Sebelius predicts pressure on narrow networks


HHS: Exchange plans should respond to consumer wants

HHS Secretary Kathleen Sebelius in ClevelandExchanges are private-insurance markets, and it’s up to private insurers to provide the products consumers want, Health and Human Services (HHS) Secretary Kathleen Sebelius told MHE during a press conference in Cleveland today.

“As consumer interest grows and puts pressure on the companies to say ‘we want broader networks,’ there will be a new filing for Qualified Health Plans for 2015,” Sebelius says. “And I think insurance companies are hearing that from a lot of their customers. They want more choice. They’re willing to pay more money for broad access to a network, and I think we’ll begin to see that.”

She says the exchange plans also offer better benefits than consumers had in the individual market before. 

“A lot of people had no idea what their plans covered and often didn’t cover much-insuring some of the people some of the time for some things and with often unlimited out-of-pocket costs,” she says.

Ohio connection

Sebelius is a native of Cincinnati, Ohio, and points out that Ohio Governor John Kasich, a Republican, recently expanded Medicaid in the state. His original 2014 budget plan included Medicaid expansion but did not get past the legislature. Rather, in October, he turned to a seven-member Controlling Board to approve his request to spend $2.56 billion in federal money to expand Medicaid coverage.

HHS is encouraged by the number of states that have expanded Medicaid, and officials expect that in coming years, more states will opt in. Of the 31 governors that chose to expand Medicaid, 11 are Republicans, “and we’re in conversations with lots of others,” Sebelius says.

One argument among states-apart from partisan politics-is whether Medicaid expansion will realize a return on investment. While HHS will largely pick up the tab, states will eventually have to chip in 10% for the cost of the new populations. But Sebelius believes the economics won’t add up for the states that opt out.

“Missouri is losing $5 million a day by not expanding Medicaid,” she says.  “That’s the amount of federal dollars that would come into the state.”

Affordable care?

Even with 9 million people signed up for Medicaid and private plans under the Affordable Care Act, many believe with high deductibles and relatively rich coverage, that the plans aren’t as affordable as HHS makes them out to be.

“What we have in the market is a variety of choices,” Sebelius says. “The danger is some people don’t know what questions to ask. For the first time ever, the law says there is a limit on out-of-pocket costs regardless of what deductible you’ve chosen. You can’t pay more than $6,350 a year-that has never been a part of insurance before.”

In the exchanges, there are choices that include higher and lower premiums as well as higher and lower deductibles. She says having coverage with the financial security of out-of-pocket limits is far preferable to experiencing a healthcare event and medical bills “that follow you around for the rest of your life.”

Cleveland Mayor Frank Jackson was also on hand at the conference. Sebelius notes that 45 private plans are offered in the exchange in the Cleveland area and that 40,000 consumers in Ohio had signed up for coverage by the end of December.


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