AccessHealth CT Meeting: 2016 Open Enrollment and All-Payer Claims Database

By Max Friedman 

1d0cb851c6aeec1f7ea57b5a7487207c_400x400The AccessHealth CT Board of Directors held their February meeting this morning, where they discussed the results of the 2016 Open Enrollment period and the continuing work to gather data on health care spending in the state.

Here are some highlights:

2016 Open Enrollment 

  • AccessHealth CT saw an increase in people enrolled in Qualified Health Plans (QHP) of 20,462 from November through January. Of those, 19,499 were brand new customers to the exchange, the rest may have had coverage previously and were reenrolling.
  • A total of 116,019 people are enrolled in QHPs, with the vast majority receiving Advanced Premium Tax Credits and/or Cost Sharing Reductions to help them afford their health insurance premiums and out of pocket expenses.
  • Connecticut’s Medicaid plan, HUSKY, saw 42,248 new people deemed eligible through the exchange system, and 258,577 total Medicaid determinations were made during open enrollment. Arielle Levin Becker of the Connecticut Mirror wrote about Open Enrollment earlier in February.

All-Payer Claims Database 

  • The exchange’s All-Payer Claims Database (APCD), which will include the payment and pricing information of the major public and private payers (private insurance carriers, Medicare and Medicaid), is intended to increase transparency in the health care system. One hope is that consumers will use the Consumer Decision Tool from AccessHealth CT to evaluate insurance options to choose an affordable plan. We’ve written before about whether this will really work.
  • The APCD team has been in a testing phase, using submitted 2012 data from insurers to test how the system works. One lingering issue is the lack of information from self-insured payers. Large companies often have self-insured health plans for their employees, meaning that they pay the costs through a health insurance carrier as a third-party administrator. Aetna and Cigna have been submitting data for plans that they manage, while Anthem and United have been resisting, despite doing so in other states.
  • There is much anticipation around the outcome of Gobeille v. Liberty Mutual Insurance Company in the Supreme Court. Vermont is trying to compel Liberty Mutual to submit payment information for their employee plan to their APCD, while Liberty Mutual claims that they are exempt due to federal laws. We’re waiting for the Supreme Court to rule in June on this issue. Many members of the Board, including Lieutenant Governor Nancy Wyman, were worried about this issue, reiterating the importance of having a wide swath of health care cost information in the database. They suggested writing a letter urging the insurers to participate in the APCD.

Coming Up 

The Board will meet again next month. We can expect more information on plan designs for 2017, and more detailed information on enrollment.

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