[ad_1]
By Christine Monahan and Madeline O’Brien
The 2023 open enrollment season marked the third 12 months of Washington State’s public option-style plan, “Cascade Select.” In its preliminary 12 months, value and entry challenges hindered the state’s objectives of driving down prices and enhancing Affordable Care Act (ACA) market competitors. A current report by the Washington Health Care Authority suggests these points have remained precept considerations for state officers charged with implementing the general public choice program. This weblog offers an replace on how Cascade Select plans carried out within the not too long ago concluded open enrollment interval, and descriptions key points to look at as Washington strikes ahead with its first-in-the-nation program.
2023 Open Enrollment Update
Cascade Select plans are publicly procured merchandise run by non-public insurers, with state-imposed limits on supplier reimbursement. Washington chosen three insurers to supply Cascade Select plans in 2023, down from 5 insurers chosen in earlier years. In choosing these three insurers out of seven bidders, Washington balanced increasing Cascade Select plans to extra counties with rising plan affordability, whereas minimizing the variety of new plans in already aggressive counties to scale back selection overload. On all fronts, Washington’s public choice program confirmed progress in 2023.
Cascade Select plans have been out there in 34 out of 39 counties, up from 19 in 2021, giving 98 % of present trade prospects entry to a public choice plan. Cascade Select plans additionally usually noticed decrease fee will increase relative to different plans, and have been the bottom value silver plans in 25 counties.
Further, enrollment development in Washington’s public choice plans accelerated in 2023. According to preliminary information, Cascade Select plan enrollment has greater than tripled since 2022—roughly 27,000 people enrolling in a the plans throughout 2023 open enrollment, together with 10,000 new prospects and 17,000 prospects who re-enrolled. These totals signify greater than 11 % of complete market enrollees and 27 % of recent enrollees Graphics counsel few enrollees moved out of Cascade Select plans between 2022 and 2023.
Key Issues to Watch
For the longer term, Washington policymakers are evaluating the general public choice’s efficiency and contemplating modifications to additional advance state objectives.
Increasing Affordability
Currently, Washington’s main hook for rising affordability by its public choice program is capping the mixture reimbursement charges Cascade Select plans pay suppliers at 160 % of Medicare charges. While the plans typically have decrease premiums than different merchandise offered on Washington’s market, vital premium reductions have but to materialize, even when Cascade Select plans hit the reimbursement goal. Despite information exhibiting that three insurers got here in beneath the 160 % goal in 2021, just one insurer achieved meaningfully decrease premiums for its Cascade Select plans in 2023. The Health Care Authority is working with its sister businesses, the Washington Health Benefit Exchange and the Office of the Insurance Commissioner, to discover methods to additional cut back premiums. Options the state could discover embody decreasing its reimbursement cap, adopting a disaggregated cap to raised goal excessive value providers, suppliers, or areas, and setting premium discount targets much like Colorado and Nevada’s public option-style plans. The Health Care Authority can be analyzing how conflicting timelines and obligations regulating plans amongst it and its sister businesses could also be limiting the Authority’s negotiating energy over insurers bidding to supply Cascade Select plans. For instance, in 2023, the Authority was negotiating its contracts whereas plan charges have been below assessment by the insurance coverage division.
Requiring Insurer Participation
Under the statute establishing Washington’s public choice program, the Health Care Authority is exploring whether or not it could be helpful to require insurers collaborating in public worker profit swimming pools or different Health Care Authority applications, comparable to Medicaid, to bid for Cascade Select contracts, with out requiring the Authority to simply accept these bids. This could be much like the method established in Nevada, the place Medicaid managed care organizations must submit bids to supply public choice plans starting in 2026.
While such a requirement may enhance selection, the Health Care Authority has cautioned that extra insurers in areas with adequate market competitors could not improve the entry and affordability objectives of the general public choice program. For instance, Regence Blue Shield provided public worker profit pool protection in 2021 and 2022, however the Health Care Authority rejected the bid from Regence-affiliated BridgeSpan to supply a Cascade Select plan in 2023 primarily based on restricted service areas and excessive fee proposals. Similarly, two out of 5 Medicaid insurers in Washington already supply the general public choice plans, whereas one other two have been rejected in 2023 and the ultimate insurer doesn’t at present take part within the particular person market. Additionally, problems associated to community continuity and totally different procurement processes may create obstacles for insurers trying to bid throughout applications.
Improving Provider Participation
Cascade Select networks, whereas complying with state community adequacy necessities, are comparatively slender in comparison with different market well being plans in Washington. The Health Care Authority suggests this can be partially as a result of plans’ decrease reimbursements: a number of insurers bidding to supply Cascade Select plans in 2023 reported that suppliers declined to affix their networks as a result of combination reimbursement cap. While Washington at present requires sure hospitals to contract with at the least one Cascade Select insurer, this requirement doesn’t prolong to non-hospital suppliers or guarantee that hospitals will contract with a number of insurers providing public choice plans. Anecdotally, insurers have recommended that many suppliers—notably these in giant well being techniques—have been prepared to contract with only one Cascade Select insurer to fulfill their statutory obligation, turning down alternatives to contract with different public choice insurers.
The Health Care Authority means that requiring all suppliers who choose into public profit pool plans to additionally take part in Cascade Select may assist to develop public choice plan networks and enhance shoppers’ plan selection. However, the state company additionally acknowledges that increasing plan networks should be balanced in opposition to affordability objectives. They additionally describe a dedication to working with the Office of Insurance Commissioner to additional analyze supplier community info as this system continues.
Looking Ahead
Washington has made significant progress in implementing its public choice program, and continues to try for enhancements to premium affordability and entry. As extra states contemplate and launch their very own public choice applications, classes realized from Washington’s preliminary challenges and up to date successes could assist information their efforts.