Secretary Kirwan opened this morning’s Connector Board meeting with the good news of recent increased call volume and sign-ups for both Commonwealth Care and Commonwealth Choice. Then they launched into their two topics of the day, both relating to next year’s Commonwealth Choice plans. You can see all the reports and powerpoints from the meeting here.
CommChoice Bid Specs
Bob Carey led the Board through a discussion of options in requesting renewal bids for CommChoice plans. Since the plans are new and the Board does not yet have good data to guide them, the staff has recommended that instead of going through a full re-bidding process this year, the Board request that the current carriers bid to renew their current plans. Bob Carey set forth 3 primary goals in framing the re-bidding request: (1) cost control and affordability, (2) simplifying and improving member choices, and (3) maintaining program stability.
Carey presented 7 options for the Board to consider implementing to meet those goals: (1) increasing cost-sharing for the gold level; (2) increasing cost-sharing for all levels; (3) capping premium increases; (4) / (5) allowing carriers to offer bronze plans and/or silver plans with both broad and limited network options; (6) encouraging carriers to exclude Tier 1 drugs from a deductible (without raising the maximum deductible allowed); and (7) prohibiting CommChoice carriers from using industry codes to rate non-group plans.
Carey alluded to options 1 and 2 at last month’s Board retreat when he shared the staff’s belief that the gold plans include too rich of a benefit package, reflected by the fact that only 9% of CommChoice purchasers have enrolled in those plans. By raising the cost-sharing in the gold plans, the Board could moderate the increase in premiums in those plans while keeping the cost-sharing below the average on the market today. This could be done while keeping the other plan levels at their current actuarial value or they could increase cost-sharing in those levels as well. In response to the second option, Celia Wcislo asked why they should make changes to the silver and bronze plans if only the gold plans are “broken.” She and Nonnie Burnes pointed out that raising cost-sharing to lower premiums does not make plans more affordable. Echoing her, Dolores Mitchell pushed plans to lower their premiums while maintaining benefits by implementing “smarter and better” cost controls.
In response to the idea of capping premium increases, Jonathan Gruber expressed the concern that premium caps alone could lead to more variation among plans, making comparisons harder. Leslie Kirwan pointed out that asking for plans to provide bids within a premium cap could offer a good point of comparison and a strong signal to plans that the Board is looking for them to be creative in controlling costs.
There was more widespread praise for other options. All Board members agreed that industry codes are confusing and antiquated. The idea of exempting Tier 1 drugs from a deductible came out of the Board’s discussion of the MCC drug coverage standards last month. While Board members did not want to raise the deductible cap for drugs in higher tiers, all agreed that plans should be encouraged to exempt drugs from the deductible. Finally, Board members liked the idea of driving down premiums through the use of select or tiered networks. Wcislo pointed out that unlike raising cost-sharing, narrowing networks would control costs, not just shift them. Gruber responded that both tactics involve “some pain,” just different kinds. However, Tom Dehner and Mitchell both agreed that being told you can’t get a needed health care service is very different than being told you must choose among a smaller number of doctors. Turnbull pointed out that select networks are a way to improve quality as well.
Lou Malzone expressed concern over the number of plans available to people. Along the same lines, Michell asked the Board to consider not automatically renewing all Seals of Approval. Kingsdale expressed concern that fewer plans may decrease the Connector’s market share, but Wcislo pointed out that pushing carriers last year lead to lower prices in the 2nd round of bids. Turnbull stressed that the Board should continue to push plans to be innovative in controlling cost by implementing the preferred design features from last year’s RFR and other creative ideas. Kingsdale, Kirwan and Mitchell agreed, pointing out that while the Connector has power as a result of the attention paid to their work.
The Board will vote on which of these options to move forward with at the next meeting.
Small Group CommChoice
Kevin Counihan provided the Board with an update on the staff’s work to implement Small Group CommChoice. The staff continues to recommend that employers offering CommChoice plans to their employees identify a benchmark plan and that employees be able to “buy up or down” to plans in the same level (they are now calling this “Employer Plan + Choice”).
Of the 64 employers surveyed, 76% preferred this Employer Plan + Choice option to the status quo (of limited or no employee choice) as did all of the 22 employees surveyed. 92% of brokers surveyed thought that the market would prefer this option.
Board members raised a few concerns. Mitchell, Turnbull and Wcislo expressed concern that providing employers with list bills laying out how much more they pay for older employees could lead to discrimination. Turnbull also asked that the staff consider and report back on the possibility of “modified” list billing spreading to the general market. Rick Lord pointed out that with increased choice, employees will need more guidance.
Executive Director’s Report
In his ED report, Jon Kingsdale focused on the November 15th deadline to sign up to be covered by the end of the year. The Connector has been busy over the last 6 weeks leading up to the deadline with activities including:
- increased advertising, including news coverage on Channel 5, NECN, and CNN;
- 9 Outreach and Enrollment events, with 17 more planned in the next 3 weeks; and
- 3 million postcards sent from DOR to all Massachusetts tax-filers.
The results have been encouraging. Over 1200 uninsured individuals have attended the Connectors outreach events. On Tuesday, there were 7,000 calls to the Connector, and on Wednesday, the Connector’s (award-winning!) website saw almost 13,000 hits and 1,000 e-applications for CommChoice.
Kingsdale stressed that while the November 15th deadline has passed, both CommCare and CommChoice will be able to accept applications at least into next week to ensure coverage by December 31st.
There wasn’t time for Rosemary Day’s Operating Report, but the progress reports are available online. As of November 1st, CommCare enrollment is at 132,919 individuals and CommChoice enrollment is up to 10,199 individuals.
Secretary Kirwan closed with a thank you to the Connector staff for all of their extra outreach efforts and to DOR for their thoughtful work on the tax forms and penalties. (By the way – the revised, but still draft, health insurance tax forms are available mass.gov/dor/hcinfo)
The first (of 2) December meetings is just over 2 weeks away — stay tuned!
Lisa Kaplan Howe and Lindsey Tucker
