The power of collective communities reared its head when Washington Insurance Commissioner Mike Kreidler announced early in August the commission’s selection of health care plans for the new Washington health benefits Exchange that excluded Medicaid managed care plans.

Recall that the intent of the Affordable Care Act is for all to have coverage. The uninsured in our state can choose from plans under the new Washington Health Benefits Exchange starting October 1 for health care coverage starting January 1, 2014. Kreidler selected 31 health care  plans, including Bridgespan Health Company, Lifewise and Premera Blue Cross. None of the Medicaid managed care plans that applied, including Community Health Plan of Washington, Molina Healthcare and Coordinated Care, were selected.

In our community, Asian Pacific Islander Coalition (APIC), a statewide API advocacy organization, rang the alarm with phone calls to Kreidler’s office, emails to county and state lawmakers and public testimony to let our communities and leaders know that this is a problem. Vulnerable populations such as the poor, elders, limited English-speaking people and people of color will be adversely impacted. These populations include people served by community health centers such as International Community Health Services (ICHS) and Sea Mar Community Health Center patients.

The lack of Medicaid managed care plans in the exchange is a problem because it is very costly, disrupts continuity of care and whole family care, jettisons benefits and limits choice.

The selected plans are cost-prohibitive, commercial plans with premiums higher than Medicaid plan premiums. In many situations, those premiums are even higher than the penalty for remaining uninsured.  So its likely that most uninsured people will forego coverage and just pay the penalty, defeating the purpose of the Affordable Health Care Act.

This decision, no doubt, will have the greatest impact on minority and low-income populations, many of whom are currently being served by community health centers.

Their continuity of care will be disrupted. Medicaid patients go on and off of Medicaid as their incomes change. Community health centers see a significant number of Medicaid patients, and when these patients become ineligible for Medicaid due to increased income, they will have to enroll in another plan. This means they may no longer be able to see their primary care provider where they have established care.

In addition, many of those who are uninsured have children who are on Healthy Options and are covered by Medicaid.  Without the Medicaid plans being included in the exchange, families will not have the choice of all members being seen by the same provider or clinic.

Patients will also lose benefits with community health centers who have additional services that the private commercial plans do not offer. These services include language interpretation, eligibility assistance, health education, nutrition, social work, chronic disease management, dental services, mental health services and more.

Part of the intention of implementing health care reform is to ensure people have more choices when selecting their health plan. Excluding the Medicaid managed care plans from the exchange automatically limits the choice for many patients. There are a number of areas in our state where there is only one exchange plan available to patients, which does not constitute choice. The community health centers services and the Medicaid managed care plans are offered in at least 30 of the 39 counties in Washington.  Including the Medicaid plans would provide much more choice for patients across the state.

The state health exchange board delayed approval of the providers questioning the availability of real choices to the consumers. Two of the plans (Bridgespan and Premera Blue Cross) come from the same company. Many counties would only have one provider. Also, the Commissioners wanted to understand why the Medicaid managed care plans were excluded and hoped that issues that barred them from being selected would be resolved.

Kreidler was under pressure to establish the Benefits Exchange by August 31 of this year. President Barack Obama’s Health & Human Services Secretary Kathleen Sebelius extended the deadline to December 14, 2013 for all states interested in establishing their own insurance benefit exchanges. Hopefully, this buys time for all to resolve issues so that vulnerable populations would be served well.

The exchange board’s recent request of Kriedler to give rejected plans more time to prove they can meet the health exchange standard is a testament to advocacy organizations, communities and electeds for  mobilizing quickly to avoid what might have been chaotic and catastrophic for our vulnerable communities. It speaks to the legacy of activism, honoring Dr. Martin Luther King for the 50th anniversary of his Washington March.

But the problem is not resolved. Stay tuned.

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