Health Care Exchange (09/23/2014)

Final
STAFF SUMMARY OF MEETING

HEALTH CARE EXCHANGE

Date:	09/23/2014	ATTENDANCE

Time:	01:40 PM to 04:10 PM	Balmer	X
		Landgraf	*
Place:	HCR 0112	Lundberg	*
		Nicholson	X
This Meeting was called to order by		Primavera	X
	Representative McCann	Stephens	X
		Tyler	X
This Report was prepared by		Ulibarri	X
	Dave DeNovellis	Aguilar	X
		McCann	X
		X = Present, E = Excused, A = Absent, * = Present after roll call

Bills Addressed:		Action Taken:
Presentation from Connect for Health Colorado Public Comment		Witness Testimony and/or Committee Discussion Only Witness Testimony and/or Committee Discussion Only

01:41 PM -- Presentation from Connect for Health Colorado

Representative McCann, chair, called the meeting to order.

The committee members introduced themselves.

Sharon O'Hara, board chair, Steve Erkenbrack, board member, Gary Drews, interim chief executive officer, and Cammie Blais, chief financial officer, introduced themselves and presented an update on Connect for Health Colorado (the exchange). They provided the committee with a number of handouts, including:

• Powerpoint slides of the committee update (Attachment A);
• the financial plan extract from the slides (Attachment B);
• the marketplace dashboard (Attachment C);
• a summary of exchange expenditures (Attachment D);
• the board member’s biographies (Attachment E); and
• a marketing infographic regarding the upcoming open enrollment period (Attachment F).

140923 AttachF.pdf

Mr. Drews has been the interim CEO since Patty Fontneau left the Connect for Health Colorado in July and previously worked at the Colorado Health Foundation.

01:51 PM

Mr. Drews discussed the exchange's goals and challenges for the upcoming year, including policy discussions with the Centers for Medicare and Medicaid Services (CMS) and the Department of Health Care Policy and Financing (HCPF); increasing the number of plans, carriers, and providers available through the exchange; reaching potential enrollees; and transitioning from technological buildout to ongoing operations. He stated that fiscal sustainability is the exchange's main focus. Senator Balmer asked about any disparity between people who enrolled and those who paid the premiums. Ms. Blais discussed the number of effectuated enrollments.

02:01 PM

Mr. Drews responded to questions from Representative Landgraf about evaluating the number of consumers served through the exchange and what challenges they expect for the upcoming open enrollment period. Ms. Blais discussed Senator Lundberg's questions about the number of uninsured persons potentially eligible to purchase insurance through the exchange. Mr. Erkenbrack stated that projections are difficult because there is little previous data due to the exchange's infancy. Senator Lundberg noted that the role of the oversight committee is to see if the exchange is working and it needs data to do that.

02:11 PM

Senator Aguilar discussed the number of insured and uninsured residents in Denver county. Ms. Blais responded to questions from Representative Stephens about insurance plan pricing inside and out of the exchange. Mr. Erkenbrack noted that the exchange is intended to supplement, rather than replace, the insurance market. Ms. O'Hara stated that the information she has seen indicates that a large number of people with preexisting conditions are now insured. Ms. Blais responded to questions from Senator Nicholson about what the exchange considers to be hard-to-reach populations.

02:19 PM

Ms. Blais responded to questions about the issues individuals encounter when they move between Medicaid eligibility and exchange eligibility.

02:23 PM

Ms. Blais discussed the upcoming open enrollment period. She stated that the exchange and HCPF will use a shared eligibility system so that eligibility determinations will happen in one place. Ms. Blais noted that the shared system will launch in early November and it will streamline the process for customers. She discussed affordability and noted that 58 percent of the exchange's enrollees received some amount of subsidy. Ms. Blais noted that the number of individual plans available increased to 176 and small business plans increased to 120. Ms. Blais responded to questions about various channels through which exchange customers may receive assistance.

02:34 PM

Ms. Blais responded to questions from Representative Tyler regarding the small business exchange (SHOP). She clarified the number of individual accounts paying for insurance for Senator Lundberg and Representative Landgraf. Ms Blais discussed network adequacy.

02:40 PM

Ms. Blais discussed the marketing and outreach goals for the upcoming open enrollment period. Mr. Erkenbrack responded to questions from Senator Balmer regarding whether Medicaid expansion was a good policy decision. He stated that the role of the board is to implement policies, not to judge the merits of legislative decisions. He noted that HCPF is better suited to answer Medicaid questions. Representative Stephens discussed an introduced bill from the 2014 session regarding a Medicaid pilot program. Ms. Blais described planned upcoming marketing events.

03:00 PM

Ms. Blais described the new shared eligibility system with HCPF. She spoke about the design work done over the last year and the rollout timeline. Ms. Blais discussed the exchange's 2014 plan and its 2015 plan to grow and retain its customer base.

03:13 PM

Ms. Blais discussed the exchange's 2014 audit activity. Ms. O'Hara spoke about the board's plan and process for hiring a permanent CEO. She stated that the board plans to have a candidate selected for the committee's approval by mid-December. Ms. Blais responded to questions regarding the number and cost of the audits performed on the exchange.

03:21 PM

Ms. Blais discussed the exchange's financial and sustainability plan. She spoke about the exchange's revenue approach and noted that the board approved a $66 million budget for 2015. Ms. Blais said that she anticipates the annual operating budget to decrease significantly after some of the fixed technology contracts expire.

03:32 PM

Ms. Blais responded to questions from Senator Nicholson regarding whether the exchange had established criteria for website advertising. She noted that the exchange has not taken any web advertising plan to the board or to stakeholders, nor have they submitted any other ancillary revenue plans. Ms. Blais stated that there appears to be many cost and product sharing opportunities with other states. Mr. Erkenbrack noted that anonymous shopping available in Colorado's exchange encourages more people to browse and other states might look into that. Senator Lundberg asked about whether the board has considered what might happen if there is significant changes to state and federal policy.

03:43 PM

Peg Brown, Vincent Plymell, and Tara Smith, representing the Division of Insurance (DOI) within the Department of Regulatory Agencies, came to the table to respond to committee questions regarding plan pricing and rate increases. They provided the committee with a number of handouts, including:

• a DOI news release regarding 2015 health insurance rates (Attachment G);
• a list of frequently asked questions regarding DOI rate review (Attachment H);
• a list of various charts concerning, pricing, the number of carriers on the exchange; and weighted average increase or decrease per geographic region (Attachment I); and
• a marketing infographic showing the 2015 average cost increase or decrease for Colorado health plans (Attachment J).

140923 AttachG.pdf

140923 AttachH.pdf

140923 AttachI.pdf

140923 AttachJ.pdf

Ms. Brown responded to questions from Senator Lundberg about rate and pricing levels across different regions. Ms. Smith described the division's rate approval process. Ms. Brown responded to questions and noted that more plans have shifted from preferred provider organizations (PPO) to health maintenance organizations (HMO).

03:57 PM

Ms. Smith responded to questions about transparency in plans regarding covered benefits and deductibles. She noted that consumer education is very important. Ms. Brown responded to questions from Senator Aguilar and stated that carriers are responsible for network adequacy. She noted that the DOI is collecting provider directories and data in order to develop sufficient metrics for network adequacy.

04:06 PM -- Public Comment

04:06 PM -- Brad Niederman, a health insurance broker representing himself, came to the table. Mr. Niederman stated that he had some questions regarding the number of plans shifting from PPOs to HMOs, the maximum allowable deductible for health plans, and noted that tax credits are not available for catastrophic plans.

04:10 PM

The committee adjourned.