Monday, November 19, 2012
Basic Health Plans?
As some of us know, the ACA includes a provision for states to set up a Basic Health Plan (BHP) that would essentially prevent families from churning (the process of losing and gaining coverage) between Medicaid and the exchange, and reduce coverage disruptions. I thought this was an interesting new article that discuss the pros and cons for states thinking about establishing a BHP. The article also notes that California will be considering a bill to establish a BHP in the upcoming special session. It will be interesting to see how the BHP debate in CA will play out, especially since this only now being seriously considered by states on the brink of 2014.
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I went to a briefing on the BHP last year. There were strong arguments against the BHP because it would take a significant chunk of consumers out of the Exchange and reduce the Exchange's ability to spread risk as well as have the clout to negotiate with health plans. There were also concerns about churning and that the State would have to then screen and enroll individuals for Medi-Cal, SCHIP, BHP, and the Exchange, which adds another administrative layer for eligibility determination.
There was debate whether those below 200 FPL are a sicker population so putting them in a BHP would actually help the Exchange manage risk. The arguments in favor of the bill were that the premiums and cost sharing in the Exchange would still not be affordable and the BHP would be the affordable option for consumers. Providers participating in BHP would probably be reimbursed equal to or greater than Medi-Cal rates, while the Exchange would have a much richer reimbursement rate, which could potentially mean better access to providers.
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