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Health exchange to offer retroactive coverage

Those in limbo on health exchange to get new stopgap option

By Meredith Cohn, Andrea K. Walker and Erin Cox, The Baltimore Sun

10:30 PM EST, January 13, 2014

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Consumers stuck in limbo, unable to access the state's glitch-prone online health exchange, will be allowed to get coverage through the plans they want under an agreement that state officials worked out with insurance companies.

Gov. Martin O'Malley plans to announce the option Tuesday, the day lawmakers scheduled briefings on the exchange's performance and on a different plan to give coverage through a state-backed health plan to thousands of uninsured who were thwarted by technical problems from enrolling in time to get coverage by Jan. 1.

"We're really appreciative that the insurance companies are going the extra mile to help get through this transition," said Dr. Joshua Sharfstein, state health secretary.

All four carriers on the health exchange agreed to the plan, and officials plan to begin reaching out Tuesday to people they know are having problems on the website, Sharfstein said. Consumers must register for the plan by Jan. 21 by phone through the exchange call center.

Consumers will be able to submit doctor and other bills dating back to Jan. 1 once they pay January and February premiums.

Chet Burrell, president and CEO of Carefirst BlueCross BlueShield, said allowing retroactive plans would be less complicated for consumers than signing up for a state plan only to switch to a private plan later.

"For people who were stuck in the process somewhere and wanted and needed the coverage, we wanted to do whatever we could as a partner with the state to help alleviate the problem," Burrell said.

Sharfstein and Lt. Gov. Anthony Brown, the state's point man on health care reform and a Democratic candidate for governor, were slated Tuesday to discuss their original stop-gap plan and brief lawmakers about efforts to fix the website. The hearings will give lawmakers their first — and perhaps only —chance this legislative session to ask questions about what's being done to repair the site.

The website has been technologically challenged since its Oct. 1 launch, falling behind on enrollment goals and leaving an unknown number of people without coverage in the new year.

The new plan will not replace the one to allow those without coverage temporarily into the Maryland Health Insurance Plan, which comes with its own premiums, deductibles and copays. The high-risk pool was created years ago for people who could not get private insurance because of pre-existing conditions.

Sharfstein said the administration will still offer the MHIP plan "as a basic safety net." It requires passage by the General Assembly as emergency legislation.

"There still could be people who fall through the cracks," Sharfstein said.

That proposal, though, has been criticized. Officials had estimated that a few hundred to several thousand people could enroll in MHIP at a cost of $5 million to $10 million. Montgomery County Del. Heather Mizeur, also a Democratic candidate for governor, said that may not be the best use of state resources.

As a high-risk pool, the plan's premiums "are exorbitantly higher than what could be found in the commercial market under the exchanges," said Mizeur, who ran a health care consulting business before launching her campaign.

Attorney General Douglas F. Gansler, another Democrat in the race for governor, said the short-term fix through MHIP could throw away millions of taxpayer dollars after the millions already spent on the health exchange — without a full explanation of what went wrong.

Gansler has been sharply critical of Brown's oversight of the troubled website.

"He didn't tell the people of Maryland when he knew ahead of time that this would fail," Gansler said after a news conference at his campaign headquarters in Silver Spring. Gansler said Brown needs to tell the public what happened to the $107 million used to build the exchange.

"In order to fix the problem, we have to know what happened," Gansler said. "We need to make sure people get access to health care."

Brown's campaign manager Justin Schall responded in a statement, saying, "Once again, Doug Gansler sounds just like a Republican attacking health care reform," Schall said. "Instead of working with the legislature and the governor's office to offer practical solutions, he is simply trying to score cheap political points to further his own political ambition."

Republicans have called for a special committee with subpoena powers. And some Democrats have said an investigation would be launched once the site is running properly.

State Sen. Thomas "Mac" Middleton, chairman of the finance committee, called for a briefing from state and exchange officials after a hearing on the MHIP emergency legislation. He said Monday he expected "there will be plenty of questions," but that it was not the time to investigate what went wrong. That would happen down the road.

"We'll get a briefing so the full committee can have an opportunity to understand where the administration is in getting the bugs out of the system," the Charles County Democrat said. "The priority ought to be getting the system up and running so people who need health care can get it."

However, Senate President Thomas V. Mike Miller said Tuesday's hearings will be the opportunity for senators to ask all the questions they want about the exchange's problems. "People are going to be allowed to vent," he said.

Miller said that unless the hearing uncovers evidence of serious problems, such as conflicts of interest or "total incompetence," that would be the end of any Senate investigation. He said that if the exchange's problems were the result of conflict between a contractor and subcontractor, that would not be enough to merit further hearings.

During hearings in both the House and Senate, Brown, Sharfstein and Carolyn Quattrocki, interim exchange director, are expected to testify.

Brown also pledged a full investigation after the website is running smoothly.

"That's something that will be done, but right now we don't want to divert attention" away from problem solving, Brown said. "We are making progress, but we're not satisfied until we enroll more and more Marylanders."

Meanwhile, insurers support the plan to offer retroactive coverage.

"From a public health perspective, this is good because it offers people continuity of care," said Dr. Peter Beilenson, who founded and runs Evergreen Health Co-op, which is offering a health plan on the exchange.

Beilenson said, however, that he was concerned consumers wouldn't get enough information about all the carriers during a phone call to be able to make an informed choice. That could work against Evergreen, which is new and has less name recognition than the larger insurers.

"We will compete the best we can," he said. "This is good for consumers."

Baltimore Sun reporters Kevin Rector and Michael Dresser contributed to this article.

meredith.cohn@baltsun.com

ecox@baltsun.com

andrea.walker@baltsun.com