12:10pm: Public Policy Options for Sustaining Mass. Health Reform
Kingsdale: Unfortunate reality is that health cost trend is already set for 2008.
Lord: Hard to keep up with so many things. What stands out for me is the slide showing how increasing premiums affect the number of folks subject to the mandate. This trend is just not sustainable.
Kingsdale: Unitarian slide…Public Policy Options for Sustaining Mass. Health Reform
1. Cost to state government of MHR
2. CMS waiver
3. Health care cost trend
4. Gain/loss of employer sponsored coverage (crowd out)
5. Number of uninsured. (especially <300%fpl)
All five are deeply inter-related.
Most employers are trying to figure out the law. It’s a conservative field. If there’s an iceberg, we haven’t seen the tip of it. Over the next few years, we have to watch it. It’s also a full employment economy. With a recession, it’s a totally different story.
Turnbull: important study coming out soon on employer behavior in MA by Jon Gabel.
1. CommCare bid specs & negotiations
2. CommChoice bid specs and Seal of Approval
3. CommCare benefits and co-pays
4. CommCare enrollee premiums
5. Minimum Creditable Coverage and Affordability Schedule
6. CommCare enrollment management
7. Eligibility for CommCare employer sponsored insurance and Insurance Partnership
How sophisticated are plans in disease and care management, pharmacy management, etc. Varies across plans.
Turnbull: Are we obligated to contract with all four MMCOs, regardless of terms and conditions?
Dehner: The requirement is exclusivity for the four, but not a requirement to contract with all of them.
Kingsdale: What can the board do and when are you going to have to do it. CommCare specs by November, the 16th. In December specs out. CoPays for CommCare need to think about, even if no change. Copays below 100% set in law, we do for 100-300%. Probably want to look at options and price them out ahead of time – so February marked for that. In March, marker for what’s in House One. We set Minimum Creditable Coverage in 2009 for 2010. No need to do that before then. Need to set affordability every spring for December – so need to revisit in the spring. Also, affordability for CommChoice by December 1.
Carey: CommChoice Policy Options:
• Promote select network products in Bronze and Silver levels
• Do not award ‘seal of approval’ to carriers to annual trend above set percentage
• Reduce value of Gold plan benefits and allow comparable benefit reductions at Silver and Bronze levels
Turnbull: anything we can do to make the range of choices easier is important to do. Narrowing range of choices and making them more understandable and cost effective is valuable.
Malzone: Talking with carriers, more plans they have to administer, the more complicated it is and harder to administer. This is too complicated for normal citizen.
Mitchell: Focus groups came through loud and clear; folks do not want an infinite number of choices.
Kingsdale: One carrier had 14% trend one year, 6% the next year, and 14% the year after that. Important to recognize we are the tail on the dog in this. Need to consider multi-year perspective.
Wcislo: Is there no way that we can use combination of GIC and us to get better deal?
Kirwan: We are looking at ways to move toward aligning these, including MassHealth, and you’ll be hearing more about these.
Carey: Set gold standard equal to 100% of actuarial value; silver at 80% and bronze at 60%. So if you drop gold down, it has ripple effect down on silver and bronze.
Options for Gold Plan Benefits: (Current/Option/Effect on Rates)
PCPs and Specialists: $10/ $15/ -1.8%
PCPs/Specialists: $10/ $15-25/ -3.5%
Outpatient Surgery: $0/ $100/ -0.8%
ER (waived if admitted): $50/ $75/ -0.3%
Estimated Effect (total): – 3.9%-5.6%
Carey: Issue with bronze, value is the same, but the copayment and cost sharing is different.
Mitchell: What do we have to do procedurally to do away with this formulaic relationship, and look at what a good package is on its own merits.
Kingsdale: Need to look at the whole set of specs. We need to give carriers good guidance on Silver and Bronze. We can adjust the relativity of Silver and Bronze as an alternative.
Burnes: What is the effect of this on Silver and Bronze?
Kingsdale: Let’s say 10% premium churn, and we did this and kept relativity the same … their cost sharing goes up. Still more people for whom premium is affordable, but they would have to pay more out of pocket.
Gruber: Come back to us and show all three levels. Arrogant of us to assume that we know better than insurers what the right set of choices are. We should continue to allow choice so we can learn what works. We on this board tend to think we’re smarter than we really are.
Malzone: I’m a firm believer in narrowing choices.
Turnbull: I don’t think we know better than people what they like to buy. But we have a lot of good experience for us to say what we think is good to buy. It’s not arrogant.
Gruber: That’s what MCC was.
Turnbull: Different from now where there are 22 different options. Dolores doesn’t offer that number of choices. Incomprehensible for people.
Kingsdale: We asked people – they said they wanted three benefit levels, and we’re giving them what they want. Both legitimate concepts. Bunch of people want benefits without drugs. We don’t think so.
Turnbull: Jon and I have fundamental disagreement here.
Wcislo: We have 8,000 people we could survey and ask why they picked what they did. Somebody could ask them, what attracted you to this? We can get more educated information.
Lord: I would prefer to be less prescriptive what we put in specs. We picked the wrong standards. Let the insurers come back with a variety of products. We don’t have to give all them the Seal of Approval.
Kirwan: We need to strike the right balance.