Highlight on Minnesota: Health plans’ red ink worst in a decade

Nonprofit insurers in Minnesota reported an operating loss of $687 million on nearly $25.9 billion in revenue for 2016, according to a trade group for insurers, the Minnesota Council of Health Plans. The financial results were the worst in a decade, with losses in both the state public health insurance programs and the marketplace where individuals purchase coverage for themselves.

Overall, revenue from premiums increased 4 percent over the prior year, while expenses increased 6 percent to $26.6 billion. State public programs accounted for more than half of the overall losses, followed by continued losses in the individual market. According to the report, on average, health insurers paid $763 per second for care. To pay those bills, insurers withdrew nearly $560 million from state-mandated medical reserves. The bulk of the financial losses reported did not result from the employer group and Medicare markets, which remained steady, and where most Minnesotans get health insurance.

In the individual market, Blue Cross and Blue Shield of Minnesota said it lost $142 million for 2016, compared to a $265 million deficit the previous year. The decline mirrored the drop in enrollment, the insurer noted, rather than an improvement in the business. Over the last 10 years, health insurers returned a profit in seven. The numbers reported by the trade group focused solely on revenue and income from the health insurance business, as investment returns made by insurers were not counted in the numbers. Some saw hope in the overall numbers, however, noting that the market was not in a “death spiral,” as some health law critics have argued, because many insurers in 2016 saw slight improvements from the previous year.

Highlight on Kansas: Lack of resources impacting state employee benefits, mental health patient care

Bad news for those working for the state of Kansas: health coverage is getting worse. The state will raise premiums, raise co-pays, and raise deductibles while reducing health savings account contribution. While the state works to maintain the health plan’s cash reserves, it must also find a way to fund more resources for those experiencing mental health issues – a problem many states are facing.

Employee health plans

The Kansas Health Care Commission is concerned about the level of the employee health plan’s cash reserves, and has decided to increase the cost to state employees. The cash reserve target over the next two years is $59 million.

In order to reach this level, Kansas state employees will be subject to a 9 percent premium rate increase, while employers are subject to a 7 percent increase. Secretary of Administration Sarah Shipman stated that the adjustments are intended to “maintain plan solvency into the future” to ensure the stability of the system.

The state plan involves various levels, and the changes are different for each level. Plan A workers will have their same $1,000 deductible, but those with family enrolled will be subject to a $3,000 total deductible. Co-pays for doctor visits will rise by $10, reaching $40 for a primary care visit and $60 for specialists. Plan C, the “high deductible” plan, will subject workers to 20 percent of the cost of a doctor visit after hitting $2,750 for single workers and $5,500 for those with family coverage.

All state workers will be subject to a higher out-of-pocket maximum: $5,000 for singles and $10,000 for families. The state not only implemented all of these cost increases, but also mandated reduction in employer health savings account contributions. Single employees lose $500 there, and those with dependents lose $1,000.

When did it start?

In January 2016, a consulting firm made 105 budget recommendations to the Kansas legislature that it claimed could save the state $2 billion over five years. A considerable part of the savings came from the idea of moving all state workers to a high deductible plan. The executive director of the Kansas Organization of State Employees was quite concerned about the recommendation, noting that much of the state workforce is aging and cannot obtain adequate care through high deductible plans. She also mentioned that reduced coverage would offer even less incentive for people to work for the state, especially considering low pay rates.

Kansas feeling the mental health struggle

The state held a mental health symposium at the Kansas Statehouse to discuss issues providers are facing. Last year, Newman Regional Health almost lost its federal certification after it had issues transferring a patient with thoughts of suicide. The hospital’s CEO, Robert Wright, told CMS that the state does not have a sufficient number of mental health beds, forcing hospitals to hold these patients in emergency rooms. Hospitals may face a reduced amount of compensation or none at all for this care.

Wright believes that the issues began when the community-based care movement shuttered mental institutions, reducing the number of beds. This idea might have worked if community-based programs were given the planned amount of funding. Wright is concerned about meeting these patients’ needs without sending the hospital into bankruptcy. Last year, one of the two state-run mental health infacilities in the state was banned from accepting new patients due to overcrowding, understaffing, and safety issues.

Suggestions

Symposium attendees brainstormed ideas to address the problem and better use scarce resources. A representative of the Kansas Hospital Association said she believed that expanding Medicaid eligibility would result in many Kansas residents with mental health problems gaining insurance. Part of the problem is overcrowding in emergency rooms and a difficulty finding psychiatrists, but some raises for state-run hospitals have allowed some stabilization. The president and CEO of a nonprofit offered to train school staff on suicide prevention techniques, and state legislators admitted that the allocated resources are not enough to meet patients’ needs.