States’ Implementation Of Exchanges May Decide Fate Of ACA.

Over the holiday weekend through today, a number of national outlets reported on exchange implementation occurring across the US. Notably, from a national perspective, Bloomberg News  (5/28, Nussbaum) reports that the fate of the Affordable Care Act is “being decided far from Capitol Hill,” as “states from New York to California” work to implement the law’s insurance exchanges before the October 1 deadline. With just four months to go, the article concludes that “the prognosis is mixed.” For example, some states face “technical hurdles” and will “barely make it.” However, California’s recent announcement showed that despite “doom-and-gloom” estimates, premiums in that state will fall because of the law.

        And in a related piece, Bloomberg News  (5/28, Pettypiece, Salant) reports that conservative groups are now “targeting” the Affordable Care Act’s insurance exchanges to continue attacking the law. Heritage Action for America and Tea-party aligned FreedomWorks plan to “push Congress to cut off funding for the exchanges in the debate later this year over raising the debt ceiling.” According to the article, this is an example of the shifting strategies opponent’s of the law employ to prevent it from succeeding.

        California Exchange To Offer Lower Rates, Less Choice Among Providers. With last week’s big reveal of plans and rates to be offered on California’s insurance exchange, coverage of that state was heaviest. First, the Los Angeles Times  (5/25, Terhune) reported that though health insurance rates for the Covered California exchange “came in lower than expected” this week, “one downside for many consumers will be far fewer doctors and hospitals to choose from.” Those who “want UCLA Medical Center and its doctors in their health plan network next year, for instance,” may have to choose Anthem Blue Cross, while Cedars-Sinai Medical Center, “one of Southern California’s most prestigious and expensive hospitals, said it’s not included in any exchange plans at the moment.” The Times said “exclusive arrangements, increasingly tight networks and outright exclusions are becoming more common.”

        Bloomberg News  (5/24, Nussbaum) reported that Deutsche Bank analyst Scott Fidel told clients in a research note Friday that insurer Health Net unexpectedly posted the lowest rates for Southern California in the state’s new online health exchange and could attract a sicker population of patients as a result. Bloomberg News says that state data show “the insurer will offer a premium for a middle-income 40-year-old customer in Northern Los Angeles that’s 12 percent cheaper than any other plan,” while “in the San Diego area, Health Net’s premium will be 13 percent below the nearest competitor, Indianapolis-based WellPoint Inc.” Health Net “will offer a narrow network of doctors designed to keep costs down.” The report points out that “not all analysts were as concerned as Deutsche Bank’s Fidel.”

        Government Health IT  (5/28, Brino) reports that Covered California is “now beginning the mammoth task” of outreach to more than 5 million people it hopes to enroll. The exchange “is spending about $100 million” and “is taking an all-of-the-above approach to outreach and partnering with faith-based groups, community organizations, hospitals, clinics, agricultural trade groups, unions, and retailers like Walmart (over the objection of some unions), while hiring more than 21,000 navigators and assisters who can speak multiple languages.” The report notes “the insurance exchange in California will be a bellwether for the success of the ACA nationally.”

        In related news, the San Francisco Business Times  (5/25, Rauver, Subscription Publication) “Bay Area BizTalk” blog reported that Covered California is “paying giant PR firm Weber Shandwick $12 million over two years to market the exchange.”

        Just One Insurer To Sell On New Hampshire Exchange. Beyond California, several states were in the news over the holiday weekend for making progress, or a lack thereof, toward implementing their insurance exchanges. For example, the AP  (5/28, Ramer) reports that one week out from the deadline to apply to sell insurance on New Hampshire’s new exchange, only Anthem Blue Cross/Blue Shield has expressed interest in doing so. According to Scott Baetz, co-chairman of a panel advising the state on implementing the overhaul law, this news “was the latest in what he called a series of potential disappointments.” He said, ‘‘This is really disheartening. At this point, I don’t how much value it’s going to bring to small businesses. I feel like small businesses have been pushed to the side or into a holding pattern. And for a state like New Hampshire, that has so many small businesses, it’s really preventing us from realizing the full scope of benefits that were the intention of the Affordable Care Act.’’

        Several Insurers Expected To Sell On Minnesota Exchange. The Minneapolis Star Tribune  (5/24, Crosby) reported that in Minnesota, consumers buying insurance on the state’s new exchange “will have more choices than are currently available.” Still, “little information about the Minnesota health plans’ offerings has been made public, so it’s unknown how much the premiums will cost.”

        Seven Insurers To Sell Plans On Georgia Exchange. The Atlanta Business Chronicle  (5/28, Caldwell, Subscription Publication) reports that “seven health insurers have signed up to offer benefits plans as part of the online insurance exchange that begins enrolling Georgians in October, reports Georgia Health News.” These companies are Aetna, Alliant, Blue Cross and Blue Shield of Georgia, Coventry, Humana, Kaiser Foundation Health Plan, and Peach State.

        New Mexico Exchange Official Worries System Will Be Stressed By Demand. The El Paso Times  (5/26, Yee) examines the impact of New Mexico’s plans for its health insurance exchange, finding that one exchange official predicts that the healthcare “system is going to be stressed” as it absorbs thousands of new insured residents. Exchange vice president Jason Sandel adds, “We’re going to have to see how it all plays out.” The Times includes more perspectives from local stakeholders, including one physician who worries that “it could provide a tremendous influx of new patients, and we’re having problems keeping up with patient load now.” Payment rates are also a concern to physicians, that doctor said.

        Federal Official Expects Oklahoma Exchange To Open On Time. The Tulsa (OK) World  (5/27, Greene) reports, “Plans to build an Affordable Care Act-compliant health insurance exchange for Oklahoma are moving ahead rapidly, despite the state’s refusal to participate and Attorney General Scott Pruitt’s efforts to neuter its operations.” CMS spokeswoman Alicia Hartinger said, “When open enrollment begins on time, on Oct. 1, consumers in all 50 states, including Oklahoma, will have access to a new insurance marketplace where they will be able to compare different insurance options and enroll in health plans that meets their needs.” Hartinger said that the deadline for insurance coverage to being on January 1 will also be met. Meanwhile Pruitt has a suit in Federal court arguing that under the act, “insurance subsidies can only be distributed through state exchanges, not federally built ones.” If successful, the case would mean that there would be “no subsidies for Oklahoma consumers,” and no “tax penalties against certain companies that fail to offer qualifying coverage to employees.”