Carriers without products for sale through DC Health Link have no interest in paying fees to support it.
Insurers and their trade groups are trying to keep the body in charge of the exchange, the D.C. Health Benefit Exchange Authority, from using a broad-based “health carrier assessment” to support it.
The Patient Protection and Affordable Care Act requires managers of locally based exchanges to come up with their own revenue by 2015.
Only four carriers sell coverage through the D.C. exchange, and the district obviously has a small market.
D.C. exchange managers proposed making up for those limitations by having a wide range of carriers – including issuers of dental, vision, critical illness, and other products not sold through the exchange – join the others in paying user fees.
Wes Rivers, a policy analyst at the D.C. Fiscal Policy Institute, wrote a comment letter supporting the proposal.
Even though carriers issuing disability insurance, long-term care insurance and other “excepted products” cannot sell the products through the exchange, PPACA will help them by helping more D.C. residents get medical coverage, Rivers writes.
Expanded access to coverage should make D.C. residents healthier, and that should eventually make the residents better risks for non-medical, health-related products, Rivers says.
In addition, imposing the assessment on the large group plans sold outside the exchange should help keep large employer plans from having an edge over small group plans, Rivers says.
Laurie Kuiper of Kaiser Permanente – an exchange participant – says Kaiser wants to the assessment base to be as broad as possible.
But representatives from America’s Health Insurance Plans, the American Council of Life Insurers and the Self-Insurance Institute of America Inc. blasted the idea of requiring off-exchange carriers help pay for the exchange and questioned whether the district has the authority to impose a broad assessment.
AHIP, for example, believes the exchange authority only has the authority to impose user fees and licensing fees on sellers of qualified health plans and qualified dental plans, according to Geralyn Trujillo, an AHIP regional director.
Catherine Bresler of Trustmark Insurance Co. says a broad assessment would be unfair to insurers and policyholders that get no benefit from the existence of the exchange.
Some commenters suggested that the District of Columbia should consider using general fund money to support the exchange, and some suggested or implied that insurers might be more open to paying an exchange assessment while the exchange is building enrollment.
John Fleig Jr., chief operating officer of UnitedHealthcare Mid-Atlantic Plan, suggested replacing the open-ended assessment obligation with an assessment program that would last for just two years.