WA Health Exchange underestimates Medicaid enrollees, overestimates private-plan sign ups

Problems continue for the Washington Health Benefit Exchange (WHBE), which in its second year is failing to meet its private-plan enrollment projections. As Shift reported, prior to the start of the new enrollment period, WHBE predicted there would be 213,000 total private-plan enrollees this year – and right now the Exchange is nearly 40% short (83,000) of meeting its goal.  With the window for buying an Exchange insurance plan closing on February 15, it is highly unlikely that the WHBE will make up enough ground to meet its goal.

WHBE’s failure to attract paying customers adds strain to taxpayers who will carry the responsibility for the unmet costs to run the exchange. That’s because the exchange is funded through three mechanisms: “a tax on insurance premiums paid in the exchange, a tax on insurance companies selling policies in the exchange and state taxpayer money that funnels through the state Health Care Authority.” If the exchange’s enrollment goals are not met, the money from the premium tax and the insurance company tax is simply not there to meet costs.

Making the problem even more costly is that while the WHBE is seemingly incapable of predicting an accurate number of private-plan enrollees, it has had also seriously underestimating the number of new Medicaid enrollees. According to the Seattle Times, “Nearly 500,000 people have joined who were newly eligible for the program thanks to an expansion under the Affordable Care Act.”And, enrollment for Medicaid—called Washington Apple Health—is available year-round.

The surge in Medicaid enrollment will, undoubtedly, make access to doctors willing to take Medicaid patients worse.  The problem is due to the sizable cuts in re-imbursement payments doctors receive with Medicaid patients—the two-year increase in temporary benefits provided by Obamacare expired at the start of the year. The Seattle Times recently reported that many more Washington doctors would restrict access to Medicaid patients this year due to 70 percent drop in reimbursement rates for adults under the health plan.

WHBE spokesman Michael Marchand described the exchange’s outlook on the fiasco as “curious.” Citing the Medicaid enrollment surge, Marchand claimed the exchange was 100,000 ahead of the “overall goal.” He said, “I don’t think we’re panicking.” Rather, exchange officials are “curious” over why people who have to pay something haven’t signed up for insurance and will “will continue to explore the reasons why the goal was too high.”

Clearly, the WHBE is gearing up to shift responsibility of its failure and inflate its “success” with Medicaid numbers once the enrollment period ends this weekend. The WHBE’s excuse will be that the shortfall of enrollees is because the goal was too high in the first place. Meanwhile, it’s the taxpayers who ultimately bear the responsibility.