Insurance Board Looks to Provide Solutions for Oregonians Amid Uncertainty

September 14, 2011--As the nation heads into an era of a changing health insurance market, the aura of uncertainty that surrounds Washington DC has slowly stretched out to Oregon.

The federally-passed Affordable Health Care for America Act (ACA) will take effect in 2014, and the Oregon Medical Insurance Pool Board (OMIP) is in the process of providing clarity to the thousands of Oregonians who need access to affordable health insurance in the interim.

OMIP’s board met last Wednesday to discuss how it will continue to offer affordable insurance while providing quality benefits to people denied coverage due to pre-existing or current health conditions.

Administrator Tom Jovick emphasized that the board is focused on “a number of critical issues in governing the high risk pool”-- assuring that its members receive quality care, that the benefits are comprehensive and address their chronic medical needs, and that the cost of medical services is affordable.

OMIP has witnessed a sharp decline in membership. In June 2007, it covered 17,500 people compared to July 2011 when roughly 12,800 Oregonians participated.  

A significant challenge is “assuring that healthcare and services people receive are high quality and billed appropriately,” Jovick said.

Board members acknowledged that an overwhelming sense of uncertainty shrouds pending federal policy regulations. Issues such as the allocation of federal funding and how future legal challenges to the ACA before its implementation will certainly have an impact.

Uncertainly will likely fog discussions as the board confronts the insurance concerns of Oregonians, acknowledged Howard “Rocky” King, interim executive director of the Oregon Health Insurance Exchange.

“The challenges that we face in the next six to seven months without knowing most of the regulations is very, very tough,” King said.

A significant challenge OMIP faces in 2012 and beyond involves anticipating what options will be available to people in the high risk pool.   

Teresa Miller, administrator of the Department of Consumer & Business Services, echoed the sentiments of her peers. “This is work that we have to get right. This is really, really important.”

Rising medical costs coupled with hikes in insurance premiums concern board members. In just one year, the medical monthly expenses rose from $1,130 to $1,194 representing a 5.7 percent rate while the monthly premiums grew 16.4 percent from $548 to $638 (June 2010-June 2011).

“The biggest goal that [the board] should have is to reduce patients’ premiums,” said Dr. Robert Gluckman, medical director of Providence Health Plans.

There’s no relationship between the premiums charged by OMIP and medical costs, unlike the commercial market, Jovick said.

“Under the statutes for OMIP, we set premiums based on an average commercial premium for individual insurance plans that have benefits comparable to OMIP’s,” he added. “For the plans in which our medical eligibles enroll, the statute allows the board to surcharge those average premiums up to 25% above the average. This year the surcharge has been 10%. For the portability plans we offer and the FMIP plans (federal high risk pool), the board can set the rates no higher than the commercial market average for comparable plans.”

Other factors besides medical costs impact premium increases, he said, such as the distribution of members  among the different benefit plans, the age of the members and the number of people who move into higher age brackets, which have higher premiums.

“So far, we have seen no one moving into lower age brackets as they age, although I am sure they would like that to happen,” he said.

FOR MORE INFORMATION

To learn more about the OMIP and its board members, visit their webpage.