CT small businesses struggle with health benefits

A new survey by the Universal Health Care Foundation of CT found that two out of three CT small businesses can’t afford to offer health benefits to employees. A tiny fraction (6%) of small business owners who don’t offer coverage, don’t want to. Among those that offer health benefits, most have had to shift more costs onto workers. 41% say their inability to offer health benefits is limiting their growth, a majority believes that it impacts their ability to recruit and retain workers, and 28% believe this disadvantages them compared to larger companies. 60% say government should offer an alternative to private insurance. The report delves deeply into the types of coverage offered by CT small businesses and attitudes toward employee benefits. Most are unaware of federal small business tax credits for coverage. Eighty percent of CT workers are employed by small businesses.

Collaboration and transparency key to MD's insurance exchange success

Maryland is widely recognized as a leader in implementing national health reforms, particularly developing their state health insurance exchange well ahead of other states. Health insurance exchanges were created under national health reform as an understandable, fair marketplace for consumers and small businesses to understand and purchase health plans that provide value for the price; federal premium subsidies to make insurance affordable for individuals are only available in the exchanges. In a state visit this week, executive agencies, legislative branch and advocates all agreed that Maryland’s public and inclusive process was key to their success. Maryland passed enabling legislation, created their governance structure, and engaged six inclusive advisory committees last year. As one policymaker said, “It’s not possible that we missed anyone.” Through a transparent, comprehensive process with expert consultant support, those committees and the Board developed a strong set of operating policies that position the state to have a strong, effective exchange in place to help Maryland residents choose the best health plan for their needs by 2014. Using the same inclusive, transparent process, they are moving forward with decision-making and operationalizing those policies. Stakeholders credit soliciting public input often, engaging broad and diverse membership on committees, good communications, and transparent policymaking for their success. Legislation creating the Board excluded members with conflicting interests, creating an expert group with credibility, allowing the state to avoid problems Connecticut has encountered. Stakeholders also credit the decision to create a quasi-public entity with has critical to success. The new entity, outside government, provided public accountability and a fair process but also allowed faster procurement of expert consulting and facilitation services from diverse sources. To keep momentum going and recognizing the huge number of tasks, policymakers decided to make decisions in steps. Early on they finalized decisions in policy areas that achieved consensus, and put off more contentious debates for later such as whether to negotiate with plans to qualify for the exchange or approve any that meet standards. The financing model for the exchange’s administrative functions also remains to be worked out. Maryland is now deciding how to hire, train and certify navigators, to inform the public and assist consumers and small businesses in making the best purchasing decisions.

Bill to increase consumers on insurance exchange board passes House

Yesterday the House unanimously passed a much improved version of HB 5013. The amendment added another consumer and another small business representative to the Board, in addition to the one each in the original bill raised by the Insurance Committee. Also different from the committee version, the bill gives Republicans a voice in nominating the new members. (The only small business person on the current Board was appointed by Rep. Cafero, ranking Republican in the House. There are no voting consumer representatives and three from the insurance industry.) The bill also gives the State Health Care Advocate a vote. Advocates for consumers and small businesses had been calling for this version, adding enough consumer and small businesses representatives to make a difference. Unfortunately, the current Board at its last meeting already made their critical decision about hiring a CEO without a consumer vote. The Governor is now choosing the CEO from among the three names given him by the current Board.

The Medical Loss Ratio (MLR) Report—Just Fiddling While Rome is Burning

Today’s headline was, “Millions Expected To Receive Insurance Rebates Totaling $1.3 Billion.”The Kaiser Family Foundation estimates that 3.4 million people in the individual market will receive $426 million in consumer rebates because of the Affordable Care Act's new MLR rules. In the small group market 4.9 million enrollees will see $377 million in rebates, and 7.5 million people will get $540

Insurance exchange committee updates

The first meetings of the four CT health insurance exchange advisory committees were largely uneventful and had a lot in common. They were mainly led by consultants, lacked diversity, emphasized principles (already drafted by the consultants), timelines and goals. In three committees, access to outside information was limited and discouraged. In contrast, the Consumer committee appears to be developing a formal process to collect it. In every committee, the consultants emphasized the need to be cost conscious. The Qualified Health Plan committee did not address a very important policy decision, whether the exchange will be an active purchaser of health plans – negotiating on behalf of members as one large entity for better prices and to enhance quality. The Massachusetts connector is an active purchaser and has kept price increase well below the level of plans in the rest of the market. The Navigator committee spent most of its time talking about the role of brokers, agents and other stakeholders, navigator training and certification, and the need for good research on the exchange’s consumers. The latest federal regulations preclude brokers who are paid by insurance companies to sell their products from being paid as navigators inside the exchange. The Consumer committee talked about the Basic Health Program Option and making sure plans are affordable for consumers. Advocates at that meeting also pushed back at consultants’ suggestion that cost cutting had to come at the expense of outreach – using existing resources. (They acknowledged that outreach is often the first to be cut, with an expectation that nonprofits and community groups will do the work within their available resources.) At the Small Business committee the consultants announced that they expect to go out to bid for plans in that exchange later this summer.

Insurance exchange Board meeting update

The CT Health Insurance Exchange Board chose their three CEO candidates to send on to the Governor at last week’s meeting. The decision was made without a voting consumer representative and after another hour-long closed-door meeting. Names of the three chosen were not released; hopefully they do not have close ties to the insurance industry. A bill to add one consumer and one small business representative is making its way slowly through the General Assembly. In an interesting irony, the Board has determined that the general perception of CT stakeholders is that they have not accomplished much. Rather than consider whether the crowd is wise and improve performance, they have chosen to engage their communications consultants to fix their image with a media campaign including postcards, emails, webinars, and a website. Thankfully they have heard from CMS about the need to keep costs under some control and are looking to coordinate with state agencies, especially DSS, and with the federally funded New England IT exchange collaboration. RI, the first state to receive Level 2 exchange funding, did not receive their full request as CMS asked them to reuse available resources. CT’s exchange is reportedly also seeking to borrow a large sum from the General Fund until more federal money is granted and plan to hire nine more staff. The Board was asked to trust their leader and staff and authorize the exchange to enter into an undisclosed $3 million contract. Board member requests for information on the contract, the services to be delivered, the contractor, or the process used to choose them were denied. In good news, they will be engaging a research consultant to develop a better analysis of who likely exchange customers are, where they live, etc.

California SB 1431 To Limit Self-Funded Small Group

SB 1431 is currently working its way through the California State Senate. The Bill, authored by California State Senator De Leon, would impose new rules for those small groups under 50 employees who choose to use a self-funded or "stop loss" health insurance programs in lieu of fully-insured plans.

Currently some stop loss plans for small groups have very low attachment levels when compared to large employer self-funded health plans. In some cases the attachment (the dollar cost point where the insurer begins paying claims) for small groups is as low as $5,000 for individual attachment (per employee or dependent). Most large and mid-sized groups have a much higher attachment level--somewhere in the area of $75,000 to $100,000 per individual attachment on average.

SB 1431, if passed and signed into law, would raise the attachment rules for small groups in California to $95,000 individual attachment. Essentially that means that the employer would be responsible for the first $95,000 of an employee or dependent medical care in a plan year before an insurer could start paying claims as an insured contract for that individual. There are also other rules and formulas regarding stop loss levels for small groups in addition to the individual attachment.

Information on SB 1431 can be found at the link below:

SB 1431 De Leon

I will update with news on this bill when appropriate.

Dave
www.davefluker.com

May 21 - I have posted an update on SB 1431 available here SB 1431 Update

Dave

Blue Shield CA To Close and Replace Most Individual Health Plans in California

Blue Shield of California has announced that they will soon close virtually all of their current individual & family health plans and replace those plans with a new portfolio of health plans. This change and plan closure will be effective 7/2/2012.

The following current Blue Shield CA individual & family health plans will be closed to new enrollments not later than July 2, 2012:

*Vital Shield 900 & 2900
*Vital Shield Plus 400/400 Generic, 900/900 Generic, 2900/2900 Generic
*Balance PPO 1000, 1700 & 2500
*Shield Savings HSA 1800, 3500, 4000 & 5200
*Active Start PPO 25/25 Generic & 35/35 Generic
*Essential PPO 1750, 3000 & 4500

The following 4 plans will remain open to new enrollment on and after July, 2012:

*Shield Spectrum 5500
*Shield Spectrum 5000
*Access+ HMO
*Access+ Value HMO

Closed plan choices will be replaced by a new portfolio of health plans for new enrollments beginning in July. The new individual & family portfolio will consist of the following plans in addition the the four remaining plans listed above:

*Shield Secure Plus PPO 2000, 4000 & 6000
*Shield Secure PPO 2000, 4000 & 6000
*Shield Wise PPO 2500, 3500 & 4500
*Shield Saver PPO 4000 & 6000 (HSA-compatible)

Plan benefit information and July rates will be available in the next few days. All of the new plans include the mandatory maternity benefit.

As of today, Blue Shield has not indicated a process for any plan transfer options for those who are currently enrolled or who will be enrolled in the closing portfolio of plans.

Those plans which are closing will have the maternity benefit (SB 222) added onto them for July 1, 2012.

Dave
www.davefluker.com

PCIP To Agents: Thanks, now take a hike!

The federal PCIP (and those states who have the federal PCIP instead of a state run version) announced today that effective May 1, PCIP will discontinue the agent/broker referral fee. PCIP claims that the enrollment numbers in the PCIP have 'increased dramatically' in the last six months and they no longer need agents/brokers to assist individuals with the plan benefits and enrollment.

Coincidentally, the dramatic enrollment increase was experienced during the short cycle that federal PCIP actually paid the one-time referral fee to agents and brokers to assist with enrollment into the program.

In California, the PCIP is run by the state via MRMIB and initially paid a $50 one-time referral fee identical to MRMIP. When federal PCIP added agent compensation in October, 2011 to try and increase enrollments, they offered $100 per applicant and CA PCIP increased the fee to $100 one-time to match the federal PCIP. Six months later, federal PCIP is cancelling the referral fee altogether and I would expect CA PCIP to either reduce back to $50 or down to zero to match federal PCIP.

This is bad news for individuals seeking assistance with PCIP benefits, formularies, provider networks and enrollment in the PCIP. I have enrolled quite a few people in both MRMIP and PCIP in recent months and neither has been a particularly easy process. I continually get calls from people who already applied for PCIP and were never enrolled, PCIP never received their application paperwork, or they were denied enrollment for reasons that were at best 'unclear'.

Sadly, the end result of this action, in addition to other recent anti-agent actions, will be further attrition of experienced health insurance agents willing to work with people under 65.

Dave
www.davefluker.com

Connecticut’s insurance exchange gets a C

This month Connecticut health care thought leaders give our state’s insurance exchange a C grade, unchanged from the March survey. Overall reform efforts did somewhat better at a C+,  and a B-/C+ for effort. Medicaid is again the bright spot, earning a B. Health Insurance Market Reform and Data-based Policymaking joined Engaging Consumers in Policymaking in earning D grades this month. Forty percent more respondents answered Don’t Know on one or more issue areas this month, emphasizing the need for better communication and coordination in health policymaking. Asked for suggestions to improve Connecticut’s progress toward reform, several themes emerged including engage consumers in policymaking, smarter policymaking, urgency -- move more quickly, and implement a public option through the SustiNet plan. For more on how CT is progressing toward reform, visit the CT Health Reform Dashboard.

Anthem Blue Cross and HCA Renew Contract

Just an update regarding the contract termination between Anthem Blue Cross and HCA (Hospital Corporation of America). As you may be aware, the agreement was terminated by HCA in early March over the inability to reach an acceptable contract.

Further negotiations were successful and multi-year contracts were achieved between Anthem Blue Cross and HCA effective April 1, 2012.

The following HCA hospitals were affected by the contract termination and are now participating providers with Anthem Blue Cross:

*Good Samaritan Hospital San Jose
*Los Robles Regional Medical Center
*Regional Medical Center of San Jose
*Riverside Community Hospital
*West Hills Hospital and Medical Center.

Have a great Easter weekend!

Dave
www.davefluker.com