Study ques­tions need for two Cal­i­for­nia agen­cies over­see­ing health plans

Modern Healthcare - - REGIONAL NEWS - —Bar­bara Feder Ostrov

Cal­i­for­nia should con­sider merg­ing its two in­sur­ance reg­u­la­tory agen­cies in the wake of the Af­ford­able Care Act, ac­cord­ing to a study that re­news a con­tentious de­bate over how the state should over­see health plans.

Cal­i­for­nia is the only state in the na­tion to have two agen­cies over­see­ing health in­sur­ance. The Cal­i­for­nia Depart­ment of In­sur­ance cov­ers tra­di­tional indemnity in­sur­ance and some PPOs, while the Cal­i­for­nia Depart­ment of Man­aged Healthcare has tra­di­tion­ally reg­u­lated HMOs but re­cently picked up some types of PPOs.

“The reg­u­la­tory frame­work of who’s mak­ing de­ci­sions about the terms of en­gage­ment be­tween plans and con­sumers is im­por­tant, and it’s shifted a lot with the Af­ford­able Care Act,” said Mar­ian Mulkey, chief learn­ing of­fi­cer at the Cal­i­for­nia HealthCare Foun­da­tion. “In the long run, we need to think about whether hav­ing to do it twice (with two agen­cies) in­stead of do­ing it once is serv­ing Cal­i­for­nia and Cal­i­for­nia con­sumers.”

The not-for-profit health pol­icy think tank com­mis­sioned the study to up­date a 2011 re­port that ex­am­ined how Cal­i­for­nia would im­ple­ment the ACA with two reg­u­la­tory agen­cies. That re­port also ques­tioned the wis­dom of hav­ing two agen­cies with dif­fer­ent man­dates.

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