Washington Insurance Commissioner Mike Kreidler, a former eye doctor, knows a botched operation when he sees one.
“Botched” would be a kindly characterization of the Obamacare launch. The president — “It’s on me” — took full possession of his ailing patient Thursday. His political decision to reopen the market to insurance plans that carriers have been canceling wholesale may buy enough time to get the federally run health exchange functional.
But he did not help states where the exchanges are working well, nor an insurance industry that may have to contend with two marketplaces; Obamacare and pre-Obamacare.
Thanks to Kreidler, that will not happen in Washington.
Because states still control their own insurance markets, Obama’s announcement left to state insurance commissioners the decision to stick with plans with coverages mandated under the Affordable Care Act, or allow consumers continued access to the insurance plans they already have, and may have had for years.
Millions of health insurance policy holders — 290,000 in Washington — have received or will receive cancellation notices. Because the federal exchange has worked so very poorly, consumers cannot even find out what a replacement will cost, or what subsidy will help alleviate the charges.
That has not been the case in Washington, which ranks behind only California and New York in the number of consumers enrolled in new plans. All will be able to enroll by the March 30 deadline, Kreidler says, so there’s no need to backtrack.
The 14 state-operated exchanges, and that of the District of Columbia, have significantly outperformed the federal HealthCare.gov. All but one — Kentucky — are blue states that set out to make the new systems work, rather than root for their failure.
Kreidler says sticking with the insurance products that conform to Obamacare mandates minimizes consumer confusion and avoids damage to the careful insurer underwriting to assure premiums cover patient costs. Throwing grandfathered plans back into the market makes a shamble of those calculations, which explains industry opposition to a federal retreat from mandated plans.
The grandfathered plans add risk in another way: Many of those policyholders are the young whose good health means they need less care but choose to protect themselves and their families anyway. Their premiums help offset spending for those with pre-existing conditions, for example.
Whether premiums will match expenditures remains the great unknown as health insurance changes. Kreidler has not yet sampled the insurers to find out how that equation is working for them, but he has not heard any alarms signaling a major imbalance.
So far, Washington remains on course to get all its citizens insured if they want insurance. More than 1 million do not have coverage and likely will not if the ACA fails.
Kreidler has been determined to avoid failure since before Obamacare. He and the insurance exchange team led by Chief Executive Officer Richard Onizuka have done an exemplary job implementing the law. The patient may be in Intensive Care back in D.C., but in Washington she’s ambulatory.