Las Vegas Sun

March 28, 2024

Volatility in Washington puts Nevadans’ health care in jeopardy

Head of Nevada’s insurance exchange talks about an uncertain future

Heather Korbulic

Courtesy

Heather Korbulic, executive director of the Silver State Health Insurance Exchange, says it has been difficult to bring new insurance carriers into the state when Congress has been debating the repeal and replacement of the Affordable Care Act for seven months.

Nevadans shopping for health plans for the coming year will find fewer options under the Affordable Care Act.

While medical carriers Health Plan of Nevada and SilverSummit will offer plans in 2018, Anthem recently announced it would leave the state’s health exchange, citing volatility in the market and uncertainty in Washington, D.C.

This exit followed the news that carriers on the exchange would offer coverage only in Washoe, Clark and Nye counties, though Gov. Brian Sandoval said in a press conference Aug. 15 that the more than 8,000 affected consumers in 14 rural counties would be covered by SilverSummit.

Silver State Health Insurance Exchange Executive Director Heather Korbulic spoke about what consumers can expect going forward, steps they should take to ensure coverage and what elected officials need to do to make progress.

“While this is a really big accomplishment and we’re thrilled to be able to say that all Nevadans will have access to a plan, we’re going to be working over the next year on trying to develop a more competitive marketplace and really thinking through what we can do within our state to stabilize the marketplace,” Korbulic said.

What does Anthem’s exit mean?

Less competition on the exchange, less choice and opportunities for consumers.

What does it mean for the future of the ACA in Nevada?

It’s not just Nevada. It is a matter of federal stabilities that need to be assured for carriers across the country. All of my colleagues in every other state and division of insurance commissioners, we all agree that we need — and carriers need — to have assurances that cost-sharing reductions are going to be paid and that they’re not going to be this month-to-month payment business currently playing out in Washington, D.C. Those are critical.

We also need to understand if the individual mandate, or the tax penalty for consumers who don’t have coverage for a year, that that’s going to be enforced. And the reason we need to know that ... is because people who are younger and healthier, we need to find a mechanism to incentivize them to be on the exchange or to be in the risk mix.

If we only see sick people enrolling in health insurance, and we don’t capture and entice the younger, healthier people into the market, then premiums and costs are exponentially greater.

Insurance is all about risk and assessing what your risk is going to look like. You need to have at least a starting point in understanding what your risk is, and by not giving some kind of clarity or assurances, then what we’re seeing is a real dicey risk mix, and carriers are rightfully concerned about it. ... We don’t want any reduction in the number of people who are insured in our state, and it’s just one challenge after another right now.

What are you hearing from customers on the exchange?

For the most part ... the 89,000 Nevadans who are on the exchange are concerned about having access to affordable insurance. That means having access to the subsidies that have helped them purchase the insurance plans they’re on right now.

So what we’re trying to do is make sure they understand that there will be options available to them, that we recognize this disruption from Anthem will be significant, but that we’re working closely with them and the Division of Insurance to help them find their way to a new plan. ... We have a shortened enrollment period, down from 90 days to 45 days, and so we really need to get consumers out into the enrollment facilitators’ hands and shopping the marketplace.

The exchange and the Division of Insurance are working carefully on doing what are called cross-walking plans, or auto re-enrollment. So for consumers who don’t actively shop the marketplace, who are already enrolled in a plan, they will automatically be enrolled into a similar plan, whatever is on the exchange that is as close to the plan that they had as possible.

How are rate proposals from other carriers affected by Anthem’s move?

The two other carriers are going to be absorbing the pool of people that Anthem has been insuring. They’re wanting to understand what that risk looks like, and what that consumer body looks like. ... I think these carriers are looking at those unknowns and doing actuarial analysis and will be submitting rates.

What can be done to attract other carriers?

It’s difficult to talk about bringing new carriers into the exchanges across the country when we had our congressional body debating the repeal and replace of the ACA over the past seven months or so and not having assurances that the policy will even exist moving forward, or that there will be anything in place. ... I’m always talking to regional and national carriers and really trying to encourage them to come into the Nevada marketplace, but you don’t see a lot of new carriers jumping into the game when we don’t have assurances about the future of the ACA.

My conversations are like, for instance with a regional carrier, “You’re an important part of this community; we’d like to see you serving the population that receives exchange plans and subsidies. Is there any interest from your organization? How can we help you? What can we do to incentivize you knowing that I don’t have control over federal stability?”

Originally under the Affordable Care Act, insurance companies were offered what were called reinsurance programs from the fed. If your losses and claims went over x-y-z amount, then the federal government would reinsure those companies on those losses. That actually never played out, and insurance companies did not receive the amounts that had been promised to them, and that went away quickly as the result of lawsuits.

We need to start exploring having reinsurance programs at a federal level and at a state level. That’s a conversation that the exchange and the division and the governor’s office have been having.

Any nuts-and-bolts advice for consumers?

It’s going to be critical for you to, during open enrollment, get connected with a free, in-person enrollment facilitator through our webpage and find a plan that works for your budget and your family’s health needs.

Are there state or national initiatives we can keep an eye on?

There are pending waivers for reinsurance programs. Alaska just had its approved, and then Oregon will be submitting one here pretty soon. So all of those are going to be indicative of what the landscape looks like for the rest of us who might follow behind.

At a state level, the governor signed into law (Senate Bill) 394, which was Sen. (Pat) Spearman’s bill that looks into research and study on feasibility of allowing Nevadans to purchase Medicaid plans. That’s a long-term project, but I think it’s worth paying attention to.

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