By Christine Monahan and Madeline O’Brien
The 2023 open enrollment season marked the third yr of Washington State’s public option-style plan, “Cascade Choose.” In its preliminary yr, value and entry challenges hindered the state’s targets of driving down prices and bettering Reasonably priced Care Act (ACA) market competitors. A latest report by the Washington Well being Care Authority suggests these points have remained precept issues for state officers charged with implementing the general public choice program. This weblog offers an replace on how Cascade Choose plans carried out within the just lately concluded open enrollment interval, and descriptions key points to observe as Washington strikes ahead with its first-in-the-nation program.
2023 Open Enrollment Replace
Cascade Choose plans are publicly procured merchandise run by personal insurers, with state-imposed limits on supplier reimbursement. Washington chosen three insurers to supply Cascade Choose plans in 2023, down from 5 insurers chosen in earlier years. In choosing these three insurers out of seven bidders, Washington balanced increasing Cascade Choose plans to further counties with rising plan affordability, whereas minimizing the variety of new plans in already aggressive counties to scale back selection overload. On all fronts, Washington’s public choice program confirmed progress in 2023.
Cascade Choose plans had been accessible in 34 out of 39 counties, up from 19 in 2021, giving 98 p.c of present change clients entry to a public choice plan. Cascade Choose plans additionally usually noticed decrease charge will increase relative to different plans, and had been the bottom value silver plans in 25 counties.
Additional, enrollment development in Washington’s public choice plans accelerated in 2023. Based on preliminary knowledge, Cascade Choose plan enrollment has greater than tripled since 2022—roughly 27,000 people enrolling in a the plans throughout 2023 open enrollment, together with 10,000 new clients and 17,000 clients who re-enrolled. These totals characterize greater than 11 p.c of whole market enrollees and 27 p.c of latest enrollees Graphics recommend few enrollees moved out of Cascade Choose plans between 2022 and 2023.
Key Points to Watch
For the longer term, Washington policymakers are evaluating the general public choice’s efficiency and contemplating modifications to additional advance state targets.
At the moment, Washington’s main hook for rising affordability by means of its public choice program is capping the combination reimbursement charges Cascade Choose plans pay suppliers at 160 p.c of Medicare charges. Whereas the plans typically have decrease premiums than different merchandise offered on Washington’s market, vital premium reductions have but to materialize, even when Cascade Choose plans hit the reimbursement goal. Regardless of knowledge displaying that three insurers got here in under the 160 p.c goal in 2021, just one insurer achieved meaningfully decrease premiums for its Cascade Choose plans in 2023. The Well being Care Authority is working with its sister companies, the Washington Well being Profit Trade and the Workplace of the Insurance coverage Commissioner, to discover methods to additional cut back premiums. Choices the state could discover embrace reducing its reimbursement cap, adopting a disaggregated cap to raised goal excessive value providers, suppliers, or areas, and setting premium discount targets much like Colorado and Nevada’s public option-style plans. The Well being Care Authority can be inspecting how conflicting timelines and tasks regulating plans amongst it and its sister companies could also be limiting the Authority’s negotiating energy over insurers bidding to supply Cascade Choose plans. For instance, in 2023, the Authority was negotiating its contracts whereas plan charges had been underneath evaluate by the insurance coverage division.
Requiring Insurer Participation
Below the statute establishing Washington’s public choice program, the Well being Care Authority is exploring whether or not it could be helpful to require insurers taking part in public worker profit swimming pools or different Well being Care Authority applications, similar to Medicaid, to bid for Cascade Choose contracts, with out requiring the Authority to just accept these bids. This is able to be much like the method established in Nevada, the place Medicaid managed care organizations must submit bids to supply public choice plans starting in 2026.
Whereas such a requirement might enhance selection, the Well being Care Authority has cautioned that further insurers in areas with ample market competitors could not improve the entry and affordability targets of the general public choice program. For instance, Regence Blue Protect supplied public worker profit pool protection in 2021 and 2022, however the Well being Care Authority rejected the bid from Regence-affiliated BridgeSpan to supply a Cascade Choose plan in 2023 based mostly on restricted service areas and excessive charge proposals. Equally, two out of 5 Medicaid insurers in Washington already provide the general public choice plans, whereas one other two had been rejected in 2023 and the ultimate insurer doesn’t presently take part within the particular person market. Moreover, problems associated to community continuity and totally different procurement processes might create obstacles for insurers making an attempt to bid throughout applications.
Bettering Supplier Participation
Cascade Choose networks, whereas complying with state community adequacy necessities, are comparatively slim in comparison with different market well being plans in Washington. The Well being Care Authority suggests this can be partially because of the plans’ decrease reimbursements: a number of insurers bidding to supply Cascade Choose plans in 2023 reported that suppliers declined to hitch their networks because of the mixture reimbursement cap. Whereas Washington presently requires sure hospitals to contract with not less than one Cascade Choose insurer, this requirement doesn’t prolong to non-hospital suppliers or guarantee that hospitals will contract with a number of insurers providing public choice plans. Anecdotally, insurers have prompt that many suppliers—notably these in giant well being techniques—had been keen to contract with only one Cascade Choose insurer to fulfill their statutory obligation, turning down alternatives to contract with different public choice insurers.
The Well being Care Authority means that requiring all suppliers who decide into public profit pool plans to additionally take part in Cascade Choose might assist to develop public choice plan networks and enhance shoppers’ plan selection. Nonetheless, the state company additionally acknowledges that increasing plan networks have to be balanced in opposition to affordability targets. Additionally they describe a dedication to working with the Workplace of Insurance coverage Commissioner to additional analyze supplier community data as this system continues.
Washington has made significant progress in implementing its public choice program, and continues to attempt for enhancements to premium affordability and entry. As extra states think about and launch their very own public choice applications, classes realized from Washington’s preliminary challenges and up to date successes could assist information their efforts.