Officials still ironing out exchange kinks
By Neal P. Goswami
VERMONT PRESS BUREAU | November 05,2013
MONTPELIER — Shumlin administration officials met with insurance companies Monday to hammer out details on how to execute an extension of a state mandate requiring individuals and small businesses to buy health insurance on the state exchange.
Details remain elusive, but officials said there was some progress Monday evening on several key questions in the wake of Gov. Peter Shumlin’s surprise announcement Thursday. Robin Lunge, the administration’s director of health care reform, said she and others met for three hours and will reconvene again today.
“We still have a level of detail that we need to clearly work through,” Lunge said. “As soon as we have that worked through we plan on issuing some clarification around all of these questions. We know people have a lot of questions but I don’t want to prematurely answer and then have to make more decisions.”
Administration officials and both of the insurance company teams were planning to continue working independently Monday night, she said, in preparation for today’s meeting.
“It’s been a very collaborative process. When you operationalize something you need to think it through from all angles,” Lunge said.
For weeks Shumlin had steadfastly maintained that Vermont Health Connect, the state’s version of the online exchanges required under the federal Affordable Care Act, was on solid footing. But last week, citing major technical problems with the exchange site, he announced a three-month delay of the mandate.
Vermont is the only state requiring individuals and small businesses with 50 or fewer employees to purchase health insurance on the online insurance marketplace. With the website malfunctioning and the Jan. 1, 2014, coverage deadline approaching, Shumlin chose to exercise a provision in state law to extend it, providing certainty to the 100,000 or so Vermonters who will need to obtain insurance on the exchange.
Both individuals and employers will now be able to maintain current health care plans through March 31, 2014, even if they do not meet the new coverage requirements under ACA.
Shumlin also announced that small businesses can obtain insurance plans for employees directly with Blue Cross Blue Shield and MVP Health Care, the state’s two insurers.
Under ACA, insurance carriers can be considered “agents” of the exchange system and sell insurance plans directly to employers, bypassing the need for the exchange site. Shumlin said small businesses choosing this transitional option will make payments to the insurance carriers directly rather than through the exchange.
Extending the deadline raises several questions, though.
For example, it has yet to be determined if deductibles will carry over into the new year. The two insurance carriers stand to lose money if deductibles are allowed to extend into the new year.
“It will have financial implications, that’s for sure. But that’s just speculation at this point because I don’t know if that’s what’s intended,” Kevin Goddard, vice president of external affairs for BCBS, said ahead of Monday’s meeting. “It’s hard to assess what the financial implications are because we really don’t know what the details are yet.”
Whether new insurance cards will be issued for extended plans that would have previously expired before the mandate was extended remains unclear. And how payment for insurance plans will be processed must also be determined.
Goddard said BCBS officials are hoping to finalize plans with the state over the mandate extension this week.
“Certainly we hope within the next several days to have these details worked out because we need to communicate them and implement them,” he said.
BCBS and MVP could also face losses because some of the insurance rates approved by the state for 2014 are higher than 2013 coverage plans. Extending the existing insurance plans could mean a loss.
Despite the potential financial implications, Goddard said the focus remains on delivering health insurance to Vermonters.
“I know the focus of Blue Cross, and I believe the focus of MVP and the state, is ensuring there is no interruption of coverage in all of this,” he said.
Meanwhile, BCBS is not seeking any permanent changes to Vermont law to allow small businesses to purchase plans offered on the exchange directly from insurers permanently beyond the March 31, 2014 extension. Some opponents of Vermont Health Connect have called for such a change.
“The state made those policy decisions two years ago,” Goddard said. “We are not thinking about that at all. Our overriding focus is we’ve got between 60,000 and 80,000 Vermonters between us to ensure that their coverage is not interrupted and get them onto these new exchange plans in the next few months. ... We haven’t spent a minute on going back to the Legislature and asking them to rethink the policy on this.”
Susan Gretkowski, senior government affairs strategist for MVP, deferred all questions Monday evening to Lunge.
“We worked through a number of issues and we’re still working with the state,” she said.