Despite ACA Uncertainties, Connecticut's Health Exchange Moves Ahead | Connecticut Public Radio

Despite ACA Uncertainties, Connecticut's Health Exchange Moves Ahead

Jan 30, 2017
Originally published on January 26, 2017 12:10 pm

No one knows what will happen to the Affordable Care Act, or to coverage for the roughly 300,000 Connecticut residents insured under the program. But the state office in charge of the ACA is still making plans for the future – hoping to make the private marketplace more attractive for insurers.

While the ACA may have been attractive to some consumers, it has been less so to insurers.  Two of the four original insurance companies in the marketplace aren't in it anymore. Access Health CT CEO Jim Wadleigh says he wants to change that dynamic.

“What can we do to help make the business environment that our carriers are in easier for them to be more successful?”

Here’s one quick fix. Insurers have told Wadleigh that they lose money on customers who miss open enrollment periods and go through special enrollment – that's the process reserved for people with big life events that merit new insurance. 

“What the carriers are telling us is, these customers are coming in…finding a reason that they have a life event because they’re sick, get services, and then drop out.”

But Wadleigh says those people are expensive. This week, he’s asking his board to approve a plan to make sure no one is gaming the system. 

“If we can do a better job enforcing the special enrollment, we think we can reduce the premiums by potentially 6 to 10 percent.”

Another way to reduce costs? Shrink provider networks. So, let’s say you live in Hartford. Do you really need to pay for a plan that covers a doctor’s visit in Danbury?

“Customers are telling us they would go with a network choice option, or a narrow network, if it was cheaper and/or had a lower deductible.”

The question is whether these and other moves will attract more insurers. He has one clue: He's already getting questions from existing carriers who want to know whether other insurers are looking to get into the marketplace.

“So what that is telling me is that the carriers think that we’re making changes in the positive direction, and expect that other carriers would be interested joining our exchange with that.”

Whether they do – and whether the exchange will even be around for them to join – is still very much unclear.

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