Covered California's leader says its decision is only fair to those insurers who took on the risk of a brand new marketplace in 2014. But the state's insurance commissioner says limiting choices is unfair to consumers.
Covered California yesterday issued rules that will limit where UnitedHealth Group can sell health coverage on the exchange under the Affordable Care Act, a controversial move that some consumer advocates backed as justified but the state’s insurance commissioner panned as unreasonable.
As issue is a tough regulatory question: is it fair to protect insurers who took a risk in an untested market—and perhaps enrolled the sickest customers—at the expense of offering consumers fewer choices for the time being?
That’s essentially what officials at Covered California have done. Because UnitedHealth bolted the state’s individual insurance market on the eve of ACA open enrollment in 2013, Covered California isn’t letting the payer back in all at once. Instead, rules adopted Thursday restrict any plan operating in the state in 2012 to 5 of 19 regions where there are fewer than 3 health plan choices.
That means that the 4 large health insurers who accounted for all but a sliver of the state’s exchange business last year will have it mostly to themselves through 2016, according to critics of Covered California’s move.
Exchange officials don’t see it that way. Plans that took the lead in signing up the 1.2 million consumers in the first year of the ACA should not be undercut by payers like UnitedHealth who waited on the sidelines and now want to join the exchange. UnitedHealth has joined 23 exchanges nationwide.
But the limited coverage options in certain parts of California have upset consumers, particularly those in remote areas who may need to be treated out of state in an emergency. In some parts of the state, Anthem Blue Cross was the only choice available in 2014. One press account chronicled the story of a patient whose Anthem pan covered his emergency care across the border in Nevada after he had a heart attack, but would not cover his follow-up visits with his regular doctor in nearby Reno, Nev.
Covered California’s Executive Director Peter Lee sounded unfazed in an interview about the 2015 choices. “In every corner of the state, consumers will have at least 2 plans to choose from.”
Around the Web
Limited Insurance Choices Frustrate Patients in California
California Rejects UnitedHealth’s Bid to Sell Obamacare Statewide
Commonwealth Fund Report Details Pervasive Racial and Ethnic Disparities in US Health Care, Outcomes
April 18th 2024Using 25 health system performance indicators, the Commonwealth Fund 2024 State Health Disparities Report evaluated racial and ethnic disparities in health care and health outcomes both within and across US states and highlighted the urgent need for equitable health care policies and practices in the US.
Read More
Navigating Health Literacy, Social Determinants, and Discrimination in National Health Plans
February 13th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the February 2024 issue of The American Journal of Managed Care® about their findings on how health plans can screen for health literacy, social determinants of health, and perceived health care discrimination.
Listen
Study Links COVID-19 Pandemic to Rise in Neoadjuvant Chemotherapy for Ovarian Cancer in US
April 17th 2024There was greater use of neoadjuvant chemotherapy among US patients with ovarian cancer (OC) during the COVID-19 pandemic to reduce potential COVID-19 exposure and cancer treatment-related complications.
Read More
Drs Raymond Thertulien, Joseph Mikhael on Racial Disparities in Multiple Myeloma Care Access
December 28th 2023In the wake of the 2023 American Society of Hematology Annual Meeting and Exposition, Raymond Thertulien, MD, PhD, of Novant Health, and Joseph Mikhael, MD, MEd, FRCPC, FACP, chief medical officer of the International Myeloma Foundation, discussed health equity research highlights from the meeting and drivers of racial disparities in multiple myeloma outcomes.
Listen