Politics & Government

Insurance commissioner Kreidler wants new open enrollment for those whose health policies are ‘stuck’ in state exchange

Washington state Insurance Commissioner Mike Kreidler says a new enrollment period may be needed next month to help consumers whose health insurance applications have gotten stuck online at the Washington Health Benefit Exchange. The exchange has put into effect a series of system fixes that have so far failed, and insurers say the repairs done in late June have created new problems.

Problems include insurers not getting paid after consumers sign up and doctors not knowing patients’ plans have been terminated. Despite these problems, health reform is credited with helping to drive down Washington’s rate of uninsured to less than 10 percent for the first time in years.

“We’re early in that process — evaluating what our options are. One is we could offer an open enrollment period to individuals who are in the exchange but having problems. There’s 20 to 30 percent of people in the exchange who don’t get subsidies; they could buy on the outside,’’ Kreidler said in an interview with The Olympian and News Tribune on Tuesday.

Kreidler, a Democrat and advocate of health reform, went on to say he intends to create a new special enrollment period and only needs to be sure he has the legal authority. His interest, he said, is driven by the hundreds of people complaining at his office, which has no jurisdiction over the exchange but is seen as the savior of last resort.

The commissioner, who regulates insurance plans, once encouraged the public to buy through the exchange and now says he feels responsible to help, even though he has no direct say over the exchange.

Exchange spokesman Michael Marchand says roughly 6,000 accounts have problems with invoicing. At issue is whether payments made by consumers into the online system are getting to insurance carriers, which clearly is not happening in many cases. The result is that patients go for care and discover they don’t have coverage — or doctors provide care and can’t get paid.

Marchand did not have an opinion on Kreidler’s idea to give an emergency exit for those having problems on the exchange. He said Wednesday the exchange, its consultant Deloitte and carriers are focused on finding solutions that work in the short and long term. The exchange is racing the clock to fix its issues before open enrollment for 2015 begins in mid-November.

“We’re real concerned about it,” said Sydney Smith Zvara, executive director for the Association of Washington Health Plans. She said that despite continued promises of repairs, none have completely solved the problems with payments and invoicing.

The association has written to legislators about the issue, saying high numbers of the 160,000 to 170,000 individual-market plans handled by the exchange have problems.

“Our estimate is about 15 percent of the commercial enrollees … have experienced an issue,” Zvara said recently. Problems range from insurers not getting an invoice or getting an invoice without notification from the exchange that a person is considered covered or other glitches.

The Seattle Times reported last week on the case of Evelyn Wilhelmson, a 61-year-old from Spokane who discovered in June she’d been terminated from coverage after signing up in December with automatic payments from her bank account. Still unable to get proof she was insured, she canceled a long-planned trip to Norway, which requires proof of insurance for travelers, the newspaper said.

Lawmakers holding a work session on exchange issues last week also had concerns, and some were frustrated they could not point to a date when the problems would be solved. They heard from spokesmen for Premera Blue Cross about problems that continued even after the latest major repair to the exchange portal was done in late June.

As Zvara put it, health insurers “have not seen any meaningful improvement yet in the situation … There are a few little things that maybe got a little better. But overall there is no significant … improvement. And in fact in some cases a number of new issues have surfaced as a result of glitches associated with the latest bundle of system changes.”

Taxpayers may not be on the hook for fixing the exchange, according to Marchand. He said consultant Deloitte, which created the online portal at wahealthplanfinder.org, would be responsible.

That is because ongoing repairs “are all operational needs that would fall under the existing contract. They are part and parcel with being able to have a fully functional application” via the online portal, Marchand said.

He said Deloitte and exchange staffers are doing an account-by-account audit that may discover common issues behind problems that allow a broader solution.

Audit results are due by the end of July, and the exchange is targeting August to have new repairs in place, Marchand said.

That is about the time Kreidler thinks the escape hatch needs to be open for consumers, some of whom have spent months trying to get their accounts fixed — to no avail. Kreidler said there is no more leeway for the exchange.

“The carriers need to have this corrected in the next two weeks in order to be able to implement all of the changes necessary … before we start the process of starting open enrollment in mid-November,’’ Kreidler said. “That’s the kind of lead time they need to get their systems cleaned up … so they don’t carry it over into the next year.’’

Another option is to have the state transition to the federal exchange. But none of the parties is considering that right now.