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Friction At Board Meeting As Health Exchange Problems Continue

HBE Board meets in Seattle on August 14.

HBE Board meets in Seattle on August 14.

“The system fixes that were implemented have not resolved these defects, and instead, the number of detrimentally affected accounts has grown.” In a letter to Washington Health Benefit Exchange Board Members dated August 12, Premera Senior Vice-President Kitti Cramer provided details showing the health insurance premium aggregation and termination notice problems at the Exchange are far larger than previously thought. In May Premera had 9,000 subscribers and their families whose accounts could not be reconciled and by late July that number had grown to 13,000.

At the HBE Special Board Meeting on August 14 in Seattle, other carrier representatives joined Premera in documenting the problems and in calling for an end to the mandated duplication involved with the Exchange trying to collect premiums. They also expressed concern over whether the existing problems can be corrected with enough lead time for the next open enrollment period which begins November 15.

Premera’s letter also pointed out that Washington is one of only three states trying premium aggregation at their state exchanges, since the federal government will only send subsidies to the carriers. Aggregation is not working in any of the three states.

Nonetheless, HBE staff pleaded for more time explaining that they are making some progress and that premium aggregation is too deeply embedded in the software system to be easily removed at this point. They stated that since July 15 payment issues had been resolved for 7,680 individuals and that additional key fixes would be implemented at the end of August for major problems and again at the end of September for secondary problems. But they still could not answer Board questions as to how many enrollees were still not reconciled or why it has taken so many months to address the problems.

On August 7 the Governor and Insurance Commissioner attempted to mitigate some of the problems by working out a process to permit some enrollees with billing problems to pay their carriers directly.

Meanwhile, the main purpose for scheduling the NBE Special Board meeting was to approve an annual budget as the basis for their 2015-17 request to the Legislature. It was not to be. Concerns were already present over a pre-meeting decision to delay any premium aggregation budget discussions to the next regular Board meeting. Board members from both sides of the political spectrum were also unhappy with different aspects of the HBE staff documentation.

In an unusual twist during the public testimony, expanding funding for the SHOP (the Small Business Health Options Program) was even questioned by Sheri Nelson from the Association of Washington Business. She pointed out that the major insurers are still not participating and both the carriers and small businesses still fail to see any significant value that would justify the costs.

Over a month ago the HBE staff had originally laid out a “bare bones” budget of about $53 million per year, a $13 million increase over the level budgeted for 2015 by the Legislature as part of the 2013-15 budget, but consistent with what the HBE had originally requested in 2013. Several Board members led by Teresa Mosqueda and Ben Danielson were not happy with that sum and demanded that additional services be added that would increase the annual cost to $63 million. These “Cadillac” expansions in the cost of the Exchange were met by opposition from other Board members including Bill Hinkle, Don Conant, and Bill Baldwin.

With a significant division in his Board and a need for further information from the HBE staff, Chair Ron Sims proposed that for discussion purposes only, the HBE staff should develop a $58 million budget to be analyzed at the August 28 Board Regular meeting. With limited objection and a little smile on his face, Ron declared a “consensus” and adjourned the meeting.

 


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