{"id":36997,"date":"2022-12-02T12:51:13","date_gmt":"2022-12-02T19:51:13","guid":{"rendered":"https:\/\/www.durangoherald.com\/tj\/colorado-officials-accused-of-trying-to-tip-scales-in-favor-of-a-jared-polis-health-insurance-policy\/"},"modified":"2022-12-02T19:51:13","modified_gmt":"2022-12-02T19:51:13","slug":"colorado-officials-accused-of-trying-to-tip-scales-in-favor-of-a-jared-polis-health-insurance","status":"publish","type":"post","link":"https:\/\/www.durangoherald.com\/tj\/colorado-officials-accused-of-trying-to-tip-scales-in-favor-of-a-jared-polis-health-insurance\/","title":{"rendered":"Colorado officials accused of trying to tip scales in favor of a Jared Polis health insurance policy"},"content":{"rendered":"

\"Gov.
Gov. Jared Polis delivers his big idea pitch \u2013 about a state-level \u201cpublic option\u201d health insurance plan \u2013 to the audience at The Colorado Sun\u2019s Big Ideas 2020 Forum at the Cable Center on the University of Denver campus in 2020. (Eric Lubbers\/ The Colorado Sun)<\/span><\/figcaption><\/figure>\n<\/p>\n

The Colorado Option, the new health insurance program that seeks to give people better coverage at lower prices, is the result of years of work by Democratic lawmakers, state officials and advocacy groups to prove that a more consumer-friendly insurance plan can be a winner in the free market.<\/p>\n

But now, health insurance brokers say the state is unfairly trying to tilt that playing field in the Colorado Option\u2019s favor.<\/p>\n

The controversy has to do with plans that are being suggested to people who buy health insurance on their own and whose current insurance carriers are leaving the state.<\/p>\n

Two carriers \u2013 Bright Health and Oscar Health \u2013 are pulling out of Colorado for 2023. Combined, around 50,000 people purchased a Bright or Oscar plan this year on Connect for Health Colorado, the state\u2019s online insurance exchange. Those folks will need to pick a new plan with a new insurance company for 2023.<\/p>\n

When they log into their account on Connect for Health to make that selection, the platform will give them a \u201csuggested plan\u201d that they can sign up for with only a couple of clicks. Those suggested plans this year are all Colorado Option plans, a request the state Division of Insurance made to Connect for Health officials.<\/p>\n

The Colorado Option, created by the legislature last year, is a government-designed health insurance plan that offers a standardized set of benefits. It is then priced and sold by private insurance companies on the open market at premium rates that are mandated by law to eventually drop to 15% below 2021 levels, taking into account inflation. If prices don\u2019t drop enough, the state insurance commissioner will be able to step in and dictate hospital prices to achieve the premium reductions.<\/p>\n

The Division of Insurance was heavily involved in advocating for and creating the Colorado Option, which is a signature policy achievement of Gov. Jared Polis and Democrats in the state legislature. State Insurance Commissioner Michael Conway, who heads the Division of Insurance, is a Polis appointee. Thus, giving a boost to Colorado Option plans could be seen as interfering in the free market to make a political initiative more successful.<\/p>\n

\u201cAll of this, to me, is an obvious attempt to steer people into the Colorado Option, whether that is a better fit for them or not,\u201d Brad Niederman, a health insurance broker, said at a meeting last month of the Connect for Health board.<\/p>\n

\"Colorado
Colorado Insurance Commissioner Michael Conway speaks at a public forum in Frisco on Feb. 21, 2020. (John Ingold\/The Colorado Sun)<\/span><\/figcaption><\/figure>\n<\/p>

In most counties, Colorado Option plans this year aren\u2019t the least expensive. That means consumers just looking to find the lowest-cost plan could sign up for something more expensive than they intended if they go with the suggested plan, health insurance brokers say.<\/p>\n

\u201cColorado Option plans are more expensive than (other) plans when most people are shopping on price,\u201d said Meagan Fearing, a broker and the president of the Colorado State Association of Health Underwriters, a brokers group.<\/p>\n

Fearing said she ran one quote for a client in El Paso County and found 10 to 15 plans that were cheaper before she got to a Colorado Option plan.<\/p>\n

If consumers want to shop for a plan that\u2019s not the suggested plan, they have to go all the way back through Connect for Health\u2019s system, reentering their financial information.<\/p>\n

\u201cIt\u2019s a much more cumbersome process,\u201d Fearing said.<\/p>\n

Choosing the suggested plan could also mean having to change doctors. Connect for Health used an algorithm to match each Bright and Oscar consumer with a new plan. In Connect for Health parlance, this was called \u201cmapping\u201d or creating a \u201ccrosswalk.\u201d<\/p>\n

The algorithm took a carrier\u2019s service area into account, leading to a broad geographic parsing of the state. Bright customers in the Denver metro area, for instance, were mapped to Colorado Option plans offered by Kaiser Permanente.<\/p>\n

But Kaiser has its own network of doctors and clinics, while Bright used Centura\u2019s network. If a Bright customer chooses the suggested Kaiser Permanente plan in the Denver metro area, they will almost certainly not be able to keep their doctor, Fearing said.<\/p>\n

The suggested plan algorithm also doesn\u2019t take into account the specific prescription drugs a person might need or the specific hospitals they would like to use.<\/p>\n

With this mapping, in my strong opinion, we are doing Connect for Health Colorado customers a great disservice,\u201d Niederman, the broker, said at the Connect for Health board meeting.<\/p>\n

Representatives for insurance companies said they were also bewildered by the process.<\/p>\n

\u201cWe\u2019ve just found this really confusing and didn\u2019t understand how the crosswalk was determined,\u201d Amanda Massey, the executive director of the Colorado Association of Health Plans, an insurer trade group, said during the board meeting.<\/p>\n

Massey declined to comment further.<\/p>\n

State says better communication was needed<\/div>\n

Fearing isn\u2019t on the Connect for Health board but she sits on an advisory group to the board. She said the issue of favoring Colorado Option plans was never brought to that group\u2019s attention, calling the lack of communication a travesty.<\/p>\n

\u201cWe should have been talking about this much sooner,\u201d she said.<\/p>\n

Conway, the insurance commissioner, agreed and apologized during the Connect for Health board meeting.<\/p>\n

\u201cThat\u2019s on me. That\u2019s my fault for not sharing that we did talk some of these things through,\u201d he said.<\/p>\n

The issue was partly one of timing, state officials said. While the state had more notice that Oscar would be pulling out, Bright\u2019s announcement of its departure came only a couple weeks before open enrollment began.<\/p>\n

\u201cWe were just trying literally to figure out who was going to stay on the exchange and who was going to go off,\u201d Kevin Patterson, the CEO of Connect for Health, said in an interview.<\/p>\n

Connect for Health has previously offered suggested plans, but that typically occurs when an insurer discontinues a specific plan \u2013 think of a car company deciding to discontinue a specific model. In those cases, the suggested plan offers another choice within the same insurer, leading to little disruption.<\/p>\n

But the departures of Oscar and Bright are the first time in seven years that a carrier has left the individual market entirely in Colorado. That meant Connect for Health\u2019s methods for suggesting a new plan from a different carrier were rusty.<\/p>\n

Patterson called the mapping system \u201cby far one of the most imperfect processes that we have\u201d and said officials and other stakeholders need to talk more about how it should work.<\/p>\n

\u201cWe have to think about this from an exchange perspective \u2013 do we want to be in a position where we pick winners and losers?\u201d he said.<\/p>\n

A previous attempt to boost the Colorado Option<\/div>\n

This is not the only instance of the Division of Insurance and Connect for Health seeking to elevate Colorado Option plans this year. There was also a previous attempt, involving how plans were sorted on the exchange.<\/p>\n

There are 166 health insurance plans being sold on the exchange this year, split across multiple insurance carriers, counties and bronze, silver and gold levels. That makes for a sometimes bewildering forest of options on the exchange.<\/p>\n

To better organize the chaos, Connect for Health creates a sorting system called \u201cpreferential display.\u201d In most years, the preferential display favors lower premium prices, so the cheapest plans are what people searching for coverage will see first \u2013 though the exchange has other options for sorting plans. Think of it like the results that appear on the first page of a Google search.<\/p>\n

But, when open enrollment kicked off this year, Connect for Health, at the request of the Division of Insurance, gave Colorado Option plans top billing in the preferential display.<\/p>\n

Conway, the insurance commissioner, said the goal in prioritizing Colorado Option plans was to help people better compare coverage. Because the Colorado Option is built on a standardized benefit design \u2013 meaning what people get from their coverage should be the same across all Colorado Option plans \u2013 Conway said that made it simpler for people to shop because all they needed to consider was price and the plan\u2019s provider network of doctors and hospitals.<\/p>\n

\u201cWe want consumers to know when they are looking at Colorado Option plans that it\u2019s an apples-to-apples comparison,\u201d Conway said in an interview.<\/p>\n

The decision to highlight Colorado Option plans in the preferential display provided the rationale for also making Colorado Option plans the suggested plans for Bright and Oscar customers, Conway said.<\/p>\n

But, after criticism, the state backed off the preferred billing for Colorado Option plans, instead going back to sorting plans by premium price. By then, it was too late to change the suggested plans.<\/p>\n

\u201cWe\u2019re out of runway to actually change anything from a technology standpoint,\u201d Patterson said.<\/p>\n

Conway, though, said he hopes to push for preferential display favoritism for Colorado Option plans again next year, reiterating that he believes the plans provide the clearest opportunity to compare coverage. Sorting plans just by premium price gives carriers an incentive to underprice their plans in the hope of signing up more people, Conway said. That could lead to unsustainability that sees more carriers falter.<\/p>\n

Highlighting Colorado Option plans would give consumers a broader view across all insurers, he said.<\/p>\n

\u201cI think that\u2019s good for the market and good for the sustainability of the market, too,\u201d he said during last month\u2019s Connect for Health board meeting.<\/p>\n

Urging consumers to shop<\/div>\n

The dispute has left lingering questions and frustrations. But people on all sides of the issue agree that the complexity of the situation shows why consumers looking for insurance in the individual market need to be proactive shoppers this year.<\/p>\n

Fearing, the president of the state\u2019s brokers group, said people should think about using a broker to help navigate the system and make sure they end up with a plan that meets their needs.<\/p>\n

\u201cDon\u2019t just click through the path of least resistance,\u201d she said.<\/p>\n

Patterson also highlighted the importance of shopping.<\/p>\n

\u201cThis year is more important than last year to make sure you shop,\u201d Patterson said. \u201cThere are just so many big things moving around.\u201d<\/p>\n

But, at last month\u2019s Connect for Health board meeting, some members questioned how this encouragement of shopping squares with the idea of offering suggested plans.<\/p>\n

\u201cIf you\u2019re a member and you see something show up in your inbox that says (Connect for Health) has a plan that is a suggested match for your other plan, that carries weight,\u201d said board vice chair Marc Reece, who also works as the senior director for state government affairs for Aetna\u2019s western region. \u201cIf we\u2019re making a suggestion, knowing that that carries weight, how do we balance that against the message to be sure to shop?\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

Health insurance brokers say the state is interfering in the free market to favor the Colorado Option, potentially at consumers\u2019 expense <\/p>\n","protected":false},"author":1,"featured_media":36998,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[],"tags":[233,28],"naviga_topic":[],"class_list":["post-36997","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","tag-coloradosun-com","tag-headlines"],"acf":[],"author_name":"Website Administrator","_links":{"self":[{"href":"https:\/\/www.durangoherald.com\/tj\/wp-json\/wp\/v2\/posts\/36997","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.durangoherald.com\/tj\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.durangoherald.com\/tj\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.durangoherald.com\/tj\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.durangoherald.com\/tj\/wp-json\/wp\/v2\/comments?post=36997"}],"version-history":[{"count":0,"href":"https:\/\/www.durangoherald.com\/tj\/wp-json\/wp\/v2\/posts\/36997\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.durangoherald.com\/tj\/wp-json\/wp\/v2\/media\/36998"}],"wp:attachment":[{"href":"https:\/\/www.durangoherald.com\/tj\/wp-json\/wp\/v2\/media?parent=36997"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.durangoherald.com\/tj\/wp-json\/wp\/v2\/categories?post=36997"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.durangoherald.com\/tj\/wp-json\/wp\/v2\/tags?post=36997"},{"taxonomy":"naviga_topic","embeddable":true,"href":"https:\/\/www.durangoherald.com\/tj\/wp-json\/wp\/v2\/naviga_topic?post=36997"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}