Higher Cost-Sharing, Narrow Networks, Here to Stay in ACA Health Plans

Higher cost-sharing and narrow networks in Affordable Care Act health plans are here to stay.  That was the assessment of a health-care consultant who was the first head of the federal Office of Health Insurance Exchanges.

From the outset, the two main strategies for keeping premiums down in ACA plans has been managing health-care provider networks and higher cost-sharing through deductibles, coinsurance and copayments, Joel Ario, a managing director of Manatt Health Solutions, said at a reporter’s briefing on open enrollment for 2016 held at the National Press Club in Washington.

“Affordability is still Job No. 1 for the exchanges,” said Ario, who headed the Department of Health and Human Services’ office from 2010, when it was first created, until 2011. Ario has also served as the head insurance regulator for Pennsylvania and Oregon.

The next ACA open enrollment runs from Nov. 1 through Jan. 31, 2016, for 2016 health plans.

At the briefing, two directors of state-run ACA exchanges highlighted what they are focusing on as the 2016 open enrollment nears. Mila Kofman, executive director of the D.C. Health Benefit Exchange Authority, said the District of Columbia’s exchange is improving decision-support services by adding a Consumers’ Checkbook tool that allows consumers to enter their health-care data to get information on which plans would be their best bets in terms of overall premiums and out-of-pocket costs.

Peter Van Loon, an official with Access Health CT, said that individual consumers using Connecticut’s exchange are “getting a lot more sophisticated” about asking where they can go to get the most affordable, high-quality health-care.

Connecticut is seeing the “emergence of provider organizations taking risk and acting as their own insurers,” Van Loon said.  He added, “I think that in the future we’ll start to see providers on the exchanges directly.”