Colorado Division of Insurance Releases First Look at Health Plans for 2015

The Colorado Division of Insurance released preliminary information this week from plans submitted by health insurers for Affordable Care Act (ACA) coverage in 2015. Rate and benefit information for the 2015 plan year was submitted to the Division of Insurance (DOI) on June 6th. Since that time, DOI staff has been conducting initial reviews to check the filings for completeness.

According to the preliminary study of rate filings provided by the DOI, Colorado residents and small businesses could face anywhere from a 10 percent increase in their health insurance premiums next year to a 10 percent drop in prices.

Commissioner of Insurance Marguerite Salazar commented, “We are pleased to see such a high number of carriers and plans. Rates seem to be holding relatively steady, which means we will continue to see a strong market in 2015 that will provide Colorado consumers with many options for health insurance.”

Over the summer, the Division of Insurance staff will examine each plan to make sure it is in compliance with the requirements of the Affordable Care Act and state and federal laws. The DOI will review the rates to ensure they are not excessive or inadequate. In addition, the DOI will also verify whether the plans meet the federally defined metal tier coverage levels: bronze (60% of medical expenses paid by the plan), silver (70%), gold (80%) and platinum (90%). These percentages are referred to as “actuarial value.” 

During the review period, Colorado consumers can submit public comments on the filings, which will be reviewed and considered by the Division of Insurance. The DOI will complete its review in September, then notify carriers and Connect for Health Colorado of the approved plans for 2015. Once approved, final plans will be posted on the DOI’s website. DOI will also provide summary information and charts detailing the number of approved carriers and plans for 2015, both on and off Connect for Health Colorado. Read the press release from the DOI here.  

New Study From CHA Shows Impact of Medicaid Expansion on Hospital Volumes

A new study from the Colorado Hospital Association (CHA) shows the impact of Medicaid expansion on hospital volumes in the 26 states that chose to expand Medicaid eligibility under an option offered through the Affordable Care Act. The study shows that the Medicaid proportion of patient volume at hospitals in states that expanded Medicaid increased substantially in the first quarter of 2014. At the same time, the proportion of self-pay and overall charity care declined in expansion-state hospitals. You can listen to the article on Colorado Public Radio here, and read the study from CHA here.

What Will Happen As Networks Continue to Narrow?

In the midst of all the turmoil in healthcare these days, one thing is becoming clear: No matter what kind of health plan consumers choose, they will find fewer doctors and hospitals in their network — or pay much more for the privilege of going to any provider they want.

These so-called narrow networks, featuring limited groups of providers, have made a big entrance on the newly created state insurance exchanges, where they are a common feature in many of the plans. While the sizes of the networks vary considerably, many plans now exclude at least some large hospitals or doctors’ groups. Smaller networks are also becoming more common in healthcare coverage offered by employers and in private Medicare Advantage plans.

Insurers, ranging from national behemoths like WellPoint, UnitedHealth and Aetna to much smaller local carriers, are fully embracing the idea, saying narrower networks are essential to controlling costs and managing care. Major players contend they can avoid the uproar that crippled a similar push in the 1990s. Read the article in the New York Times here.

Division of Insurance to Seek Shift on Geographic Rating Areas for 2015

Press Release from Colorado Division of Insurance (May 9, 2014)

The Colorado Division of Insurance (DOI) today announced it will ask the federal government for approval to change Colorado’s geographic rating areas for health insurance for 2015.

Geographic rating areas are geographical units made up of metropolitan statistical areas (MSAs), counties or three-digit zip codes, which are used by insurance carriers to price premiums.

The DOI seeks to reduce the number of rating areas from 11 to nine, combining four rural areas into two larger rating areas, while retaining the seven urban (or metropolitan statistical areas, or MSAs). Such a change will require approval from the U.S. Department of Health and Human Services.

“Consolidating the higher health cost regions into larger rating areas will spread the risks and the costs of providing health care more equitably over a larger population,” said Marguerite Salazar, Commissioner of Insurance. “We understand that people across the state are concerned about high health care costs and the impact on health insurance premiums. This is the fairest way of addressing the issue and working toward stable premiums in all regions of the state.”

The announcement comes after a meeting last week of the Health Care Cost Study Group. At that meeting, the DOI put forth three options for rating areas following presentation of an actuarial analysis commissioned by the DOI for the study group. The DOI invited comments through Wednesday, May 7.

The DOI received 306 comments of which 138 addressed the rating area options. Of those, 117 were supportive of the nine rating areas structure.

As part of this change, on Friday, May 9, DOI will formally request approval from the Department of Health and Human Services to change Colorado’s rating area structure. Due to this change, the DOI also will extend its deadline for insurance carriers to provide plans and rates for 2015 from May 15 to June 6, providing time for insurance carriers to adjust to the new areas.

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The Colorado Division of Insurance regulates the insurance industry and assists consumers and other stakeholders with insurance issues. DORA is dedicated to preserving the integrity of the marketplace and is committed to promoting a fair and competitive business environment in Colorado.

Insurance Extension Decision Could Impact Many Coloradans

Insurance Commissioner Marguerite Salazar announced Friday that state residents who extended plans that do not meet minimum benefits required under federal healthcare reform before the end of last year may extend them again through the end of 2015 if their insurers continue to sell the plans.

It is unknown how many of the roughly 100,000 people currently covered by such plans in Colorado will have the opportunity to re-up and will choose to do so. But the people in such plans are viewed by many health analysts to be healthier than those who recently have purchased insurance for the first time. And keeping them out of the larger risk pool could cause prices for insurance policies to rise across the board.

Read more about how the extension decision could impact Coloradans in the Denver Business Journal or read about a national study on the impact of the canceled plans in Politico.

Is Rate Relief Coming to Colorado's Ski Towns?

Last Friday, Colorado Insurance Commissioner Marguerite Salazar said she wants to redraw the geographic rating boundaries which previously lumped together Garfield, Pitkin, Eagle and Summit Counties and created the most expensive insurance market in the U.S. Commissioner Salazar announced that by redrawing the boundaries, those counties will now be part of a 22 county region. 

Read more about the change in boundaries in Kaiser Health News or in Health News Colorado.

HHS Secretary Kathleen Sebelius Resigns, OMB Director Sylvia Mathews Burwell to Step In

Health and Human Services Secretary Kathleen Sebelius announced her resignation Friday, ending a tumultuous tenure as the public face of the Affordable Care Act. In a Rose Garden ceremony, President Obama nominated his budget director as her successor.

According to federal health officials, Sebelius approached Obama in early March and told him that, with the insurance enrollment period ending that month, the time had come for new leadership at HHS. A White House official, who spoke on the condition of anonymity to discuss internal deliberations, said Sebelius told the president that “she felt confident in the trajectory for enrollment and implementation of the Affordable Care Act.”

Obama on Friday nominated Office of Management and Budget Director Sylvia Mathews Burwell to take Sebelius’s place. Although Burwell does not have an extensive background in healthcare policy, she is known for her strong management skills and has experience in issues of poverty and global health issues from her time at the Bill and Melinda Gates Foundation. Moreover, she is popular on Capitol Hill. The Senate confirmed her as OMB director 96 to 0 almost exactly a year ago. Her nomination to lead HHS will require Senate confirmation as well. Read the full article in The Washington Post.

Final Surge Pushes ACA Enrollment in Colorado

Enrollment for private health insurance coverage for this year ended Monday with a surge that led to 118,628 Coloradans signing up on the state exchange (Connect for Health Colorado). Some 12,000 people signed up during the last week of open enrollment.

Enrollments under the Affordable Care Act are expected to continue to climb over the next few weeks in Colorado. Those who started their applications prior to the deadline, but were unable to complete them, will be given more time.

Connect for Health Colorado reported yesterday (Tuesday) that between Oct. 1st and March 31st, more than 277,000 Coloradans obtained either commercial or public health insurance under the Affordable Care Act. Medicaid gained 158,521 enrollees. The federal program expanded under the law in Colorado to cover lower-income single adults as well as disabled people, mothers, pregnant women and children.

Read the article in the Denver Post here.

Will New Rules to Prevent Narrowing of Networks Drive Away Payers?

Healthcare providers have raised alarms over narrow provider networks in the public health insurance exchanges, but Moody's Investors Service says proposed rules to open up the networks could drive health plans to drop out of the new market.

Proposed federal rules that would limit the ability of health plans to craft narrow provider networks for the Affordable Care Act exchanges would benefit some hospitals, but tighter regulation could create an unbearable level of risk for insurers, market analysts say. In a healthcare "sector comment" released recently, Moody's Investors Service predicts that plans to limit narrow networks in 2015 would benefit rural hospitals and safety net hospitals because those facilities are the most likely to be left out of a narrow network.

"If [hospitals] are considered essential, that would protect them from being excluded from a narrow network," Moody's Senior Vice President Lisa Martin said Monday of the new rules under consideration at the federal Centers for Medicare & Medicaid Services. "[They provide] protection in terms of market share."  Read the article in Health Leaders Media here. 

With Less Than Two Weeks To Go, More Than 100K Coloradans Have Signed Up For Private Insurance

There's less than two weeks remaining for people who don't have health coverage to get it. Plans won't be available on demand after that until next fall. So far, more than 100,000 Coloradans have now signed up for new, private health insurance plans through the state's online shopping portal. That number is less than initial goals anticipated, but still good compared with other states in general. About 15,000 Coloradans bought health plans through Connect for Health Colorado in the past two weeks. That's the fastest pace since mid-December, when there was a surge of customers getting coverage that would start Jan. 1, 2014. Read the story in CPR news here.

Connect for Heath Colorado and Colorado Medicaid have released their most recent enrollment metrics as of March 17, 2014. Since October 1, 2013, Medicaid has enrolled 151,050 individuals under the Medicaid expansion and Connect for Health Colorado has enrolled 100,112 Coloradans in private health insurance coverage.

For more Medicaid enrollment metrics, including by gender, age and county of residence click here. Additional enrollment metrics from Connect for Health Colorado can be found here.

Sweeping New Health Plan Rules Proposed

The Obama administration issued sweeping new proposed rules (PDF) late Friday affecting provider networks in insurance exchange plans, consumer access to quality information about plans, selection of plans in the small business exchanges, state rules on enrollment navigators, and reinsurance and medical loss ratios for insurers.

The Centers for Medicare and Medicaid Services (CMS) and (US Department of Health and Human Services) HHS said the proposed rules and draft standardized notices that issuers would be required to use when renewing or discontinuing plans will help to ensure consumers understand the changes and choices in the individual and group market.

“We are concerned that some enrollees, particularly those with certain complex medical conditions, are having trouble accessing in a timely fashion clinically appropriate prescription drugs,” read a preamble to the proposed rules.

Healthcare providers and consumer advocacy groups have complained about exchange health plans narrowing their networks to exclude a significant number of hospitals,physicians, clinics, and other providers. Plans say narrowing their networks is necessary to keep premiums affordable. The insurance industry and business groups are likely to view the new proposed rules with concern. Read the rest of the article in Modern Healthcare here.

With Deadline For Open Enrollment Looming, Nearly 4.2 Million Have Enrolled in Private Health Plans Sold Through Exchanges

More than 4.2 million people have enrolled in private health plans sold through the Affordable Care Act's insurance exchanges as of March 1, the Obama administration reported Tuesday.

However, the administration didn't say how many of those people have paid their first month's premiums or how many were previously uninsured.

The 4.2 million mark is well below the goal of 5.6 million that federal health officials had when open enrollment started last October. Open enrollment ends March 31 and the White House had hoped to enroll 7 million by that time. Read the rest of the article in Medpage Today here.

Grace Period Option Can Be Burden on Small Practices

A provision in the Affordable Care Act offers patients who qualify for an advanced tax subsidy when purchasing a product through the exchange a grace period in which they may neglect to pay their premiums for up to 90 days. During the first 30 days of the grace period, insurers have to pay any claims incurred by the patient. But for the next 60 days, nothing is guaranteed. If the patient visits the doctor, the insurer can “pend” the claim – wait to pay the provider until the patient pays his premium. At the end of the 90-day grace period, if the patient has not paid the premium, the insurer can cancel the coverage and refuse to pay the pended claims, or recoup the payments it’s already made. That puts the provider's office at risk.

Practices are encourages to check first with the insurer to make sure everything is in order before proceeding with the visit. If the premium has not been paid, the provider can give the patient the option of rescheduling the appointment or paying in cash and then applying to his insurer for the payment. But this extra step for verification takes time. Insurance companies are scrambling to staff up in order to answer phone calls, as well as offer portals to verify eligibility for these patients. Read more here.   

Commissioner Salazar Convenes Health Care Cost Study Group

According to an analysis from the Kaiser Family Foundation, the Colorado resort region that includes Aspen, Vail and Garfield and Summit counties has the highest health insurance premiums in the nation (click here to read the report about the rates in new geographically delineated health insurance markets). Earlier this year, Colorado Insurance Commissioner Salazar decided not to change Colorado's geographic rating system for either this year or next. Now Garfield County is threatening to sue the Commissioner for approving the rates for 2015 (read the article here).

Commissioner Salazar has convened a group to study the issue and to produce proposals for reducing health costs and premiums by May. The Health Care Cost Study Group, which which began meeting last week, includes industry representatives, health policy cost experts and consumers.

“It will be a challenge to dig into the costs of healthcare and the factors behind those costs, but this group is up to the challenge,” Salazar said in a written statement. “This is the first step in a journey to a better understanding.” Read more about the first meeting and the representatives of the study group here.

New ACA Communications Webinar Online Now

The Department of Health Care Policy and Financing, Division of Insurance and Connect for Health Colorado have released a new joint communications webinar. The webinar discusses how community partners can assist in reaching the uninsured and begin to educate consumers on how to use their coverage. The webinar also provides an overview of the resources available for consumers, partners and providers about the Affordable Care Act, Medicaid expansion, Connect for Health Colorado and the changes to private health insurance.

The webinar can be found on Colorado.gov/HCPF/ACAResources or by clicking here. Following the webinar, if you have questions you may submit them to ACAImplementation@hcpf.state.co.us.

Study Shows One in Four Families Struggle to Pay Medical Bills

According to a government survey published in the Bloomberg Personal Finance this week, one in four US families struggled to pay medical bills in 2012, and one in 10 said they had costs they couldn't pay at all.

The survey, released from the National Center for Health Statistics at the US Centers for Disease Control and Prevention, also found the lack of health insurance increased the burden of medical debt.

Major provisions of the Affordable Care Act take effect this year as the Obama administration seeks to extend healthcare coverage to most of the nation’s 48 million uninsured. The law may help lessen some of the financial burdens of medical care, said Karen Pollitz, a fellow at the Kaiser Family Foundation. "Unpaid medical bills is the number one reason why families declare personal bankruptcy,” Pollitz said in a telephone interview. “It causes people to lose equity in their homes, to endanger their retirement and their kid’s college education. It will destroy a family financially.” Read the rest of the article here.

Connect for Health Colorado and Colorado Medicaid Update

Read the latest enrollment number from Colorado Medicaid and Connect for Health Colorado below. You can read the press release in your browser by clicking here.

For immediate release:

January 17, 2014

CONNECT FOR HEALTH COLORADO AND COLORADO MEDICAID UPDATE

DENVER, CO – Between October 1, 2013, and January 15, 2014, more than 165,000 Coloradans have signed up or been approved for 2014 health coverage, according to data released today from Connect for Health Colorado and the Colorado Department of Health Care Policy and Financing.

After an extremely busy December, the first two weeks of January continues to see steady interest from Colorado shoppers and enrollment activity. January 15 was the deadline for Coloradans to sign up for private health insurance that takes effect February 1. The next deadline is February 15 to have private health insurance start on March 1. Open enrollment continues until March 31. Enrollment for Medicaid is year-round.

“We are encouraged to see steady interest from Coloradans during the second half of our open enrollment period and we are focused on reaching as many Coloradans as possible to help them shop for health insurance and apply for new tax credits to reduce costs,” said Patty Fontneau, CEO of Connect for Health Colorado.

“Together with our partners at Connect for Health Colorado, we are reaching and enrolling the uninsured,” said Susan Birch, Executive Director of the Colorado Department of Health Care Policy and Financing. “The numbers released today further demonstrate Colorado as a leader in the nation. We are among a handful of States with technology in place to allow for real time eligibility determinations for Medicaid. The technology, along with our strong network of county and community partners, has allowed us to enroll individuals into new coverage faster than many other states many of which have much larger populations to reach.”

Coloradans signed up for health insurance:
165,137 (Total) 101,730 (Medicaid) 63,407 (private health insurance)

Individual and family customer accounts:
86,235 (from PEAK) 155,854 (private health insurance)

Daily website visitors (average daily from January 1st - 15th):
4,546 (Medicaid) 7,982 (private health insurance)

** More metrics information about Medicaid is available here and more metrics information about Connect for Health Colorado is available here.

Through state laws, Connect for Health Colorado was established as a non-profit entity with a Colorado mission. In addition, Colorado is expanding eligibility for Medicaid. Private health insurance purchased through Connect for Health Colorado’s competitive marketplace and the expanded eligibility for Medicaid both take effect in 2014. Enhanced federal funding that is available starting January 1, 2014 will support the Medicaid expansion.

Connect for Health Colorado has been open since October 1, 2013 and operates with separate technology and customer service operations from the federal marketplace, healthcare.gov. Connect for Health Colorado is open to individuals, families and small businesses. Individuals and families can choose from up to 150 private health insurance plans from ten carriers and small employers can create small group plans from up to 92 health insurance plans provided by six carriers. The Customer Service Center is open from 7 am to 8 pm Mondays through Saturdays at 1-855-PLANS-4-YOU (855-752-6749). More information is available at www.ConnectforHealthCO.com.

Colorado Medicaid and the Child Health Plan Plus (CHP+) are public insurance programs for low income Coloradans. The Department of Health Care Policy and Financing administers these programs. Coloradans have multiple ways to apply for coverage, Colorado.gov/PEAK is the online application for public assistance programs including medical assistance. For more information visit Colorado.gov/hcpf or visitColorado.gov/health. The Medicaid Call Center (800-221-3943 for general questions and 800-359-1991 to check application status) are available 8 a.m. to 6 p.m. Monday through Friday. The call center is closed on state holidays.

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Contact information:
Ben Davis, ben@onsightpa.com, 303-552-6790 (Connect for Health Colorado)
Rachel Reiter, Rachel.Reiter@state.co.us, 303-866-3921 (Colorado Medicaid)

Copyright © 2014 OnSight Public Affairs, All rights reserved.

Office of Rural Health Policy Webinar on the ACA Today

Join the Office of Rural Health Policy's call today on the Affordable Care from 1:00 - 2:00 pm. You can also find a list of previous and upcoming calls on the ORHP website. As always, you can share your experiences or questions at ORHP-ACAQuestions@hrsa.gov. The call information can be found below.

Wednesday, January 29, 2014
1 - 2 pm MST
Call-in Number: (800) 857-3749
Passcode: ORHPACA

ACA Meeting in Denver on April 27th

Affordable Care Act (ACA) meeting scheduled for April 27th. Come learn the myths from the facts about the ACA and get answers to your questions on Saturday, April 27th from 1:00 – 5:00 at Manual Auditorium in Denver. Get more details in the flyer or read the agenda here.

Mediator Coming to Help with Exchange Set Up

Sparring between Colorado Department of Health Care Policy and Financing (HCPF) and the Colorado Health Benefit Exchange Board (COHBE) prompted an outside analyst to recommend a third party to triage and manage the project.

Federal grants that Colorado received to launch its exchange require outside analysts to conduct independent reviews. According to a new report from outside analysts at First Data, squabbling between state and exchange managers over IT projects and other policy decisions has been slowing down progress on the exchange.Therefore, a mediator from the Robert Wood Johnson Foundation now will come to Colorado to help managers get the giant multi-million dollar project off the ground on time by October 1st when it’s slated to open to consumers.

Yen Pham, an analyst from First Data stated, “A number of policy decisions need to be resolved by both COHBE and HCPF; they include the approach to accommodate referrals, eligibility mixed households and life change events.” Read more in the Colorado blog, Health Policy Solutions.