By Christine Monahan and Madeline O’Brien
The 2023 open enrollment season marked the third 12 months of Washington State’s public option-style plan, “Cascade Choose.” In its preliminary 12 months, value and entry challenges hindered the state’s targets of driving down prices and enhancing Inexpensive Care Act (ACA) market competitors. A current report by the Washington Well being Care Authority suggests these points have remained precept considerations for state officers charged with implementing the general public choice program. This weblog supplies 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 non-public 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 deciding on these three insurers out of seven bidders, Washington balanced increasing Cascade Choose plans to extra 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 have been accessible in 34 out of 39 counties, up from 19 in 2021, giving 98 % of present trade clients entry to a public choice plan. Cascade Choose plans additionally typically noticed decrease charge will increase relative to different plans, and have been the bottom value silver plans in 25 counties.
Additional, enrollment progress in Washington’s public choice plans accelerated in 2023. In response to 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 symbolize greater than 11 % of complete market enrollees and 27 % of latest enrollees Graphics recommend few enrollees moved out of Cascade Choose plans between 2022 and 2023.
Key Points to Watch
For the long run, Washington policymakers are evaluating the general public choice’s efficiency and contemplating modifications to additional advance state targets.
Rising Affordability
At the moment, Washington’s major hook for rising affordability by way of its public choice program is capping the combination reimbursement charges Cascade Choose plans pay suppliers at 160 % of Medicare charges. Whereas the plans typically have decrease premiums than different merchandise bought on Washington’s market, vital premium reductions have but to materialize, even when Cascade Choose plans hit the reimbursement goal. Regardless of knowledge exhibiting that three insurers got here in beneath the 160 % 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 Alternate and the Workplace of the Insurance coverage Commissioner, to discover methods to additional cut back premiums. Choices the state could discover embody reducing its reimbursement cap, adopting a disaggregated cap to raised goal excessive worth 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 analyzing how conflicting timelines and duties 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 have been underneath overview by the insurance coverage division.
Requiring Insurer Participation
Beneath the statute establishing Washington’s public choice program, the Well being Care Authority is exploring whether or not it might be useful to require insurers taking part in public worker profit swimming pools or different Well being Care Authority applications, comparable to Medicaid, to bid for Cascade Choose contracts, with out requiring the Authority to simply accept these bids. This could 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 may improve selection, the Well being Care Authority has cautioned that extra insurers in areas with adequate market competitors could not improve the entry and affordability targets of the general public choice program. For instance, Regence Blue Defend provided 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 primarily based 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 have been rejected in 2023 and the ultimate insurer doesn’t at the moment take part within the particular person market. Moreover, problems associated to community continuity and totally different procurement processes may create obstacles for insurers trying to bid throughout applications.
Enhancing Supplier Participation
Cascade Choose networks, whereas complying with state community adequacy necessities, are comparatively slender in comparison with different market well being plans in Washington. The Well being Care Authority suggests this can be partially as a result of plans’ decrease reimbursements: a number of insurers bidding to supply Cascade Choose plans in 2023 reported that suppliers declined to hitch their networks as a result of mixture reimbursement cap. Whereas Washington at the moment requires sure hospitals to contract with a minimum of one Cascade Choose insurer, this requirement doesn’t lengthen 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 massive well being techniques—have 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 may assist to increase public choice plan networks and enhance customers’ plan selection. Nevertheless, the state company additionally acknowledges that increasing plan networks should be balanced in opposition to affordability targets. In addition they describe a dedication to working with the Workplace of Insurance coverage Commissioner to additional analyze supplier community data as this system continues.
Wanting Forward
Washington has made significant progress in implementing its public choice program, and continues to try for enhancements to premium affordability and entry. As extra states take into account and launch their very own public choice applications, classes discovered from Washington’s preliminary challenges and up to date successes could assist information their efforts.
