By Al Cross
Kentucky Health News
Did Kentucky's government-sponsored insurance company fail because then-Gov. Steve Beshear and federal officials kept its rates artificially low to make Beshear's embrace of federal health reform look better?
That's what Republican state Sen. Ralph Alvarado of Winchester, using documents provided by Gov. Matt Bevin's office, suggested or claimed March 14 in a Senate floor speech about the Kentucky Health Cooperative.
"It appears that rates for the co-op may have been purposely kept down for the sake of optics, to make the rollout of the ACA in Kentucky appear successful when it clearly was not," Alvarado said, citing "multiple meetings between the co-op, the governor's office and CMS," the federal Centers for Medicare and Medicaid Services, which oversees the state-based co-ops created under the reform law, in the fall of 2014.
"Somewhere along the way rates were kept down despite these actuarial recommendations," which said the money-losing cooperative should increase its rates 35 to 40 percent for the 2015 plan year, Alvarado said. The co-op's average increase, announced in late October 2014, was 15 percent. In November, CMS expanded the co-op's $47 million solvency loan to $125 million "to try to sustain this company," he said.
Beshear denied the charges through a spokeswoman, Hayley Prim. She said in an email, "Rates were set by the co-op, which was a privately run insurance plan. Like all other insurance plans, the rates must be certified by the Department of Insurance and actuarially sound. The state did not hold rates artificially lower to improve optics."
CMS officials encouraged co-ops "to price their plans low and grow as fast as they could," Adam Cancryn reported for SNL Financial in November 2015, in a long article that is widely regarded as the best written about the failure of the co-ops. Twelve of the 23 have closed or plan to.
In December 2014, the Kentucky Health Cooperative reported a loss of $50 million, "with several hazardous financial conditions indicated," Alvarado said, but that year its chief executive officer, chief financial officer and member-services vice president got bonuses of $50,000, $40,000 and $40,000 on top of their salaries of $250,000, $179,000 and $131,000.
"This company had no money, was in deficit, and yet funds were being used clearly for bonuses," Alvarado said. Its CFO, Leonard Sherman, left the company in December 2014, according to a document filed by its liquidators.
Joe Smith of Frankfort, who was chair of the cooperative's now-dissolved board, said in an interview that the salaries and bonuses were "probably a little bit less" than typical in the insurance industry. He said bonuses were paid because the co-op enrolled many more customers than expected, but no bonuses were paid after the first year.
Smith blamed "the Republican Congress" for killing the co-op and those in many other states by limiting the "risk corridor" subsidies paid to insurance companies for covering sicker-than-average populations.
He acknowledged that the Obama administration largely abandoned the co-ops, making them "a sacrificial lamb," but he said they could not effectively compete with large insurance companies, mainly because the reform law prohibited them from advertising, as the big insurers wanted. The law created funding for the not-for-profit cooperatives as a way to provide competition with for-profit insurers and hold premiums down.
Janie Miller, who was Beshear's first health secretary, resigned as CEO of the Kentucky Health Cooperative in June 2015. That October, the co-op said it had largely eliminated its losses but would close because it was getting only a $9.7 million of a $77 million risk-corridor subsidy that it needed to stay afloat. It is now in liquidation, supervised by Franklin Circuit Court.
Alvarado said Miller and her successor, Glenn Jennings, refused to appear at a legislative budget subcommittee meeting in November. He said the Insurance Department "gave us very limited answers about what happened, [which] made me wonder if any wrongdoing was involved."
Alvarado said the legislature's Program Review and Investigations Committee should examine the co-op's finances and the Senate should issue a subpoena requiring Miller and Jennings to appear.
Prim, Beshear's spokeswoman, said, "While it is unfortunate the co-op did not succeed, an overwhelming majority of Kentuckians have a positive view of Kynect," the online exchange where Kentuckians can buy federally subsidized health-insurance policies. "It has succeeded by providing low-cost health insurance options and creating a competitive marketplace for private insurers that have kept rates low for everyone."
In his speech, Alvarado incorrectly referred to Kynect policies as Medicaid, the federal-state health plan for the poor and disabled. Beshear expanded Medicaid eligibility to Kentuckians in households with incomes up to 138 percent of the federal poverty level.
Alvarado declined to give Kentucky Health News the documents to which he referred in his speech, saying he got them from Bevin's office, which could be asked for them.
Bevin's office provided the liquidators' first report, filed Dec. 31; an actuarial report on small-group plans for 2016, submitted in July 2015; an actuarial report on individual plans for 2015, filed in August 2014; and a February 2015 letter from Miller responding to the Insurance Department's request for a "corrective action plan." None of the documents mention the meetings Alvarado said occurred among CMS, the co-op and the governor's office.
The August 2014 actuarial report said, "The financial viability of KHC is in question. . . . KHC's projections reflect very aggressive assumptions, albeit within a reasonable range, and may result in a very optimistic view of future experience."
The co-op's members used medical services more often than it expected. In the second quarter, there were 263 hospital patient days per 1,000 members, higher than the pricing assumption of 184 per 1,000 but a still a "significant decrease" from the first quarter, for which the report did not give a figure.
The co-op was also having trouble dealing with members and health-care providers. Its corrective plan filed in February 2015 addressed complaints about such things as slow payment standards, paid premiums not being posted to members' accounts, complaints from in-network providers about being processed as out-of-network, and long waits for customer service, with supervisors not being available.
The liquidators' report to the court estimated that the co-op still owes about $80 million in claims, and their financial analysis left unclear whether all those claims would be paid. The balance sheet in the liquidators' statement, dated June 30, said the co-op had $117 million in assets and $128 million in liabilities, and the liabilities included only $67.7 million in unpaid claims. However, the co-op's biggest federal loan, of $125 million, is "subordinate to policyholder obligations, claimant and beneficiary claims, operating expenses and state reserve and solvency requirements," the report said. CMS, the federal agency, has asked an independent actuary to provide its own estimate of unpaid claims.
Kentucky Health News
Did Kentucky's government-sponsored insurance company fail because then-Gov. Steve Beshear and federal officials kept its rates artificially low to make Beshear's embrace of federal health reform look better?
 |
| Sen. Ralph Alvarado |
"It appears that rates for the co-op may have been purposely kept down for the sake of optics, to make the rollout of the ACA in Kentucky appear successful when it clearly was not," Alvarado said, citing "multiple meetings between the co-op, the governor's office and CMS," the federal Centers for Medicare and Medicaid Services, which oversees the state-based co-ops created under the reform law, in the fall of 2014.
"Somewhere along the way rates were kept down despite these actuarial recommendations," which said the money-losing cooperative should increase its rates 35 to 40 percent for the 2015 plan year, Alvarado said. The co-op's average increase, announced in late October 2014, was 15 percent. In November, CMS expanded the co-op's $47 million solvency loan to $125 million "to try to sustain this company," he said.
Beshear denied the charges through a spokeswoman, Hayley Prim. She said in an email, "Rates were set by the co-op, which was a privately run insurance plan. Like all other insurance plans, the rates must be certified by the Department of Insurance and actuarially sound. The state did not hold rates artificially lower to improve optics."
CMS officials encouraged co-ops "to price their plans low and grow as fast as they could," Adam Cancryn reported for SNL Financial in November 2015, in a long article that is widely regarded as the best written about the failure of the co-ops. Twelve of the 23 have closed or plan to.
 |
| The insurance co-op's offices are in eastern Jefferson County. |
"This company had no money, was in deficit, and yet funds were being used clearly for bonuses," Alvarado said. Its CFO, Leonard Sherman, left the company in December 2014, according to a document filed by its liquidators.
Joe Smith of Frankfort, who was chair of the cooperative's now-dissolved board, said in an interview that the salaries and bonuses were "probably a little bit less" than typical in the insurance industry. He said bonuses were paid because the co-op enrolled many more customers than expected, but no bonuses were paid after the first year.
Smith blamed "the Republican Congress" for killing the co-op and those in many other states by limiting the "risk corridor" subsidies paid to insurance companies for covering sicker-than-average populations.
He acknowledged that the Obama administration largely abandoned the co-ops, making them "a sacrificial lamb," but he said they could not effectively compete with large insurance companies, mainly because the reform law prohibited them from advertising, as the big insurers wanted. The law created funding for the not-for-profit cooperatives as a way to provide competition with for-profit insurers and hold premiums down.
Janie Miller, who was Beshear's first health secretary, resigned as CEO of the Kentucky Health Cooperative in June 2015. That October, the co-op said it had largely eliminated its losses but would close because it was getting only a $9.7 million of a $77 million risk-corridor subsidy that it needed to stay afloat. It is now in liquidation, supervised by Franklin Circuit Court.
Alvarado said Miller and her successor, Glenn Jennings, refused to appear at a legislative budget subcommittee meeting in November. He said the Insurance Department "gave us very limited answers about what happened, [which] made me wonder if any wrongdoing was involved."
Alvarado said the legislature's Program Review and Investigations Committee should examine the co-op's finances and the Senate should issue a subpoena requiring Miller and Jennings to appear.
 |
| Then-Gov. Steve Beshear, discussing health reform at the Brookings Institution in D.C. |
In his speech, Alvarado incorrectly referred to Kynect policies as Medicaid, the federal-state health plan for the poor and disabled. Beshear expanded Medicaid eligibility to Kentuckians in households with incomes up to 138 percent of the federal poverty level.
Alvarado declined to give Kentucky Health News the documents to which he referred in his speech, saying he got them from Bevin's office, which could be asked for them.
Bevin's office provided the liquidators' first report, filed Dec. 31; an actuarial report on small-group plans for 2016, submitted in July 2015; an actuarial report on individual plans for 2015, filed in August 2014; and a February 2015 letter from Miller responding to the Insurance Department's request for a "corrective action plan." None of the documents mention the meetings Alvarado said occurred among CMS, the co-op and the governor's office.
The August 2014 actuarial report said, "The financial viability of KHC is in question. . . . KHC's projections reflect very aggressive assumptions, albeit within a reasonable range, and may result in a very optimistic view of future experience."
The co-op's members used medical services more often than it expected. In the second quarter, there were 263 hospital patient days per 1,000 members, higher than the pricing assumption of 184 per 1,000 but a still a "significant decrease" from the first quarter, for which the report did not give a figure.
The co-op was also having trouble dealing with members and health-care providers. Its corrective plan filed in February 2015 addressed complaints about such things as slow payment standards, paid premiums not being posted to members' accounts, complaints from in-network providers about being processed as out-of-network, and long waits for customer service, with supervisors not being available.
The liquidators' report to the court estimated that the co-op still owes about $80 million in claims, and their financial analysis left unclear whether all those claims would be paid. The balance sheet in the liquidators' statement, dated June 30, said the co-op had $117 million in assets and $128 million in liabilities, and the liabilities included only $67.7 million in unpaid claims. However, the co-op's biggest federal loan, of $125 million, is "subordinate to policyholder obligations, claimant and beneficiary claims, operating expenses and state reserve and solvency requirements," the report said. CMS, the federal agency, has asked an independent actuary to provide its own estimate of unpaid claims.
No comments:
Post a Comment