House pan­els weigh health, fu­ture of co-ops

Modern Healthcare - - THE WEEK AHEAD - — Shan­non Much­more

Congress will con­sider in­creas­ing its over­sight of not-for-profit health in­sur­ance co-ops to boost the re­main­ing cov­er­age plans cre­ated un­der the Af­ford­able Care Act.

Repub­li­cans will hold two con­gres­sional hear­ings this week to ex­am­ine the re­cent wave of co-op clo­sures. To date, 10 of the orig­i­nal 23 health plan co-ops have said they will close.

Kelly Crowe, CEO of the Na­tional Al­liance of State Health Co-ops, said ear­lier this month that many of the clos­ing co-ops were on the path to financial sta­bil­ity but could not weather the lack of fed­eral financial sup­port. The CMS will pay only 13% of the money in­sur­ers had re­quested from the risk-cor­ri­dors pro­gram, which was de­signed to help com­pa­nies off­set losses from higher-than-ex­pected claims with the help of com­pa­nies that re­ceived fewer claims than ex­pected. Last year, com­pa­nies paid back $362 mil­lion, but re­quested $2.87 bil­lion. Congress also is ex­pected to take up the ques­tion of what will hap­pen if a co-op plan can­not re­pay its fed­eral loans.

The Of­fice of In­spec­tor Gen­eral re­leased a re­port in July that found 21 of the health plan co-ops ex­pe­ri­enced net losses. Most did not meet their ini­tial en­roll­ment and prof­itabil­ity pro­jec­tions at the end of 2014.

“With HHS al­ready is­su­ing lower ACA en­roll­ment pro­jec­tions and health in­sur­ance gi­ants merg­ing to fur­ther limit com­pe­ti­tion, the pres­ence of co-ops is needed now more than ever,” Crowe said. “Though fed­eral reg­u­la­tors have taken some mod­est steps to ease co-ops’ short-term financial bur­dens, a firmer com­mit­ment to ful­fill the obli­ga­tions of the ACA’s risk pro­grams is needed to pro­vide sta­bil­ity to the mar­ket­places.”

Wit­nesses have yet to be named for the hear­ings, which will be held by the Ways and Means Sub­com­mit­tee on Health and the En­ergy & Com­merce Sub­com­mit­tee on Over­sight and In­ves­ti­ga­tions.

Re­duced financial sup­port is

putting co-ops in a cor­ner.

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