Health Insurance Exchange Board meeting update

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Today’s Access Health CT Board meeting was largely uneventful; despite that, the room was packed. The highly anticipated report from Wakely’s actuaries on their meetings with the plans to give premium proposals a “second look” was not ready. This is in lieu of negotiating premiums – a bill directing the exchange to do that died in the House this session. We heard a lot about how the process is “iterative” and that it will take three years for the exchange to be fully operational. Unfortunately, people and health plans are not being given three years before the individual mandate and insurance reforms take effect. We heard about a very large marketing campaign that is starting to explain the ACA and the exchange to Connecticut. They have hired more staff and more consultants. They have spent $58.7 million so far this fiscal year (ends this month). Next year’s budget is $74.9 million (about $250 per uninsured state resident) and calls for 59 staff. The marketing budget is $9 million for next year to include TV, radio, billboards, social media, newspaper inserts, and outreach events. They have received 26 applications for the approximately $50,000 navigator grants – they will only fund six. We are hopeful, to avoid the mistakes of HUSKY, that the twenty organizations not chosen will be engaged in outreach somehow. They’ve received 422 in-person assister applications ($6,000 each) from organizations representing 722 grant requests. They will only fund 300. There was a long discussion of differing lists of essential community providers (ECPs). In November the Board voted to require plans to include 75% of ECPs and 90% of federally qualified health centers. It took several lists and lots and lots of meetings, but they finally decided on a CMS-based list of ECPs in CT. Concerns were raised that the requirements could constrain competition and raise premiums. CA was able to keep premiums affordable with smaller provider panels, along with negotiating premiums with plans. Concerns have been raised elsewhere that an exhaustive list of ECPs reduces the number of key providers required to be in the network. Concerns were also raised over the types of providers labeled ECPs – for instance, including school-based health centers, while critical members of the state’s overall safety net, that typically are not open after school hours or in the summer and will not serve the vast majority of exchange members who are likely to be adults. They also changed some standard plans (again), to raise copays and coinsurance on one Bronze plan and delete another.