Affordable Care Act’s Changing Landscape Challenges State Division of Insurance
By: Jennifer Robinson (Las Vegas Review Journal) March 2014
The Affordable Care Act is like the weather: If you don’t like it, wait five minutes and it will change.
That is making life interesting for the Nevada Division of Insurance, which regulates insurance carriers and plans in the state. Agency Commissioner Scott Kipper was in Las Vegas on Wednesday to talk about how challenging implementing Obamacare has been in Nevada. But he also said the division is working hard to keep up as the law evolves.
“The only constant we have is that nothing’s constant,” Kipper said in a speech to about 200 members of the Las Vegas Metro Chamber of Commerce at the Four Seasons.
Take the employer mandate, which was scheduled to kick in on Jan. 1. Kipper said the division was one of the nation’s first state insurance commissions to publish an informational brochure for Nevada businesses on everything from an employer’s basic responsibilities under the law to repercussions if they didn’t provide coverage.
The brochure debuted on July 1, Kipper said, and “was state of the art for 24 hours,” until President Barack Obama’s July 2 decision to push the employer mandate to January 2015.
Even the individual mandate, still mostly in effect, has been tweaked. Obama said Tuesday that insurance divisions and carriers can let people keep existing plans through 2016, even if those policies don’t comply with Obamacare’s benefits requirements.
It was the second time since fall that Obama had urged states to grandfather noncompliant plans. Kipper’s division has looked at the issue, and decided it’s not possible to override new rules.
“It creates problems for our market. We’ve said that you can’t really do that (grandfather plans), according to state law,” Kipper said. “We’re again at a crossroads, or at loggerheads, with what’s going on nationally. We’ll evaluate our options, but we’ve reviewed this and decided it doesn’t work for us.”
Rates in general have remained stable, but it will “be very interesting to see what happens in 2015,” Kipper said.
The Division of Insurance is responsible for vetting premiums to make sure they’re not inadequate, excessive or unfairly discriminatory.
The agency can deny premiums or rate increases that flunk those standards.
The division started the 2015 rate review process in February and will continue analyzing through spring. Consumers will know the new rates when open enrollment through the Silver State Health Insurance Exchange starts its second sign-up period in November.
That doesn’t mean Kipper, who is a nonvoting member of the exchange’s board, has given up on the enrollment session that runs through March 31. Technical glitches with the exchange’s Nevada Health Link website have been “pretty well-documented, but we’re trying to get as many people enrolled as we can through the end of this month,” he said.
Still, the seven-month enrollment pause will give exchange officials time to clean up the system. The hard launch date of Oct. 1 prevented testing of Nevada Health Link before it debuted, Kipper said, but the goal now is “to get our pieces in place as early as possible so Xerox, or whoever the vendor is, can make sure the exchange works as well as it can, and address problems before it goes live.”
Exchange board members have said they are increasingly impatient with Xerox, the original contractor on the website. They have discussed bringing in consulting firm Deloitte to help Xerox work out the kinks.
The issue should be on the agenda at today’s board meeting.
“Given the amount of time we have, and given the amount of scrutiny on the exchange and the issues surrounding it, I have every confidence that, when the system goes live again on Nov. 15, it will be as easy then as it was difficult earlier this year. I think you’ll see a slimmed-down, trimmed-down, simpler way to enroll. We’ll have a much better system in place, and we’ll be able to go forward with great confidence that this thing is going to work.”
Exchange officials are also watching the results of November’s midterm election. Obamacare’s rollout has become a campaign issue in tight congressional races.
But even if Republicans gain ground in the Senate, where they are the minority, Kipper said he doesn’t expect repeal of Obamacare. What he does anticipate are “creative efforts both in the state and nationally to address some of its problems.”
Kipper also said he expects the federal government to look at changes designed to encourage people under 35 to enroll. The system needs younger, healthier consumers to defray the costs of older, sicker consumers, but so far, less than 30 percent of enrollees in Nevada and the nation have been under 35.
The Division of Insurance also plans a series of “listening sessions” with doctors, consumers and business people during the first two weeks of April to discuss provider-network sizes.
Insurers have thinned doctor networks in cities to keep a lid on premium increases, and rural areas have naturally small pools of providers. So the state needs to have a conversation about network adequacy, Kipper said.
