By Christine Monahan and Madeline O’Brien

The 2023 open enrollment season marked the third yr of Washington State’s public option-style plan, “Cascade Choose.” In its preliminary yr, value and entry challenges hindered the state’s objectives of driving down prices and enhancing Reasonably priced Care Act (ACA) market competitors. A latest report by the Washington Well being Care Authority suggests these points have remained precept considerations for state officers charged with implementing the general public choice program. This weblog gives an replace on how Cascade Choose plans carried out within the not too long ago concluded open enrollment interval, and descriptions key points to look at as Washington strikes ahead with its first-in-the-nation program.

2023 Open Enrollment Replace

Cascade Choose plans are publicly procured merchandise run by non-public insurers, with state-imposed limits on supplier reimbursement. Washington chosen three insurers to supply Cascade Choose plans in 2023, down from 5 insurers chosen in earlier years. In choosing these three insurers out of seven bidders, Washington balanced increasing Cascade Choose plans to extra counties with rising plan affordability, whereas minimizing the variety of new plans in already aggressive counties to scale back alternative overload. On all fronts, Washington’s public choice program confirmed progress in 2023.

Cascade Choose plans had been out there in 34 out of 39 counties, up from 19 in 2021, giving 98 % of present trade prospects entry to a public choice plan. Cascade Choose plans additionally typically noticed decrease price will increase relative to different plans, and had been the bottom value silver plans in 25 counties.

Additional, enrollment development in Washington’s public choice plans accelerated in 2023. In response to preliminary knowledge, Cascade Choose plan enrollment has greater than tripled since 2022—roughly 27,000 people enrolling in a the plans throughout 2023 open enrollment, together with 10,000 new prospects and 17,000 prospects who re-enrolled. These totals symbolize greater than 11 % of complete market enrollees and 27 % of recent enrollees  Graphics counsel few enrollees moved out of Cascade Choose plans between 2022 and 2023.

Key Points to Watch

For the longer term, Washington policymakers are evaluating the general public choice’s efficiency and contemplating modifications to additional advance state objectives.

Growing Affordability

Presently, Washington’s major hook for rising affordability by means of its public choice program is capping the combination reimbursement charges Cascade Choose plans pay suppliers at 160 % of Medicare charges. Whereas the plans usually have decrease premiums than different merchandise bought on Washington’s market, important premium reductions have but to materialize, even when Cascade Choose plans hit the reimbursement goal. Regardless of knowledge displaying that three insurers got here in beneath the 160 % goal in 2021, just one insurer achieved meaningfully decrease premiums for its Cascade Choose plans in 2023. The Well being Care Authority is working with its sister businesses, the Washington Well being Profit Alternate and the Workplace of the Insurance coverage Commissioner, to discover methods to additional scale back premiums. Choices the state could discover embrace decreasing its reimbursement cap, adopting a disaggregated cap to higher goal excessive worth providers, suppliers, or areas, and setting premium discount targets just like Colorado and Nevada’s public option-style plans. The Well being Care Authority can be analyzing how conflicting timelines and obligations regulating plans amongst it and its sister businesses could also be limiting the Authority’s negotiating energy over insurers bidding to supply Cascade Choose plans. For instance, in 2023, the Authority was negotiating its contracts whereas plan charges had been below evaluate by the insurance coverage division.

Requiring Insurer Participation

Underneath the statute establishing Washington’s public choice program, the Well being Care Authority is exploring whether or not it might be helpful to require insurers taking part in public worker profit swimming pools or different Well being Care Authority applications, resembling Medicaid, to bid for Cascade Choose contracts, with out requiring the Authority to just accept these bids. This is able to be just like the method established in Nevada, the place Medicaid managed care organizations should submit bids to supply public choice plans starting in 2026.

Whereas such a requirement might improve alternative, the Well being Care Authority has cautioned that extra insurers in areas with adequate market competitors could not improve the entry and affordability objectives of the general public choice program. For instance, Regence Blue Defend supplied public worker profit pool protection in 2021 and 2022, however the Well being Care Authority rejected the bid from Regence-affiliated BridgeSpan to supply a Cascade Choose plan in 2023 primarily based on restricted service areas and excessive price proposals. Equally, two out of 5 Medicaid insurers in Washington already provide the general public choice plans, whereas one other two had been rejected in 2023 and the ultimate insurer doesn’t at the moment take part within the particular person market. Moreover, issues associated to community continuity and completely different procurement processes might create obstacles for insurers making an attempt to bid throughout applications.

Enhancing Supplier Participation

Cascade Choose networks, whereas complying with state community adequacy necessities, are comparatively slim in comparison with different market well being plans in Washington. The Well being Care Authority suggests this can be partially because of the plans’ decrease reimbursements: a number of insurers bidding to supply Cascade Choose plans in 2023 reported that suppliers declined to hitch their networks because of the mixture reimbursement cap. Whereas Washington at the moment requires sure hospitals to contract with not less than one Cascade Choose insurer, this requirement doesn’t prolong to non-hospital suppliers or guarantee that hospitals will contract with a number of insurers providing public choice plans. Anecdotally, insurers have recommended that many suppliers—significantly these in giant well being programs—had been keen to contract with only one Cascade Choose insurer to fulfill their statutory obligation, turning down alternatives to contract with different public choice insurers.

The Well being Care Authority means that requiring all suppliers who decide into public profit pool plans to additionally take part in Cascade Choose might assist to develop public choice plan networks and enhance shoppers’ plan alternative. Nonetheless, the state company additionally acknowledges that increasing plan networks have to be balanced towards affordability objectives. In addition they describe a dedication to working with the Workplace of Insurance coverage Commissioner to additional analyze supplier community data as this system continues.

Wanting Forward

Washington has made significant progress in implementing its public choice program, and continues to attempt for enhancements to premium affordability and entry. As extra states contemplate and launch their very own public choice applications, classes realized from Washington’s preliminary challenges and up to date successes could assist information their efforts.