UPDATE: Some GOOD Co-Op news out of Ohio, Massachusetts & New Hampshire!
2019 OPEN ENROLLMENT ENDS (most states)
Time: D H M S
Some of the ACA provisions have been a huge success, such as the Medicaid expansion program, which has added over 14 million people to the program over the past 3 years. Others can be viewed as being successful or so-so depending on your POV, like the 12.7 million people who have enrolled in private policies via the ACA exchanges.
And then there are the portions of the law which have gone, well, not so great, to put it mildly...in particular the non-profit, public/private hybrid Co-Ops, which are the only remaining remnant of the originally much-hoped-for "Public Option". For a variety of reasons, not the least of which was an utterly unnecessary and ultimately pointless stunt pulled by Marco Rubio and other Congressional Republicans (aka the Risk Corridor Massacre), over half of the two dozen Co-Ops nationwide melted down in spectacular fashion last fall, leaving only 11 of them surviving into 2016 after the dust settled.
In light of this, I figured it would be worth posting some positive Co-Op news for a change. First up, Ohio.
You may recall that last week I went on a bit of a rant over the news that several insurance carriers, including the Ohio-based ACA Co-Op, InHealth Mutual, announced that they were dropping significant numbers of doctors/hospitals from their coverage networks...but didn't make those announcements until it was too late for the people who had just signed up to move elsewhere:
InHealth customers mad about late notice dropping OhioHealth
Some central Ohio consumers say a Westerville-based health insurer intended to keep quiet about its plan to drop OhioHealth hospitals and doctors from its provider network until it was too late for many of its enrollees to change their health plan.
...In those complaints, the consumers, who mostly live in Franklin or Delaware counties, expressed frustration over InHealth Mutual’s last-minute notice to consumers about its plan to drop most OhioHealth providers as of March 1. As many as 9,000 people could be affected statewide.
Well, today, InHealth announced that lo and behold, they've managed to come to some sort of understanding with OhioHealth after all (h/t to Henry Stern of InsureBlog):
InHealth Mutual is pleased to announce that OhioHealth will remain In-Network, uninterrupted, for the remainder of 2016.
This means that all OhioHealth System facilities and providers will be available to InHealth members at In-Network cost levels.
If any change is anticipated for our 2017 plan year, we will notify your members by October 31, 2016.
For more information, or to view our provider directory, please visit our website, www.inhealthohio.org/providers. And as always, our Customer Care team can be reached at 1-800-580-8502.
Thank you for your continued partnership as we diligently work to fulfill our nonprofit mission of providing quality, affordable health insurance that is responsive to the needs and wants of all Ohioans.
It's entirely possible, as a few "in the know" types have noted to me, that the original story was leaked by one side or the other purely as a bargaining tactic to put pressure on the other. If so, that's pretty depressing, but hardly surprising. In any event, they appear to have resolved the issue positively for all involved, so those 9,000 people can apparently rest assured now.
Meanwhile, while most of the 11 remaining Co-Ops are still in deep financial trouble, a few of them appear to staying afloat, and one of those, Minuteman Health (which operates in both Massachusetts and New Hampshire), just made that clear with a press release today:
Minuteman Health Reports Solid Financials, Membership for 2016
Financial stability, competitive premiums, and growing provider network seen as key factors
BOSTON—Minuteman Health (www.minutemanhealth.org) today reported that its financial condition and membership growth is solid, and that it is helping lead the national push for revisions in the federal risk adjustment policy that has ended up hurting smaller, more efficient health plans.
Minuteman’s to-date 2016 membership has jumped by 70.1 percent over 2015 totals, with most of the increase occurring during the open enrollment period that began November 1 and ends on January 31.
In addition to exceeding its membership targets, Minuteman has built a solid financial base, with $93 million in cash and $7 million in IBNR reserves for possible 2015 coverage payouts.
The company’s Medical Loss Ratio is an industry-positive 88.7 percent even after adjusting for the federal governments ‘3Rs’ programs. The company’s administration, fees and assessments are only one percent above budget despite challenging costs imposed by federal and state regulations.
"Our conservative approach to budgeting and growth combined with our strong provider network is helping us maintain a steady keel amid a very volatile time in the industry,” said CEO Tom Policelli.
UPDATE: Thanks to Adam Cancryn for specifying which of the remaining Co-Ops are still above water and which are in trouble:
Cohen did not specify which co-ops are facing corrective action plans. But a source familiar with the co-ops' finances said that only New Mexico Health Connections, Montana Health Cooperative and Massachusetts' Minuteman Health Inc. are not currently subject to additional oversight.
That means that the co-ops under corrective action plans are Wisconsin's Common Ground Healthcare Cooperative, Maryland's Evergreen Health Cooperative Inc., Freelancers Consumer Operated & Oriented Program of New Jersey Inc., HealthyCT Inc., Ohio's Coordinated Health Mutual Inc., Illinois' Land of Lincoln Mutual Health Insurance Co., Maine's Community Health Options and Oregon's Health CO-OP.
However, Cancryn's article also clarifies...
Both Cohen and Redmer maintained that the additional scrutiny of the co-ops means only that they need to fix parts of their operations, and not that they are in any danger of closing. Evergreen Health, for example, has steadily grown its customer base and is on track to turn a profit in 2016, Redmer said during the hearing.
The two laid out separate tracks toward long-term sustainability for the remaining co-ops. Cohen emphasized that the co-ops are still small businesses, despite their public funding, and that it is the companies' responsibility to ensure that they survive. That includes improving their overall operations, as well as diversifying their membership and finding new funding sources.
"They have every opportunity to be successful and be long-term market participants," she said. "The co-ops themselves are really going to be the ones who determine whether they will ultimately be successful."