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Cover Oregon’s Future Remains in Doubt While Health Net Backs Out

The transition team at Cover Oregon expects to choose a systems integrator on Friday who can link the federal enrollment website for private insurance plans and, separately, finish building a state system to manage Medicaid enrollments.
June 12, 2014

During her confirmation hearings, the new HHS Secretary told Congress that she’s going after states that failed to get their health insurance exchanges up and running. That’s led to speculation about whether Governor Kitzhaber intends to bring back Cover Oregon rather than have to dole out the $250 million in federal funds. Obviously no such decision would occur prior to the 2015 legislative session.  

But it could be the reason Oregon’s decided to keep the premium tax charged when people sign up for private coverage, said Jim Roberts, policy analyst with the Northwest Portland Area Indian Health Board. 

Cover Oregon officials told legislators last week they intend to raise that tax from $9.39 per person per month to $9.66 to keep up with inflation. If 100,000 people enroll in the federal exchange starting Nov. 15, Oregon could collect close to $10 million.

At that hearing, Sens.Jeff Kruse and Jason Conger, both Republicans, questioned that decision. “The fee was to permit Cover Oregon to become self-sustaining, but I’m a little puzzled . . . . when we’re going to the federal exchange,” remarked Conger.

In response, Tina Edlund who’s been tasked with salvaging the Oracle technology for the state’s Medicaid program, said there were never any plans to get rid of managing the exchange.

What Edlund meant by that comment remains an open question, and Edlund was unavailable to respond, with her spokesperson, Ariane Holm saying she was too busy for an interview. 

Once the exchange is turned over to the feds, Cover Oregon may no longer be needed since any rate increases and benefit changes are the purview of the Insurance Division. 

And, if the governor’s office is thinking about bringing back the private exchange, nothing will be forthcoming until after the fall election, predicted Tom Jovick, who managed special projects before resigning from Cover Oregon last month. 

“Anything the governor is doing right now is being driven by his campaign managers,” Jovick said. 

By hiring a systems integrator, with that decision expected on Friday, the staff at Cover Oregon will be working to link the federal enrollment website – – with private insurance plans and also build a state system to manage Medicaid enrollments. The decision to not hire such an integrator earlier was widely blamed for the breakdown and meant that Cover Oregon had to resort to manually signing up people for the exchange. 

Once that technology is sorted out, the same software developed by Oracle for Medicaid eligibility could be used to enroll people in private health plans, added Jovick, who’s also heard speculation about Oregon reintroducing the private exchange in the next year or two.  

“It will depend on how smoothly people move into the federal exchange and how well the carriers here can work with the feds and how smoothly the Medicaid transition goes,” he said. “Right now I don’t think anyone is seriously looking at this. Everyone’s focused on the transition and figuring out how to make this thing work so by November people are able to enroll in the federal system.”

Tribal programs don’t favor the federal exchange, Robert said. There have been serious delays with outreach and enrollment; health plans have been unwilling to offer contracts that benefit its members and there’s been miscommunication given out by call center staff members. It’s far easier for the tribal community to handle these concerns at a state level, Roberts explained.  

While the future of Cover Oregon remains in doubt, Jovick certainly hopes the exchange doesn’t get rolled into the Oregon Health Authority as some have predicted. 

“I don’t understand the logic of doing that; it would be a major mistake because it was the origin of the problem in the first place.” 

Health Net Getting Out

Come next November, Health Net won’t be part of the private exchange in Oregon, confirmed spokesperson Brad Kieffer, who said a thorough evaluation was done before making this “difficult decision,” while, at the same time, he declined to reveal the enrollment numbers. 

As of June 11, there were 85,782 people signed up by Cover Oregon.  

Health Net had nothing to brag about, it turns out. After making a public request to Cover Oregon, The Lund Report learned that Health Net had only brought in 2,608 members.  

It was no secret that Moda Health Plan was far and away the winner – with 65,982 members, followed by Kaiser at 6,818 and Providence with 3,886 members. 

Moda’s high numbers could indicate why it’s seeking a 12.5 rate increase from Oregon’s insurance commissioner while Providence is trying to catch up and reduce its rates by 16.9 percent.

People can comment on the proposed rates by contacting the Insurance Division, and decisions are epected in early August

Insurance agents are expected to enroll people in the federal exchange, but are still awaiting their marching orders. Richard Skayhan with Leonard Adams Insurance contacted, but was told any training would occur at the state level, from Cover Oregon, which hasn’t provided any details to his agency. 

“We have no idea what we’re supposed to do to move this thing forward,” said Skayhan. “Someone needs to train us, and right now we have no clue about how we’re going to get our hands on this.”

From his perspective, there’s absolutely no viable reason to bring back Cover Oregon. “You would think we would have learned. Cover Oregon’s been a major source of embarrassment; legislators are hopping mad about how much money we’ve spent. “

Diane can be reached at [email protected]