington Healthplanfinder, that’s been reduced to 45 minutes.
Moda Health, Columbia United Providers no longer in Washington
On October 28, 2015, Moda Health announced they were exiting the Washington market in order to focus on Alaska and Oregon. Effective immediately, they ceased sales and renewal of health plans in Washington, and 47,000 existing policy-holders had to select coverage from a different carrier for 2016.
Moda’s exit is due at least in part to the risk corridor shortfall that was announced by the federal government in October 2015. The carrier had been expecting $90 million, but found out that they would only receive about $11 million. The risk corridor shortfall was directly implicated in the closure of six CO-OPs, and the exit of WINhealth from the individual market in Wyoming and Coventry from the Kansas exchange.
Moda then announced they would also exit the individual markets in Alaska and Oregon in late January, after suffering significant financial losses in 2015. But they were ultimately allowed to resume sales of plans in Alaska and Oregon in early February, and continue to operate in those states (Moda is continuing to offer coverage in Oregon in 2017, but not in Alaska).
In mid-November 2015, Columbia United Providers also announced that they would exit the individual market in Washington. Their plans were only available in Clark County, and they only had about 100 enrollees (all through Washington Healthplanfinder) as of November 2015. Since CUP’s announcement came after the start of open enrollment, some residents in Clark County had already selected CUP plans for 2016. Washington Healthplanfinder reached out to those enrollees and helped them select new plans for 2016. The exchange noted that there are still five carriers offering plans in 2016 in Clark County.
Anyone on a 2015 plan from Moda Health or CUP was eligible for a special enrollment period triggered by loss of coverage, which is a qualifying event. They had until February 29 to pick a new plan, but if they enrolled on January 1 or later, they had a gap in coverage from January 1 until their new plan’s effective date.
Average rate increase just 4.2 percent for 2016
In August 2015, the Washington Insurance Commissioner announced that 136 plans from 12 health insurers had been approved for sale through Washington Healthplanfinder in 2016. A 13th carrier, Coordinated Care Corporation, had also submitted plans to be offered through the exchange, but those rates were still under review at that point; Coordinated Care’s rates were later finalized, and their plans are available for 2016 (Coordinated Care ultimately ended up with the second-highest market share in the exchange, with 19 percent of all enrollments for 2016).
The exchange board also approved all 136 plans to be offered through the exchange, although the last-minute exit of Moda and CUP dropped the total number of carriers to 11 and also reduced the number of plans available. But it was still an increase from 10 carriers and 90 plans in 2015, and eight carriers and 46 plans in 2014. In addition, six carriers are offering eight pediatric dental plans through the exchange in 2016.
The average approved rate increase as of late August was 4.2 percent, lower than the 5.4 percent that had been proposed by health insurers earlier in the summer. Coordinated Care Corporation had requested an average rate increase of 11.2 percent for their 26,000 exchange enrollees, but ultimately the Insurance Commissioner approved a rate increase of 7.2 percent.
The modest rate hike for 2016 comes on the heels of an even smaller average rate increase the year before, when Washington Healthplanfinder’s rates increase by an average of just 1.9 percent for 2015.
For enrollees who shopped around, rates could be lower in 2016 than they were in 2015. A Kaiser Family Foundation study compared benchmark plan (second-lowest-cost silver plan) rates for a 40 year-old in metropolitan areas across the country. In Seattle, the benchmark plan for a 40-year-old was $254 in 2015, and dropped to just $227 in 2016 (the benchmark plan isn’t necessarily from the same carrier that offered it the year before – it’s just the second-lowest-cost silver plan in a given year). That’s more than a 10 percent decrease, and is certainly good news for enrollees who don’t receive subsidies. For those who do receive subsidies, however, average subsidy amounts in Seattle are lower in 2016, since the benchmark plan is less expensive.
Premiums now paid directly to insurers
As of September 24, 2015, insureds pay premiums directly to their carriers; the exchange no longer accepts premium payments. Paying premiums directly to carriers is the norm in most states, but Washington Healthplanfinder aggregated premiums since its launch in October 2013. Enrollees have always had the option of paying premiums directly to carriers, but about 80 percent opted to pay premiums to the exchange. The aggregated premium system used in Washington was 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, the system worked smoothly in Washington, but a technological invoice problem in 2014 impacted roughly 25,000 enrollments (about 15 percent of the total) and resulted in premiums being paid even though the carrier had no record of the enrollee.
By early October 2014, according to the exchange, nearly all of the billing problems had been resolved, but there were still approximately 1,300 customer accounts that continued to have technical issues. By the time the 2015 open enrollment began in November 2014, the exchange reported that lingering billing problems from 2014 were still affecting about a thousand customers.
But health insurance carriers had a different story to tell. As of October 30, 2014, Premera Blue Cross Blue Shield had 15,000 members whose coverage was in limbo because of billing problems with Washington Healthplanfinder. And the Association of Washington Healthcare Plans estimated that the problems were still impacting about 25,000 insureds state-wide at the end of October.
Because of the billing problems that have plagued the exchange, the board voted 4-3 in mid-December 2014 to remove the exchange from the invoicing/payment collections part of the process, and turn it over to the insurance carriers, the way it’s done in most other states. There was much debate on whether that was the best course of action or not, but ultimately it was decided that carriers would take over the billing process in the fall of 2015, in time for the 2016 open enrollment period (this change was effective September 24, 2015).
In early August 2015, Richard Onizuka announced that he would be stepping down as CEO of Washington Healthplanfinder as of August 31. Onizuka had led the exchange since 2012. Pam MacEwan, who has been Chief of Staff at the exchange since 2012, became the interim CEO, and was appointed as the permanent CEO in February 2016.
Lawmakers reach agreement on exchange funding
Washington Senate Bill 6089 was signed into law by Governor Inslee in July 2015 – but the final version was much different from the original bill. Introduced by Senator Andy Hill (R – 45th District), the legislation was originally designed to significantly cut funding for the exchange. Not only would it have reduced funding for the exchange in the state budget, it would have also prohibited the exchange from receiving any of the state taxes collected on health insurance plans (currently 2 percent of premiums, and that money would have been sent to the state general fund instead of to the exchange), and it would have barred the exchange from getting reimbursement for outreach activities, even if federal funds were available to reimburse exchanges.
But the original bill faced significant push back from the exchange, insurance carriers, and Democrats in the legislature, and it didn’t advance in the House (it passed the Senate on a party line vote, but Democrats have a slight majority (51 – 47) in the House of Representatives). Instead, a rewritten version is much less harsh for the exchange’s funding, but still requires the exchange to actively work to lower costs.
On June 29, lawmakers in Washington reached an agreement on the state’s fiscal year 2016 budget – just in time, as the fiscal year started on July 1. The budget includes $110 million for Washington Healthplanfinder. That’s less than the $127 million the exchange had requested, but the exchange has said the money will be “sufficient.” It does appear that it will require them to run a very tight ship though, with few improvements or upgrades in the near future, and possible reductions in call center staffing.
The money allocated for the exchange comes from state general funds ($11 million) and federal funds ($40 million), along with $58 million from the Washington Health Benefit Exchange Account. That account is funded by the 2 percent premium tax described above, as well as a per member per month carrier assessment. The assessment is currently $4.19 per member per month, but it will need to increase to an estimated $9.78 per member per month in order to generate sufficient revenue.
Open enrollment for 2015 ended in February, although an extension was added for people who weren’t aware that they would fact a tax penalty for not having coverage.
Total enrollment through Washington Healthplanfinder amounted to nearly a million people by the end of open enrollment, including 818,697 Medicaid enrollments.
On April 22, Washington Healthplanfinder announced that total private plan enrollment for 2015 had reached 170,101 people. This is the third-highest total (behind California and New York) of any of the state-run exchanges. All of these enrollees had paid for their coverage; Washington only reported enrollments in 2014 and 2015 if they were paid-up. In most states, the paid enrollment number is about 88 percent of the total plan selections, so it’s likely that there were several thousand additional enrollments that were finalized but hadn’t yet been paid for at that point.
By the end of June, effectuated enrollment in private plans through Washington Healthplanfinder had grown to 170,171. That was about the same as the number of people (170,179) who have individual coverage in Washington outside the exchange.
Of the total private plan enrollments, more than 16,000 had enrolled during the spring special enrollment period that Washington Healthplanfinder offered for people who weren’t able to finish their enrollment by February 15, as well as people who were unaware prior to filing their taxes that the ACA includes a penalty for being uninsured. The special enrollment period ran from February 17 to April 17 in order to cover the whole tax filing season.
In October 2015, Washington Healthplanfinder released updated numbers indicating that effectuated enrollment had dropped to 152,517 people,7 9 percent of whom were receiving premium subsidies that averaged $204 per month. Washington Healthplanfinder also reported that they had facilitated Apple Health (Medicaid) enrollments for 1.4 million people in the two years since the exchange opened for business in October 2013.
75 percent of 2014 enrollees renewed for 2015
On December 31, 2014, total private plan enrollment had stood at 107,071. Of those enrollees, 27,753 were new to the exchange for 2015. The rest had a plan in 2014 and either renewed it or selected a different exchange plan for 2015.
That means about 60 percent of Washington Healthplanfinder’s 130,000 enrollees from 2014 had returned to the exchange to manually renew or make changes to their existing coverage before the end of December. Richard Onizuka, the exchange director at the time, noted in December that while many of those who had not returned to the exchange had unpaid balances on their account, that is “not a barrier to enrollment” for the coming year. If your coverage lapses during the year because you didn’t pay the premiums, you can still come back during open enrollment and sign up for the coming year (this is a provision of the ACA, and applies in every state).
About 80 percent of Washington Healthplanfinder’s 2014 plans were available again in 2015, and the exchange reported in October that roughly 100,000 of their private plan enrollees would be eligible for automatic renewal. But the exchange encouraged the rest of their 2014 enrollees to log back onto the exchange site or use the call center for assistance in updating financial information and confirming a plan selection for 2015.
The benchmark plan (second-lowest-cost silver plan) decreased in price in most of Washington state for 2015. Enrollees who kept the benchmark plan from 2014 saw rate increases that ranged from an average of 2 percent to nearly 11 percent, depending on where they live But enrollees who shopped around and switched to the new benchmark plan were able to secure significant rate decreases instead.
As of March 26, 2015, nearly 67,000 of Washington Healthplanfinder’s 2015 enrollees were new to the exchange, while the rest already had exchange coverage in 2014. At that point, total private plan enrollments stood at about 165,000 people, so roughly 98,000 of them were returning customers from 2014 – about 75 percent of the 130,000 enrollees from 2014.
Another 170k enrolled off-exchange in 2015
In addition to the 170,000 people enrolled in exchange plans in Washington for 2015, another 170,000 enrolled in private plans outside the exchange. While those plans were not eligible for premium subsidies, they’re fully compliant with the ACA’s regulations – they cover all of the essential health benefits, are guaranteed issue (no medical underwriting), and have no lifetime or annual limits on coverage.
Improvements for 2015
Washington Healthplanfinder was hard at work in 2014 to ensure that their second open enrollment period would be even more smooth and successful than their first. The exchange made significant progress on the back-end functionality of the website, improved the transmittal of enrollment and payment data to insurance carriers, and implemented critical code and data fixes to avoid repeats of the isolated – but very frustrating – billing and invoice issues that arose in 2014. As a result of all the fixes, it was expected that there would be far fewer billing, enrollment, and submission errors during the 2015 open enrollment.
From a consumer interface perspective, Washington Healthplanfinder was more user friendly in year two as well. They added screen-sharing functionality with customer support, and additional on-screen definitions to help consumers – especially those who are not familiar with how health insurance works – better understand the enrollment process.
They also added new information on the eligibility screen to make it easier to understand eligibility for each member of a household. This page summarizes the improvements Washington Healthplanfinder has made over the last year.
Consumers also had the option to pay premiums to the exchange using paper checks in 2015, as opposed to 2014 when all payments had to be electronic. Although electronic payments are widely considered to be a convenient method, they can be difficult for low-income residents.
The Washington Healthplanfinder tripled its call center staffing to 500 people during the 2015 open enrollment, and there are also 2,500 brokers in Washington who are certified to help customers enroll in a plan through the exchange.
Washington Healthplanfinder 2014 enrollment
Washington Healthplanfinder announced in September 2014 that 147,888 people were enrolled in private plans through the exchange as of the end of July. The exchange had enrolled 11,497 people with special enrollment periods triggered by qualifying events since between March 31 and July 31, and remained one of the country’s most successful exchanges. A quarter of the people who enrolled were in the 25 – 34 “young invincible” age group.
By the end of July, the exchange had disenrolled a total of 24,072 people because of non-payment, loss of eligibility, or voluntary plan terminations, but that’s an attrition rate of just 6.4 percent. Including Medicaid and private plans, 1,283,670 people were enrolled in plans through Washington Healthplanfinder at the end of July 2014.
As of October, 139,700 people were enrolled in private plans through Washington Healthplanfinder, indicating that their rate of enrollment due to qualifying events had continued at roughly the same pace throughout the summer and fall.
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).
Washington Heatlthplanfinder history
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 if needed to break a tie. In addition, the insurance commissioner and the administrator of the Health Care Authority are non-voting members.
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 had all-payer claims databases but 2014. But lawmakers persisted, and in 2015, SB5084 was signed into law, advancing the process of creating an all-payer claims database in Washington state.
The federal government funded the Washington Healthplanfinder in 2014. In 2015, marketplace operations was funded by the state with $21 million that was previously earmarked for the state’s high-risk insurance pool, and with an additional 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 could potentially use the new marketplace to purchase private plans (roughly 200,000 had done so by early 2015). The Washington insurance commissioner’s office estimates that 477,400 residents are eligible for subsidies, and state set a target of enrolling 280,000 people in 2014. Obviously it fell short of that amount – and still hadn’t reached it by year three – but enrollment could still grow in the coming years.
No grandmothered plans
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 in January 2014 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. Thus, the only non-ACA-compliant individual and small group plans in Washington are grandfathered plans; there are no grandmothered plans.
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.