Ahead of Reform, States Musing Options for Coverage Fluctuations

August 6, 2013

Posted in CMSCorporateHealthcare Policy & The MediaScience & Research

Posted in CMSCorporateHealthcare Policy & The MediaScience & Research

Most Internet startups have to think about the short term and the long tail when it comes to estimating revenue forecasts. Churn rates — or the rates at which customers sign up and subsequently drop out of services — are just part of the process companies have to sort through and account for when planning for the long range. Among insurance companies, the concern is no different, and in California, all eyes are watching how that state (the state with the 5th largest economy in the world and home to 40M people) handles fluctuating costs for healthcare consumers under ACA once exchanges kick in this fall. Qualifying benchmarks with respect to family income and federal poverty line standards are key in determining costs due to Medicaid expansion and health insurance subsidies under the reform law; families whose circumstances fluctuate are of special concern when states have to deal with issues of sudden access within previously uninsured populations as part of reform come January 1. How is California planning on dealing with this?

“Currently there is no strategy,” Dana Howard — Covered California spokesperson — told California Healthline. However, he added that the exchange “does not see the implementation of the Affordable Care Act as causing an undue amount of fluctuation between Medi-Cal and Covered California.” Last summer, the exchange board commissioned a report to examine the effect of a [basic health plan] in California.

Could it be that this looming crisis really isn’t a crisis at all? Or is it just a matter of producing novel ways of stratifying coverage to guarantee access and allow the exchange greater influence in healthcare spending in the state, using federal tax dollars? Minnesota is one of those states testing such an option. If such a tier is but one solution to decreasing coverage churn within healthcare exchanges, it seems as though one is kicking the can down the road — as the potential for decreasing churn is there, but in reality, will that be the case? And will the federal government have to, once again, step in and rewrite the rules? | LINK