Washington Healthplanfinder

Washington Healthpathfinder

Agency overview
Jurisdiction	Health insurance marketplace for U.S. state of Washington
Agency executive	Richard Onizuka, CEO
Website	wahealthplanfinder.org

Washington Healthplanfinder is the online health insurance marketplace in the state of Washington, created in accordance with the Patient Protection and Affordable Care Act. It operates together with the Washington Benefit Exchange. In 2013 it received approval for more than $150 million in federal funding. $26.3 million in funding from the American federal government has been for advertising and promotion. The marketplace web site also allows people to sign up for Apple Health.

The marketplace operates a web site and a call center and is a resource for families and small business to compare and enroll in health insurance plans. It also provides enrollees with access to tax credits. Enrollment started on October 1, 2013. During the first month of operation 7,091 people enrolled through Washington healthplanfinder. It is estimated that there are one million medically uninsured individuals living in Washington state.

In November 2013 the exchange board voted to increase the CEO’s pay by 13%.

The open enrollment period for 2016 coverage runs from October 1, 2015 to January 31, 2016. For the 2016 year, fifteen health insurers are selling 210 health plans in Washington state. The insurance commissioner for the state of Washington warns consumers that, while the plans include the same essential health benefits, they differ in deductible amounts and which medical providers are included in their health insurance networks.

On May 16, 2016, The Seattle Times reported that Health insurers in Washington state are requesting an average premium rate increase of 13.5 percent for 2017 individual plans. Also, fewer options will be offered through Washington Healthplanfinder.

Overview

There are three basic plans with varying levels of coverage available for Washington residents: Bronze (60 percent), Silver (70 percent) and Gold (80 percent). Plans with a lower percentage have lower premiums, and higher costs to the individuals (out-of-pocket costs, deductibles and co-payments). A catastrophic plan is available and designed for younger individuals (under the age of 30) and these plans will have a high deductible and a lower premium.

In 2013 no Platinum plans were not available in Washington.

Goals

Marketplace administrators hope to sign up 130,000 people by the end of 2013, and a further 280,000 people in 2014. The ultimate goal is to have all of Washington's 6.5 million residents consult the exchange website to see what healthcare opportunities are available to them.

GMMB, a market research firm with offices in Washington D.C. and Seattle which will be receiving $19 million of the federal funds, said that many uninsured Washington residents are skeptical about finding an affordable health insurance plan. Washington Healthplanfinder is working with community groups to try to overcome this obstacle.

History

Timeline

• Regular updates posted on Facebook (YouTube is under consideration)
• August 20, 2013 first radio ads
• August 21, 2013 first online ads
• week after Labor day first print ads
• August 31 deadline for submitting plan information
• mid September TV commercials
• mid September TV commercials
• October 1, 2013 website available to the public to:
  • Compare all health plans offered,
  • apply for subsidies
  • enroll in coverage that starts on January 1, 2014.

Choice of healthcare insurance companies

The announcement of the companies to be included in the Washington healthcare exchange was announced on August 1, 2013. Mike Kreidler, Washington State Insurance Commissioner said his office had approved four different companies offering 31 different plans. He rejected five other companies that also applied.

On September 4, 2013 the Washington Health Benefit Exchange Board approved six health insurance companies (plus one affiliate company) approved earlier by the State Insurance Commissioner. On September 5, 2013 the State Insurance Commissioner approved the earlier rejected Coordinated Care Company after a judge ruling on September 2, 2013 ordering the Insurance Commissioner to iron out issues that prevented the addition of Coordinated Care to the list.

The Washington Health Benefit Exchange Board approved a total of five (plus one affiliate company) non-Medicaid companies, two Medicaid companies, and 38 health plans just hours before the federal deadline for approvals expired. (The federal Office of Personnel Management is expected to approve eight additional health plans available in all states.)

October 1, 2013 exchange opens to the public

During the first week of enrollment 9,452 people were enrolled in insurance plans offered through the marketplace, and a further 10,000 completed applications. 165,000 people visited the website 837,000 times and 39,000 accounts were set up according to marketplace spokesman Michael Marchand. The call center kept the average caller waiting for an average of 10 minutes.

On October 22, 2013, the Seattle Times reported that 35,500 Washington residents had already enrolled though the web site, but of those only 4,500 had enrolled in private insurance and the other 31,000 enrolled in Medicaid. 70,000 additional residents had completed applications.

2014 enrollment

In its February 2014 final report the Washington Health Benefit Exchange provided the following statistics for 2014 enrollment:

• Total enrollment was 105,404
• Medicaid Newly Eligible Adults 214,688
• 35% of exchange (non-Medicaid) enrollees were aged 55–64
• The total number of enrollees in both Medicaid and the exchange is 768,027
• 25% of Exchange enrollees located in King County
• 55% of Exchange Enrollees were women
• Slightly less than 55% of Medicaid Enrollees were women

2015

Open enrollment

Enrollment for 2015 will start on November 15, 2014 and end on February 15, 2015.

• Individuals enrolled in the exchange in the previous year must re-enroll if they want to maintain marketplace insurance plans or Premium tax credits
• The individual mandate penalties administered through the IRS will increase to the greater of 2% of adjusted household income, or $325 per person and $162.50 per child to a maximum of $975 per family in the 2015 tax year
• Businesses with 50 or less employees can obtain health plans and tax credits on the exchange for the first time
• The number of health plans offered has doubled from the previous year to 230
• Rates have increased by an average 1.5%
• A Platinum plan is available for the first time on the exchange
• Call center help personnel has tripled to 500 individuals
• There are 2,500 insurance brokers in Washington licensed to enroll consumers in the marketplace

2015 1095-A forms mailout

On February 9, 2015, Lisa Stiffler wrote in the Seattle Times that Form 1095-As were mailed out to most 130,000 clients accounts. But, not everyone was able to view the forms through Washington Healthplanfinder website. Some tax forms have not been mailed because of problems with the data, including the need for information from the IRS.

Change in billing

In September 2015, Washington Health Benefit Exchange (WHBE) made a change to premium payments. Instead of users paying WHBE, they were asked to pay directly to their insurance company. This change affected all one hundred fifty five thousand people enrolled with WHBE. The aim of the change was to free WHBE from the billing portion of the system and alowl it to concentrate on providing comparisons of health plans.

Approved companies

• Asuris Northwest Health
• BridgeSpan Health
• Coordinated Care
• Group Health Cooperative
• Group Health Options
• Kaiser Foundation Health Plan of the Northwest
• LifeWise Health Plan of Washington
• Premera Blue Cross
• Regence BlueCross BlueShield of Oregon
• Regence BlueShield of Washington
• Molina Healthcare

On Sept 25, 2013, the Seattle Times said there were 46 health care plans in the marketplace.

Approved Medicaid companies

• Community Health Plan of Washington
• Molina Healthcare of Washington
• United Healthcare
• Coordinated Care
• Amerigroup Washington

Advertising in other states

Oregon and Colorado have been running TV commercials since the beginning of summer 2013.

Governance

A nine-member board oversees the Washington Health Exchange, led by chief executive officer Richard Onizuka.

Washington Health Exchange Board

• Margaret Stanley, retired Executive Director of the Puget Sound Health Alliance, and former Senior Vice-President of Regence BlueShield and head of public employee benefits programs in both Washington and California.
• Phil Dyer, senior VP of Kibble and Prentice/USI.
• Don Connant, General Manager of Valley Nut & Bolt in Olympia who is also assistant professor at Saint Martin's University
• Teresa Mosqeda

Management team

• Pam MacEwan, Chief Executive Officer
• Carolle Holland, Chief Financial Officer
• Molly Voris, Director of Policy
• Beth Walter, Director of Operations
• Vincent Barailler, Chief Information Officer
• Michael Marchand, Director of Communications
• Brian Peyton, Director of Legal Services

Customer support program

The Exchange has outsourced their customer service efforts to Faneuil, navigators, the insurance companies and insurance brokers. The exchange also employs translators in 175 languages.

Those that work for Faneuil, insurance companies or as navigators are limited in the scope of assistance they can provide. Generally speaking Faneuil and navigators are allowed to help clients apply for financial assistance from the government in paying for their premium and/or other cost shares. They are allowed to provide the written details of each plan a client is considering. However, they are not allowed to look up your doctors or medications to ensure they are included or to explain what your costs will be for the benefits of the plans you are considering. They can resolve any application or verification of information challenge clients face. They are not allowed to express an opinion or influence your decision to purchase one plan over another other than presenting the information provided by the insurance company. Insurance companies can explain benefits, look up doctors and medication but can't help you with the application process or challenges associated with getting financial help. Insurance brokers are allowed to everything and are allowed to provide you their biased opinion about which plan suits your needs better than others.

Criticism and controversy

Short term health plan sold with fundamental weaknesses

The Affordable Care Act (ACA), also known as Obamacare, is rife with loopholes and entanglements far too complicated for the layman to completely understand.

One of the common pitfalls for the public is found when the open-enrollment period (which, for coverage in 2017, begins on Nov. 1, 2016 and ends on Jan. 31, 2017) ends. Legally, the only health insurance option for those who miss the enrollment deadline (unless they have an significant life change) is a short-term health insurance policy. These policies have major drawbacks that are important to understand.

When the ACA was created, it was designed so that all plans have the same 10 essential benefits - several of which many patients will never use. The rationale was that these essential benefits would indirectly benefit everyone because they would create more stability in expensive areas of care where insurance companies have traditionally cut corners. The side effect has been that consumers are often subsidizing care that they can't or wouldn't use to the extent that the coverage has been extended. For example, men have to pay for maternity coverage and people who don’t use illicit drugs pay for insurance against the cost of drug rehabilitation. Cumulatively, the essential benefits could easily represent half of your premiums.

One of the most expensive and controversial essential benefits surrounds how medications are covered now compared to before the ACA. Most Americans don’t use many prescriptions and those that do typically won't receive any financial help under Obamacare until they reach a substantial deductible. That being said, medication costs are now wrapped into your deductible and go against your maximum out-of-pocket so you are afforded unlimited prescription coverage if you become critically ill in an area where medication costs are exorbitant. Before Obamacare you could opt in or out of prescription coverage and you would usually be limited to $3,000 to $5,000 of coverage. Opting out of prescription coverage might save you 20 percent of your premiums for health plans that existed before the ACA, however if you could opt out now it might represent as much as 35 percent. For 90 percent of Americans $5,000 worth of coverage was more than enough. That being said, under the old system, if it wasn't enough, the only way you could insure against the cost of medications was to work for an employer whose plan was required to give you unlimited coverage. Prescription costs represent about 20 percent of the overall cost of healthcare but most of those costs are confined to a very small number of diseases and patients. This seemingly small change in the way Obamacare covers medications is extremely expensive with little perceived value to the vast majority of consumers because few people use the majority of the medications in the United States.

The federal government knows that many people will want to sign up for affordable coverage outside of open enrollment despite the fact that they have intentionally missed the deadline to enroll. As a compromise, they allow short-term, temporary insurance policies with scaled back benefits to be fully underwritten and sold to consumers for up to 11 months. Screening out the unhealthy while limiting the length and the level of coverage afforded to the consumer makes the policy more reasonably priced. At the same, time these serious limitations discourage consumers from using temporary policies as a means to avoid paying for the more comprehensive coverage afforded by Obamacare. Beyond the coverage limitations, you also are subject to tax penalties for using short-term policies.

These penalties are based on your income and the number of people in your family that you have as a write-off against that income. The penalty is a percentage of what is leftover or a flat-dollar amount, whichever is higher. This year it is 2.5 percent. So, for example, if someone made $100,000 and has three people in their family with, say, a $20,000 write-off, their taxable income would be $80,000, leaving a penalty of $2,000 (80,000 x .025) – or, over 12 months, about $160 per month.

What some smart-marketing companies have done is solicit short-term policies as a permanent solution for their clients, downplaying the penalty and coverage limitations. In our example, the penalty was $160 per month on top of the health insurance premium for the short-term policy. If you add those numbers together you are usually paying a cost about what you would have paid through the Exchange if you paid full price (because you were not eligible for a premium subsidy). There are several caveats.

If someone receives a subsidy against their premium – meaning that their income is low enough that they would have qualified for a subsidy – for every dollar that they earned under that line, they would save 15 percent on their premium. In addition, some family's income would also have qualified them for a subsidy that reduces their deductibles. Both of those subsidies are permanently forfeited for the time you are insured by a temporary health insurance policy. As a result, if you have no other choice, it would be smart to buy a short-term policy - but keep the financial math in mind.

Furthermore, you must consider that the insurance companies selling those policies have other provisions to minimize their risk. They typically don’t cover preventative care, medications, maternity, pre-existing conditions etc., which has not only been frustrating for consumers using these policies but, at times, crippling because major events account for 80 percent of health-care costs. These companies are avoiding a great deal of that risk, as well as underwriting – looking to screen out those in poor health.

Beyond that, you may save money by purchasing a six-month policy but, if you were to fall ill during that time, when that short-term plan expires you could be excluded from renewing the policy because your health disqualifies you. Therefore, you want to purchase a plan that extends into the next open-enrollment period or you could get stuck with the entire bill.

Children’s hospital sues

On October 5, 2013 the Seattle Times reported that Seattle Children's hospital has filed a lawsuit for "failure to ensure adequate network coverage".

Overly generous tax subsidies

On October 25, 2013, the Seattle Times reported that a miscalculation effects thousands of individuals who used the website to enroll in a health plan. The problem was the calculation of a too-generous tax credit since monthly income was assumed to be annual income.

Challenges with the first Open Enrollment period

On November 25, 2013, the Seattle Times reported that less than a third of the calls to Healthplanfinder's customer support center were handled in October 2013. The call center received 167,000 calls during "office hours" of which 67,000 were throttled, and 44,000 were abandoned.

In addition to the volume of customer calls the Exchange continued to struggle with system issues (both perceived and actual issues). The Staff continued to report incremental fixes via hot fixes & code updates, but even with these incremental fixes, the call centers continued to struggle to handle the volume that consistently exceed the projected volumes by many fold.

At the April 2014 Board Meeting, the staff reported that 95% of the applications are getting through the system electronically on the first try and also that the system availability was at 98%. The Operations staff reported that even with 450 customer service representatives, the wait times were still very high, but also cited that 50% of the calls that are not getting handled are duplicate calls. The board asked for better future projections and expected improved call handling for the second open enrollment period.

The Technology QA group then reported that the Exchange hired a PM to help streamline processes across the organization to help convert the implementation culture to a more sustaining, operational culture. The QA group also reported that the stability of the system continues to improve and that the data issues created by Healthplanfinder have lessened.

At the May board meeting in Spokane, Rom Sims was officially introduced as the incoming Chair for the WA HBE Board.

The staff reported the following metrics:

Qualified Health Plans = 167,221 Medicaid Newly Eligible/Coverage Jan 1. - 318,136 Medicaid Previously Eligible but not Enrolled - 163,447 Medicaid re-determinations - 496,750

External links

• Washington Healthplanfinder (official website)
• Insurance commissioner
• Washington Benefit Exchange press release
• Washington Benefit Exchange Annual report
• February 2014 Washington Benefit Exchange enrollment report