The Connector Board met on Thursday, October 8, in what was a final meeting for Board Chair and Administration and Finance Secretary Leslie Kirwan (meeting materials are all here). Kirwan began the meeting by thanking everyone for their support and efforts for the Commonwealth Care and Commonwealth Choice and the Connector itself. Secretary Kirwan also briefly mentioned the September revenues being lower than expected and the budgetary constraints that the Commonwealth is faced with. This was followed up by her congratulations to the Connector for receiving this year’s Harvard Kennedy School Ash Institute’s Innovations in American Government Awards. Our full report is after the jump.
After the Board re-elected current vice chair Dolores Mitchell, Connector’s General Counsel Jamie Katz presented three Minimum Creditable Coverage (MCC) regulatory revisions. The three proposals would:
- add prescription drugs to the list of “core services” that all plans may not limit;
- require that plans that cover dependents provide the same broad range as provided to subscribers; and
- treat Health Reimbursement Accounts (HRAs) in the same manner as Health Savings Accounts (HSAs).
Katz made it clear that the purpose of adding prescription drugs to core services is to prohibit dollar caps on drug benefits, and not to prohibit formulary management. A further explanation and debate ensued over HRAs, HSAs, and High Deductible Health Plans (HDHPs). Katz proposed the new regulations in response to the market, where HRA enrollees were increasing in number and there are strong reasons to have HRAs comply with MCC requirements as HSAs. Board members raised concerns regarding affordability and state penalties for not having health insurance. More specifically, some were concerned that HDHP plans that were purchased along with HRAs have low premiums they may appear affordable, when in fact they are not, due to their high deductibles. Katz cited the regulations’ hardship criteria to reassure the Board that the Connector considers various factors including deductibles when deciding on an individual’s exemption or waiver from the individual mandate.
There will be a public hearing on the proposed regulations on November 17th.
The Board then heard a presentation on a future MCC revisions. At issue is how to adjust over time the out-of-pocket (OOP) maximum established by the MCC regulations. One proposal is to index the OOP maximum and the maximum deductible level so that it will rise automatically each year without need for a Board vote. Another issue is whether to continue a separate maximum for prescription drugs. One option is to set the OOP maximums to include all costs, including prescription drugs.
The staff presented the impact of the various options, and their aggregate impact on costs. An industry survey claimed that including drug spending in one overall cap would be administratively burdensome and that they needed some lead time before implementing the changes. Board member Jon Gruber stated his concern was that the cost of Bronze plans – used to set the affordability standard – not increase excessively. The Board asked the Connector staff to reevaluate the impact based on product level.
The Connector then presented their new website for Commonwealth Choice shoppers. The goal was to simplify the shopping experience and become more consumer-friendly. The new CommChoice plans are standardized, to better facilitate plan comparisons. Consumer tests of the user friendliness of the new website showed increased usability. The new website will be released in November 1, 2009.
Finally, Melissa Boudreault made her last Commonwealth Care Quarterly Update presentation to the Board before her departure. Melissa also thanked everyone for their support, especially those at the Connector, MassHealth, as well as the Connector Board. The number of enrollees showed a significant decrease in September due to moving the AWSS population to Commonwealth Care Bridge. Melissa ended the presentation highlighting the top achievements of CommCare.
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Jekkie Kim
