By Lisa Stiffler
McClatchy News Service
OLYMPIA — State Insurance Commissioner Mike Kreidler grabbed national attention last year when he broke with President Barack Obama’s efforts to mollify a public upset by canceled insurance plans.
Of late, Kreidler has been openly critical of the state’s botched efforts to make repairs to the online insurance exchange.
But he remains a champion of the effort to make universal health care a reality and says Washington state has taken some meaningful steps in that direction.
The state has reduced the number of uninsured residents by roughly 38 percent since it expanded who is eligible for Medicaid, and it opened a new insurance marketplace in October 2013.
Shortly before the kickoff of the second health insurance open enrollment period last Saturday, Kreidler defended in an interview his concerns about technology problems plaguing the state’s online insurance exchange.
“I’ll do a disservice if I portray it as perfect,” Kreidler said.
While Kreidler oversees insurance issues for the state, a separate organization called the Washington Health Benefit Exchange runs the Healthplanfinder marketplace.
Since the launch of the exchange more than a year ago, the site has struggled to resolve various technical troubles, the knottiest being the transfer of premium payment information.
Data problems
Consumers are paying their premiums, but the information and funds aren’t always being accurately transferred to the insurance companies, so it appears the people are uninsured, creating a nightmare for affected patients, doctors and insurers.
“This is something that should have been resolved early,” Kreidler said.
But the problem still wasn’t fixed by the time the exchanges opened for enrollment Nov. 15.
A key to solving the problem, Kreidler said, is for the exchange to have a more robust system for tracking consumer complaints to help them identify systemic problems more quickly.
Before enrollment opened, the exchange said roughly 1,300 accounts had payment problems, but insurance companies have claimed it’s more than 10 times that number.
And from June to October, consumers lodged more than 500 complaints with the Office of the Insurance Commissioner regarding problems with their premiums, though the OIC is helpless to fix them.
‘Open, transparent’
“I feel very strongly that you have to be open and transparent and you can’t sweep things like this under the rug,” Kreidler said, “or your credibility will be diminished.”
Putting some of the technical challenges aside, “I’m pleased with the success the exchange has had,” Kreidler said.
“We’re still doing much better than anyplace else in the country. We’re doing remarkably well.”
The updated Healthplanfinder website should be a better shopping experience for customers, he said, making it easier to compare plans and figure out which ones cover specific medicines and doctors. Customers can more readily see what their out-of-pocket expenses will be.
But it’s essential that the website fix the remaining technical problems and reach sales goals to stay afloat.
Self-sustaining
The exchange is required to be self-sustaining beginning in January, and its funding depends on selling enough plans through Healthplanfinder.
Health insurance plans are taxed, and for plans sold through the exchange, that money is given back to Healthplanfinder.
Additionally, the exchange is charging insurance companies a $4 fee or “assessment” for each plan sold.
In addition to individual insurance plans, the exchange has for the first time a statewide marketplace for businesses employing 50 or fewer people, called Healthplanfinder Business.
2 companies
But only two insurance companies are offering plans through the exchange, and in most counties, only Moda Health is selling coverage.
By the start of open enrollment, roughly 140,000 people had coverage through the exchange, and the agency hopes to sign up 85,000 more in the individual market by Feb. 15 when the enrollment period ends.
“I’m still optimistic” the exchange will continue growing and meet its goals, Kreidler said.
2015 challenge
The Affordable Care Act requires nearly all Americans to have insurance — and wields a penalty for those who do not.
In 2014, the penalty was fairly modest: whichever was larger — 1 percent of a household’s adjusted income or a flat $95 per adult and $47.50 per child, up to a certain level.
Uninsured Americans in 2015 will be penalized 2 percent of their adjusted income or $325 per adult and $162.50 per child (there are some exceptions to who can be penalized).
2 percent penalization
A single person earning $40,000, for example, would get hit with the 2 percent and owe nearly $600.
Kreidler said he expects the threat to start having a more meaningful effect.
“There is a psychological part of this,” he said.
While insurance will still cost more than the penalty, at least people would be getting the benefits of coverage.
People will think, “I’d rather get something for my money rather than just throwing my money away,” he said.
“More and more people will begin to recognize the benefits.”
