State Marketplace Variation
The Alliance for Health Reform held a briefing entitled “Health Insurance Marketplaces: Different Strokes for Different States”. I think the title was an apt description of all the variation that is going on in states that are implementing their own Marketplaces. In many ways, it looks like a natural experiment. Sarah Dash of the Georgetown University Health Policy Institute (CHIR) highlighted some of the different approaches states are taking which are discussed in more detail in a recent report by Urban and CHIR. For example, 4 states are choosing to selectively contract with a limited number of plans, 6 states are serving as a market organizer by limiting the number or type of plans and 8 states are allowing all plans who meet standards to participate. Three states and DC required insurer participation. Maryland for example is requiring that insurers above a certain size in both the individual and small group market must participate in their Marketplace. Five states are setting “waiting periods” for insurers who decide not to participate during the first year. Six states aligned coverage inside and outside their Marketplaces to minimize adverse selection. 8 states and DC are requiring additional coverage levels beyond silver and gold. Six states required insurers to offer standardized plan designs ranging from 3 plans in Oregon to 17 in California and 7 states and DC required plans to be meaningfully different.
States are ahead of the federal requirements in several areas, for example, the federal regulations will require quality reporting in 2016, however 9 states are displaying quality measures the first year and 10 states are developing state-specific quality rating systems. Most states are providing employee choice options on the SHOP, while the federal marketplace has postponed employee choice until 2015. Some states have released plan premiums. Sara Collins from the Commonwealth Fund discussed a recent analysis by ASPE in HHS that found the proposed individual silver plan premiums in 2014 range from 10 — 18 percent lower than CBO estimates. Premiums in the federal marketplace will not be released until September.
Joseph Thompson, the Surgeon General for the State of Arkansas, discussed the state’s premium assistance waiver program where the state plans to send 225,000 uninsured low income residents to private plans in the Marketplace rather than expand their Medicaid program. The state is hopeful that enrollment in the same QHPs that serve the commercial population will improve payment and delivery of care. Under the plan the state will send low income persons that are not medically frail to the Marketplace to select a QHP. The state has been developing a standardized self-assessment screening form and estimates that about 10 percent of the uninsured will be determined frail and be referred to the Medicaid fee for service program while the rest will be served by the Arkansas Marketplace.
Resources
Listen as GHG Senior Consultant, Donna Burtanger, discusses sales and marketing capabilities in the upcoming Health Insurance Marketplaces (Exchanges). Learn the three most important items customers participating in the Exchanges look for in a potential health plan, and how to ensure you are marketing to the correct demographic.
Health plans operating within the Exchanges must evolve from a culture of sales and marketing to a culture that is member-centric and more accountable with a greater sense of urgency. GHG can help, find out how.
From sales and marketing to staff training, data management and reconciliation, GHG Founder & Executive Chairman John Gorman breaks down each potential roadblock and offers tips and suggestions on how to keep your organization moving on the right path before the launch of the Exchanges, in this recording from the 2013 GHG Forum.