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Valerie Bauman
Puget Sound Business Journal|www.bizjournals.com/seattle

Washington state Insurance Commissioner Mike Kreidler is accusing Premera Blue Cross of using its political influence to gut a bill designed to protect the public from Ponzi schemes and financial meltdowns.

Premera sought and won an amendment last week to a bill known as the Holding Company Act that would give insurers a lengthy appeals process before the public release of financial information that they consider proprietary, such as reports on how they manage risk and other sensitive financial records.

When the change was made, Kreidler’s office fired off a press release saying the insurance company has too much influence in Olympia, and that the changes would harm consumers. read more »

 

Some of the biggest critics of the latest $2.6 million ad campaign promoting the state Health Benefit Exchange are members of the exchange board.

“Was this the best use of our dollars to reach people?” asked Margaret Stanley, the board chairwoman.

In addition to Stanley, several other board members said last week they were concerned that the latest ad campaign featuring two rappers was bordering on offensive. The rappers, one white and one black, are interacting with real Washingtonians who have used the Healthplanfinder and rapping in reaction to those experiences.

“I would kindly ask you to take it off the air,” said Bill Hinkle, a new member of the board. “I just think it has to go.” Hinkle, a former state representative from Eastern Washington, moved that the ads be removed, but the motion failed without being seconded. read more »

 

The Washington State Hospital Association (WSHA) is suing the state Department of Health over new rules that subject hospital affiliations to a state review process.

The process is called Certificate of Need, and historically it has been used as a tool to ensure that hospital beds and medical services are distributed appropriately around the state. In other words, the process works to prevent a glut of hospital beds and duplicated services in some areas and a dearth of services in other regions.

The WSHA filed the petition Feb. 13 in Thurston County Superior Court, asking the court to invalidate the rules that recently expanded the Certificate of Need’s scope of authority. read more »

 

While Washington’s health exchange has struggled with ongoing technical problems, nearly 700,000 people have successfully navigated the system to enroll in commercial health plans or Medicaid.

That number isn’t widely reported, because nearly 260,000 of those people were just re-enrolling in Medicaid.

While those numbers of re-enrollments don’t count toward “new” enrollees under the Affordable Care Act (ACA), they are a testament to the volume of enrollments the Healthplanfinder site has been able to handle successfully. read more »

 

State Insurance Commissioner Mike Kreidler wants insurance companies to provide more information up front about provider networks and to offer proof they are giving consumers the access to providers that they’re paying for.

One of Kreidler’s most critical goals in developing an 80-page set of new rules was to ensure that when people purchase health plans, they will have enough doctors to choose from — in other words, an adequate network.

Kreidler’s rules would require insurers to prove that their networks can provide consumers with care within a reasonable amount of time and without having to travel long distances. The changes would require more thorough and earlier reporting from insurance companies. read more »

 

Providence and Swedish medical centers have received federal approval to participate in a Medicare program that rewards hospital systems with a payout when they save the feds money on health care.

Providence, which governs Swedish, created the Accountable Care Organization, which is one of 123 new ACOs across the country that the feds recently approved to partner with Medicare. The Providence/Swedish ACO is the only new one approved in Washington, and just the third in the state since the U.S. Department of Health and Human Services started offering the opportunity.

ACOs are partnerships between health care providers with the goal of slowing the growth of medical costs while improving quality of care. ACOs that operate in partnership with the federal Centers for Medicare and Medicaid (CMS) aim to win federal incentive payments when they hit targets for cheaper, better care. read more »

 

The Washington state health exchange has enrolled more than 248,000 people in health plans through Medicaid and private insurance plans.

In the past three months, Healthplanfinder has enrolled about 71,000 people (about 29 percent of the total) in commercial health insurance plans, and another 177,000 in Medicaid plans.

The Washington Health Benefit Exchange missed its goal of enrolling 130,000 people in commercial health plans by the end of 2013, but another 72,000 people have applied for private coverage and have not yet paid. Once those payments are complete, the number of private enrollments will be above that benchmark. read more »

 

Several trends dominated headlines in health care this year: the arrival of state and federal health exchanges, the push to develop outpatient clinics directly in communities, and ongoing hospital consolidation.

Here’s a look at some of the highlights.

The exchange

The Washington insurance exchange was the state’s health care news story of 2013.

The state chose to expand Medicaid and get an early jump on the massive technical undertaking that would eventually become known as the Healthplanfinder, an online marketplace for health coverage. read more »

 

The federal government announced it will offer a loophole to small businesses in Washington state that will allow those eligible to receive tax credits of up to 50 percent for insuring their employees.

“I was disappointed our state’s SHOP (Small Business Health Options) program was going to be so limited in 2014,” Gov. Jay Inslee said in a statement. “There are an awful lot of small businesses that would like to offer health coverage to their employees but have had a hard time keeping up with rising insurance rates. For a while now, we have been looking for a way to make sure small businesses in all counties have some way of getting financial support to offer their employees comprehensive, affordable coverage.”

Except for Clark and Cowlitz counties, Washington doesn’t have a small business exchange, which under the Affordable Care Act was the only way for them to receive tax credits starting in 2014. read more »

 
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