In a new piece on the Health Affairs Blog, SHADAC Principal Investigator Lynn Blewett discusses the recently announced plan, brokered by the Minnesota Department of Commerce, to cap enrollment in Minnesota’s individual market in an effort to prevent the market from collapsing.
The Caps
The enrollment caps, along with significant rate increases, are aimed at preventing a market collapse following the announcement that Blue Cross Blue Shield (BCBS) would leave the individual market—an announcement that sparked concerns about other insurers doing the same—and are meant offer some insulation against an influx of the enrollees from BCBS, which had a higher risk profile than other insurers in the state. The caps include each plan’s current enrollment (from 2016) plus a small number of openings for new enrollees and apply to all but one narrow-network HMO plan, called Blue Plus, that is owned by BCBS.
The Implications
Dr. Blewett points out a key problem with the new policy: There will be no plan option for the five counties in which Blue Plus is not offered (Benton, Morrison, Crow Wing, Mille Lacs, and Stearns counties) once the state-wide caps in the other plans are met. As Dr. Blewett explains, the enrollment caps create conditions in which the ACA core principle, guaranteed issue, will not apply to everyone, and the rate increases for remaining plans “are likely to make coverage unaffordable for many.” Potentially exacerbating this problem is that there are 18,000 remaining uninsured in the counties where Blue Plus is not available. These and other remaining uninsured throughout the state (234,000 people total) will also be looking for affordable coverage, and “accommodations will need to be made to ensure access to plan coverage once…caps have been met.”
Dr. Blewett points to additional areas of concern surrounding Blue Plus, including potential problems accessing major providers in certain areas of the state and the incentive for Blue Plus to recruit the healthiest of its current enrollees (for whom BCBS has health status information). She notes that it will be critical to inform people of their choices (or lack of choices) during this transition.
Possible Solutions
Among other policy options and solutions for these issues, Dr. Blewett identifies the following:
- Hold a special legislative session to address large premium increases through a rebate program.
- Establish a state-based reinsurance system for its entire individual market.
- Provide access to a public option such as the Minnesota Care Program for those living in counties with no plan options after enrollment caps are met.