Lawmakers grilled officials from Washington’s Health Benefit Exchange Thursday, making it clear they’ve heard plenty from constituents who say they’ve paid their premiums but still don’t have health coverage — in most cases because premiums, which they paid to the exchange, aren’t getting to the insurer.
“We’ve all heard a lot,” said Rep. Eileen Cody, D-Seattle, a member of the Joint Select Committee on Health Care Oversight, which held Thursday’s hearing. “I just want to know when it’s going to be fixed.”
The lawmakers’ tales of patient woe were backed up by brokers, a representative of the state’s doctors and Len Sorrin, representing Premera Blue Cross, whose company received the lion’s share of enrollments on the exchange.
Sean Graham of the Washington State Medical Association noted the effect of such problems on doctors and other providers, as well. One doctor checked a patient’s coverage, performed surgery, and then was told the patient didn’t actually have coverage. As a result, the patient received a $13,000 bill, he said.
That’s “not sustainable” either for patients or doctors, he said.
Some fixes to the exchange’s information technology have helped, said Pam MacEwan, the exchange’s chief of staff. But the last one didn’t work, and actually introduced a new problem, MacEwan said, although it was quickly fixed.
“We can’t go into the next enrollment with these issues,” she said, and will either see improvement soon or “begin to look at contingency options.”
Sorrin, of Premera, said insurers have collected premiums smoothly over the years, and suggested that the exchange ought to give up that role.
But MacEwan said it would cost a great deal to change the exchange’s system, which was built with that function deeply embedded in its machinery.
Cody wondered who gets stuck with the bill if the exchange has accepted a premium payment that gets stuck in the system and never gets to the insurer.
“Seems to me the exchange is,” said Cody, who chairs the House Health Care & Wellness committee.
MacEwan said she hasn’t heard anything about a pile of unpaid claims at the exchange.
Sen. Randi Becker, R-Eatonville, who heads the Senate Health Care committee, said that kind of glitch increases the cost of doing business for clinics and doctors’ offices. Just looking at the cost to the exchange, she said, isn’t a “true picture” of total cost.
The lawmakers also focused on 2015 and what’s to come.
The exchange must be “self-sustaining” by 2015, so accurate enrollment projections are key. A 2 percent assessment on premiums will provide some revenue — but not enough — and the exchange board will have to ask the Legislature for money.
Officials from the exchange and the state’s Health Care Authority, which operates Medicaid, said they are discussing whether the HCA should increase its payments to the exchange, because Medicaid enrollees use the exchange machinery and phone support.
The exchange has estimated in the past it will have to tack on a premium assessment of a few dollars as well for 2015.
MacEwan rolled out projections for exchange enrollment for 2015 coverage: 233,000 people are expected to buy commercial health plans (“Qualified Health Plans” or QHPs). The 2015 enrollment period, beginning Nov. 15, ends on February 15, 2015.
Molly Nollette from the Office of the Insurance Commissioner said her office has estimated that the number of uninsured in the state has been reduced by 38 percent since Oct. 1 of last year, but it’s not clear whether that accounts for Washington’s marked population growth.
For documents submitted to the oversight committee, go here.