The Affordable Care Act has put Sandy Praeger at odds with most of her fellow Republicans in Topeka, Kan.
The Kansas Commissioner of Insurance shared the frustration many had over the health exchange website problems, and she’s voiced concern over how shifting rules and delays impact the insurance industry.
But Praeger has remained a supporter of federal health reform, a proponent of Medicaid expansion, and a critic of Gov. Sam Brownback’s approach to health policy.
She answered five questions as part of our monthly series, KC Checkup:
How has the Affordable Care Act affected insurance companies in our area?
“It is challenging because the rules are changing so they’re trying to plan now for next year. Normally, companies would submit their rates to us by the end of April for the 2015 policies, and we may have to extend that now that there’s some new change in the marketplace, and they’re going to be looking at who might want to keep their grandfathered policy. Those are probably people who don’t think they need health care services, so you’re going to have healthier people staying out of those exchange policies, which could impact the price of the exchange policies. So companies are struggling with trying to stay on top of the changing rules.”
There’s been a lot of frustration with insurers canceling individual policies. How significant have those cancellations been in Kansas?
“We allowed companies to keep the individual policies in force through the end of this year. We had a very small percentage of folks that potentially could have been dropped, but ultimately, they were not.”
Who do you think has been on the losing side of implementation?
“The individual mandate says everyone has to buy coverage. And for someone — a younger person especially — who’s buying a more comprehensive policy, they potentially could be charged considerably more than they might have been charged otherwise if they were buying a more scaled-back kind of a policy because the rule says you can’t be charged less than a third of what older people are charged. There’s a rating band of 3-to-1, and that does ... potential can increase the cost for younger, healthier folks. But, if their income is such that they qualify for some significant credits, the good news is there’s a way to offset the cost.”
Kansas had been considered a ‘maybe’ on Medicaid expansion, and now it’s pretty clear that’s not going to happen. A lot of groups, like the Kansas Hospital Association, are continuing to push for some kind of expansion. Do you think that is possible with the current politics of the state?
“I don’t see it happening this year, and that’s unfortunate because it’s fully funded for the first three years with federal dollars. A hundred percent for the expansion so that number between 32-33 percent up to a 100 percent of the federal poverty level – whatever it takes to expand that, it’s fully paid for with federal dollars, gradually phases down to a 90/10 match.”
What do you think has been the impact of KanCare?
“It’s early yet, but what we are seeing is — and some of this is hearing it anecdotally — that the three for-profit insurance companies that have been contracted with to deliver services to all the KanCare population – this is the entire Medicaid population, which includes people with disabilities that have just been folded in this year – that they’re slow to get their claims paid.
"So the providers delivering the services are having to wait in some cases up to, I think the contract allows up to three months. But they’re having to wait up to get paid. And I think there’s concern that people are not getting some of the services they think they’re entitled to. And that may all get sorted out.
“The concept behind it is a good concept, and that’s finding ways to do a better coordination of care. I mean, that’s one of the cornerstones of the Affordable Care Act is to provide care in a more coordinated fashion. There are pilot projects called accountable care organizations. So KanCare is similar to an accountable care organization in terms of bringing providers together to provide the comprehensive set of benefits that the folks on KanCare – Medicaid population and the disability population and long-term care population need.”