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HealthCare Checkup

The Seattle Times health-care team tracks the local impact of the Affordable Care Act.

December 4, 2013 at 11:09 AM

Kreidler testifies in D.C., promises vigilance on health exchange

Washington Insurance Commissioner Mike Kreidler told lawmakers Wednesday he is concerned about the narrow provider networks of some health plans on the state’s online insurance exchange but said his office will do everything it can to make sure insurance carriers provide consumers appropriate access to the benefits promised in their policies.

Testifying before the U.S. House Ways and Means Health Subcommittee, Kreidler said his office has made clear to insurance carriers that if a customer cannot get access to a covered benefit from a provider in their network, the carrier must cover the cost of the service from an out-of-network provider at the in-network benefit level. “If the promise has been made in the insurance policy, we are going to make sure the insurers live up to that promise,” he said.

Kreidler appeared as a witness during a hearing that focused on the “adverse impacts” of the Affordable Care Act. He had been invited to testify by the subcommittee’s ranking Democrat, Rep. Jim McDermott of Seattle.

In his testimony, Kreidler urged the panel to have patience with the new insurance exchanges during the early enrollment period. “Rome wasn’t built in a day,” he said. He also noted that in Washington, one of 14 states running its own exchange, more than 175,000 residents have enrolled in coverage to date.

Other witnesses focused on current and potential problems with the online insurance exchanges.

Scott Gottlieb, resident fellow at the American Enterprise Institute, a conservative think tank, highlighted the narrow provider networks of some exchange plans.

Gottlieb said most consumers probably won’t know until after they enroll in a plan which doctors and hospitals are included.

He said the AEI has looked at some of the plans to try to determine which doctors and hospitals they include in their network, but with little success. “This information isn’t available,” he said. “We looked hard for it.”

Kreidler responded that such information is indeed hard to find, including in Washington state. “Dr. Gottlieb identifies one of the challenges we have,” he said. “That information isn’t as readily available right now, but we’re working to correct that.”

He said consumers who want to know details about a plan’s network should call the insurance company and ask those questions.  “People can find out,” he said. “It’s just a little bit more challenging right now.”

Kreidler received national media attention recently after President Obama announced he would allow insurance companies to extend individual health insurance policies set to expire at the end of 2013.

Kreidler announced almost immediately that would not implement that proposal in Washington state.

He was asked about that decision by Rep. Dave Reichert, a Republican from Auburn who is a member of the Ways and Means Committee but not the health subcommittee.

Reichert noted that 290,000 people in Washington received cancellation notices from their insurers this fall and that President Obama had offered to let people keep their canceled plans.

“You decided, sir, to separate yourself from the president on that request and not allow those 290,000 people to keep their health insurance,” he said to Kreidler. “Did you speak to any of those insurance carriers before you made that decision?”

Kreidler responded that he had not, but that he had received a statement from the Association of Health Insurance Plans (AHIP) that indicated that health insurance companies “were very distressed by what the president proposed.”

Reichert interrupted Kreidler then, noting that his time to ask questions was about to expire.



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