Official says health care site right call for W.Va.
10/29/2013 - The Charleston Daily Mail. By Dave Boucher.
CHARLESTON - Despite early rollout problems at the federal level, West Virginia made the right call partnering with the federal government in creating its health insurance exchange, a top state health official said.
"I still stand by the decision to be in the partnership model, and still think despite the federal issues today we would only be subjecting our customers to higher costs," Jeremiah Samples, assistant to Department of Health and Human Resources Secretary Karen Bowling and a former state Insurance Commission administrator, recently told the Daily Mail.
The head of the only health insurance provider participating in the state's exchange agrees, but a consumer health care advocate thinks it's time for the state to start considering creating its own exchange.
"Overall, clearly, should we have set up our own website? Yeah, you bet ya," said Perry Bryant, executive director of the nonprofit West Virginians for Affordable Health Care.
"We couldn't have done any worse."
Under the Affordable Care Act, also known as "Obamacare," practically all Americans are required to have health insurance.
The law allowed states three different options for offering that insurance: they could create their own health care exchanges, let the federal government handle all the work or partner with the federal government in building the exchange.
Although the state initially started down the path of creating its own exchange -- in 2012 the Legislature passed a law allowing for a state exchange and officials investigated steps necessary to move forward with one -- West Virginia eventually became one of seven states to agree to a partnership.
All systems opened for enrollment Oct. 1.
Bryant and officials at the state and federal level agree consistent problems with the HealthCare.gov federal health web portal have greatly limited the number of people able to actually sign up for insurance.
At the same time, several states operating state-based exchanges are showing signs of early success. Officials in Kentucky, New York and other states running their own exchanges report healthy enrollment numbers and largely glitch-free websites.
Choosing the partnership exchange was the right decision then for West Virginia and remains the right decision now, Samples said Monday.
When the decision was made, it was Samples' job to look at all the options as the director of health policy for the state offices of the Insurance Commissioner. The decision, as many do in state government, boiled down to the cost.
"We were looking at up to $18 million in a single year," Samples said.
A state-based system would have required a large information technology infrastructure. While the federal government would have picked up the costs for creating that system, Samples said all of the costs of maintaining it for the future fell on the state.
"It came down to, we didn't have the population size to really justify (creating) our own IT infrastructure..." Samples said.
Fred Earley is president of Highmark Blue Cross Blue Shield West Virginia, the only provider in the state offering coverage through the exchange. He also was involved in discussions about which option was best for West Virginia, and agreed the partnership was the most cost-effective option at the time.
"The development cost to operate it for a state-operated exchange, given limited size and scale, was not economically feasible," Earley said.
Under the partnership, the federal government is really in charge of most of the exchange. That also means the federal government will fully reimburse the Insurance Commission for plan management costs, Samples said.
At the same time, people receiving benefits through the exchange will need to pay an "administrative fee" to the federal government to help cover its operating costs once the system is up and running, Samples said. That cost should be lower than under a state-based exchange, he said.
Bryant doesn't think the costs of a state-based exchange would be too burdensome. Having complete control of the system is a huge benefit as well, Bryant said.
It's still a possibility for the state, and one he thinks officials should start to look at if glitches persist at the federal level.
"Given the track record of (the U.S. Department of Health and Human Services) right now, I think it's something that we should seriously consider," Bryant said.
Every state can change how it participates in the exchange every year, Samples said. In theory, that means by February 2014 the state could submit the "blueprint" documents necessary to move forward with a state-based exchange, or tell the federal government to take control.
There's always a possibility costs could come down in the future, Samples said. But he said there's no guarantee the state would do a better job with the exchange.
Although Earley at one point supported the state-based exchange, he later came out in support of the partnership. He said Monday it's too early to change course.
"They made the original decision to go with the partnership model after a lot of study and deliberation..." Earley said.
"You never want to make a decision of that magnitude in a knee-jerk reaction."
Bryant admitted there might not be the political will at the moment for such a move. But he's confident it would be a win for the state.
While Earley and Samples don't think it's time for a system shift, they agree problems at the federal level are affecting West Virginia.
Earley wouldn't say how many people in West Virginia have signed up for coverage through the exchange until the federal government releases its own enrollment numbers.
However, he called the state numbers "disappointing" and "much less than what we had hoped for."
Bryant, Samples and Earley agree continued issues with the federal web portal pose significant problems for the system as a whole.
People with serious health risks are more likely to battle with the federal health care website to ensure they get coverage than people who are relatively healthy. That leaves the door open for a higher percentage of sick people actually participating in the system.
The entire law is based on the idea that healthy people -- through the individual mandate --will sign up and pay for insurance, helping cover costs for the less healthy and keep costs relatively low for all.
"If you only have the older, less healthy people sign up, premiums are higher," Bryant said. "It can be a death spiral."
Samples also used the phrase "death spiral" in describing potential problems if the federal portal continues to falter and healthy people don't sign up.
Anyone who doesn't have coverage by March 31, 2014 faces a fine. In the first year of the law, it's $95 or 1 percent of a person's taxable income, whichever is greater.
The faltering federal rollout recently drew calls from some lawmakers to push back the sign-up deadline. Sen. Joe Manchin, D-W.Va., said he's working on legislation that would delay the penalty entirely in its first year.
"If people can't get the coverage and they've tried, how are you going to impose some type of mandate or penalty?" Samples said.
He pointed out the state-based Medicaid expansion is going well. Earlier this year, Gov. Earl Ray Tomblin decided the state would increase coverage eligibility to 138 percent of the federal poverty line.
More than 60,000 have enrolled since Oct. 1, Samples said Monday. Many signed up through auto-enrollment letters, but there are still thousands more eligible who have not signed up, Samples said.
Originally the state sent out 118,000 letters, and Samples said it plans to send them again to those who did not respond to the first round of letters.
People can also sign up for the expanded Medicaid coverage through www.wvinroads.org which is operating without problems, Samples said.