Connecticare, the largest single insurer on the state's health insurance marketplace has decided to terminate its agreement with Access Health Connecticut.
Sources close to the negotiations between Access Health and Connecticare told NBC Connecticut the termination agreement may not be a done deal and it's possible that Connecticare may in fact have to offer plans when Open Enrollment starts on Nov. 1.
Earlier today, Connecticticare said it was deciding whether or not to stay with Access Health and later released a statement saying,"We have asked Access Health CT to extend their deadline so we can continue to work together to ensure that the over 50,000 Connecticut citizens we serve can keep their health plan."
The decision by Connecticare comes after a New Britain Superior Court judge denied a request to reverse the Insurance Department's refusal to allow the insurer to raise rates by more than 17 percent for the more than 50,000 policyholders who purchased their plans on Access Health Connecticut.
The impact of the move is not yet clear, as only one insurer would be left on Access Health Connecticut offering plans and that would be Anthem.
Connecticare’s attorney sent a letter to Access Health last week stating it would leave the exchange as a direct result of the rate review decision.
However, sources confirmed to NBC Connecticut that the largest hurdle for Connecticare could be federal provision that requires 180 days notice for a carrier to inform an exchange that it will not participate in open enrollment. United Health terminated its involvement in all marketplaces in the Spring, meaning its 180 day window ended before open enrollment. It is not yet clear whether the federal provision would be applied in this case.
If Connecticare does in fact leave the exchange and not offer plans during Open Enrollment, that would leave Anthem as the sole carrier offered on Access Health.
Access Health's Jim Wadleigh said last week that if Anthem is only remaining health insurance provider, then it's possible it could provide some of the most affordable options for customers because it would be able to assess what's needed for the company's risk pool. The goal, healthcare experts have said, when it comes to a risk pool is that you need healthy customers and those who have greater healthcare needs. The premiums paid by each enter a risk pool, and the goal is for more people with fewer healthcare needs to purchase coverage, providing a financial cushion to those who require the most care.
In a joint statement, Wadleigh and Lieutenant Governor Nancy Wyman wrote, Access Health CT’s number one priority has always been and continues to be our customers. We are a national leader in healthcare because we are 100 percent committed to ensuring that Connecticut residents have access to affordable, high quality healthcare. ConnectiCare’s decision is certainly a challenge, but AHCT will continue to adapt to the changing healthcare market with an eye on ensuring our consumers the best options.
United Health announced earlier this year that it would leave all exchanges because it received lower than expected returns from the marketplaces. HealthyCT was told by the federal government that it did not have financial viability to continue to offer exchange plans. That left Anthem and Connecticare as the remaining options for consumers.
Angela Mattie is a business professor at Quinnipiac University. She's helped to craft health policy and has observed the industry for decades. She says Access Health has always been viewed as the gold standard for how to run an exchange because of its options, technology, and overall effectiveness signing up customers. Connecticut has one of the lowest uninsured rates in the country.
"Access Health was considered one of the healthiest exchanges in the country.The jury is still out on the success or failure of exchanges which have really crucial to the success of the Affordable Care Act," Mattie said.
Mattie said the exchange model was meant to improve and encourage competition and hopes Monday's developments doesn't change that.
"I think we can’t throw the baby out with the bath water. I think the Affordable Care Act and the establishment of the exchanges, to quote Neil Armstrong, was one small step for man and one potential giant leap for mankind."
The full statement from Access Health Connecticut can be found here: