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Editorial: Statewide coverage expands under Affordable Care Act

Wed., May 13, 2015

In August 2013, prospects for robust competition among Washington health insurers were looking grim. The Washington Health Care Exchange Board refused to certify 31 of 35 insurance plans because they didn’t meet guidelines set by the Office of the Insurance Commissioner. Eventually, eight companies sold plans on the exchange in the first year, with only one, Lifewise, offering plans in all 39 counties.

Contrast that inauspicious debut with this week’s announcement that 13 insurers want to offer 188 exchange plans for 2016. That’s up from the 10 insurers offering 90 plans this year. The new plans must survive the approval process, but it looks like more choices are on the way.

Getting more plans into rural areas has always been a struggle. But Eastern Washington should benefit from the increased offerings because one of the new carriers, UnitedHealthCare, would offer plans in all counties. In 2014, the first year of the exchange, many rural counties had only two plans to choose from. This year, every county has at least three plans. Most have more.

Spokane County has gone from four plans to eight.

Before the Affordable Care Act, which also expanded Medicaid eligibility, 13 percent of Spokane County residents were uninsured. As of February, that figure was 3 percent, according to Better Health Together, a nonprofit group that helps people sign up. Nationwide, an estimated 16.4 million Americans have gained health care coverage.

Even health care inflation, which had spun out of control, has calmed considerably.

The insurance commissioner reports the average proposed premium increase for 2016 plans is 5.4 percent, but that figure is sure to drop as plans undergo regulatory scrutiny. Last year, premium increase requests averaged 8.6 percent, and ended up at 1.9 percent.

That does not appear to have discouraged UnitedHealthCare or the other new market entrants.

Furthermore, the 2016 requests would average only 2.4 percent if not for the $14-per-month charge that’s tentatively assessed insurance plans under the state Senate’s budget proposal. That’s up from $4. The revenue finances administration of the exchange, which lost federal start-up money last year. Whether that assessment survives budget negotiations remains to be seen, but if it goes down, so will premiums.

The news isn’t so good for small-business coverage, where reform hasn’t gained much traction. As of early March, only 72 companies had enrolled in Washington’s business exchange. If Congress ever stops fruitless efforts at total repeal, this is one area where it could improve the law.

Another is costs. Though health care inflation has slowed, U.S. spending still leads the world by a considerable sum. Reform cannot be considered a success while that continues.

Nonetheless, after a nightmarish beginning, health care reform has made impressive strides in expanding coverage.