Oregon’s Health CO-OPs and Insurance Exchange Expect to Collaborate

Since the CO-OPs health plans will be offered through the exchange, those plans must meet all the exchange’s requirements
The Lund Report

May 14, 2012—Anticipating future collaboration, representatives of Oregon’s two developing healthcare CO-OPs gave a presentation to the state health insurance exchange’s board last week.

“They asked us to come and be part of a presentation on co-ops, to learn more about them and their role,” said Cory Streisinger, who chairs the board of Community Care of Oregon, a healthcare CO-OP getting off the ground in Oregon after receiving $57 million in grants and
loans from the Center for Medicare and Medicaid Services.

“CO-OP” stands for “Consumer Operated and Oriented Plans,” which pretty much sums up what a healthcare CO-OP is: non-profit health insurance plans governed by a member-controlled board of directors. The self-employed, the uninsured and other consumers who buy individual health insurance are expected to purchase such coverage, assuming it’s more affordable.

CO-Ops will offer federal subsidies to those earning below 400 percent of the federal poverty level, and because of this, people who transition out of Medicaid because their incomes improve will also be a “natural market,” Stresinger said.

CO-OPs were created by the Patient Protection and Affordable Care Act after the public health option failed to gain footing, and Congress set aside $6 billion in start-up funds.

Community Care of Oregon is expected to start enrolling members in October 2013, and provide coverage in January 2014. The Freelancers CO-OP of Oregon should also get under way at the same time.

CO-OPs must offer coverage through state health insurance exchanges, according to federal law. The exchange will allow individuals and small businesses to purchase health insurance electronically, and expect to drive down rates, making insurance more affordable by having a
large group of purchasers.

Oregon’s exchange, created by the Legislature in 2011, is well on its way to becoming a reality and offering coverage by January 2014. Lisa Morawski, spokeswoman, said that exchange staff expect to “be working closely with the CO-OPs as we move forward.”

She said that all the plans CO-OPs offer through the exchange must meet its requirements as qualified health plans, which have yet to be established, as well as be certified.

CO-OPs are required by the Patient Protection and Affordable Care Act to offer a silver and gold plan—the only distinction between the plans is the level of cost-sharing. Under a silver plan, people could pay up to 30 percent for deductibles, co-payments and co-insurance, and 20 percent for the gold level plan. Streisinger said Community Care of Oregon will “definitely have individual plans,” but the CO-OP isn’t certain about offering small business options.

“We don’t know very much about what the small group market is going to look like under the exchange,” she said. “Will small business continue to be buying small business insurance plans, or will it be preferable for small business to provide premium support for their workers to buy
individual plans on the exchange?”

Community Care of Oregon may also offer health insurance outside of the exchange.

“We want to make options available in the ways that are most attractive to the people who are looking to be members,” Stresinger said.

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