by Jinghong Chen
Washington Gov. Jay Inslee (D) signed into law a bill in May to create standardized health plans on the Washington Health Benefit Exchange, the state’s insurance marketplace, starting on Jan. 1, 2021. Under the program “Cascade Care,” the Washington State Health Care Authority will contract under a Request for Quotation (RFQ) process with one or more carriers to offer the standardized silver and gold qualified health plans. The law also requires health plans to reimburse providers and facilities at up to 160% of the Medicare rate to keep premium and deductible costs down. Currently, 14 of Washington’s 39 counties have only one individual health plan option on the exchange, with Kaiser Foundation Health Plan of Washington holding the highest market share with more than 53,000 enrollees. According to a Milliman report prepared for the Association of Washington Healthcare Plans, based on the bill as written on Feb. 14, 2019, provider medical revenue is estimated to decline due to the mandated reimbursement level and migration from the employer group market and the uninsured. The graphics below offer a current overview of Washington’s marketplace and individual market and show the net results under three migration scenarios.
CLARIFICATION: The Milliman report prepared for the Association of Washington Healthcare Plans is based on the bill as written on Feb. 14, 2019, which had provider rates set at 100% of Medicare. The final bill set rates at 160% of Medicare, a scenario not modeled by Milliman.
NOTE: Regence BlueCross BlueShield of Oregan, Asuris Northwest Health, Regence BlueShield, BridgeSpan Health Company and UnitedHealthcare also operate in Washington’s individual market. Baseline medical revenue, reflective of all health benefits segments, is estimated at $38.6 billion. The estimate was assessed for reasonableness relative to CMS Health Expenditures by State of Provider amounts for the State of Washington.
SOURCES: AIS’s Directory of Health Plans, as of May 2019. Washington Health Benefit Exchange and Milliman, Inc. Visit https://bit.ly/2HHXcVe.