CO-OP Operators Remain Optimistic in the Face of Iowa CoOportunity’s Woes, AIS Newsletter Reports

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After Iowa’s CoOportunity Health was taken over by the state, CO-OP operators in other states tell Atlantic Information Services’s Inside Health Insurance Exchanges that they don’t face the same risk and contend that CoOportunity’s problems are not representative of the whole group.

In the wake of Iowa and Nebraska Community Operated and Oriented Plan (CO-OP) CoOportunity Health’s takeover by the Iowa Insurance Department in late December, Atlantic Information Services, Inc.’s (AIS) Inside Health Insurance Exchanges (HEX) asked other CO-OP leaders how their companies are doing. As the newsletter reports in its January issue, CO-OP operators in other states tell HEX that they don’t face the same risk and contend that CoOportunity’s problems are not representative of the whole group.

“CoOportunity is an unfortunate occurrence,” says Peter Beilenson, M.D., CEO of Maryland CO-OP Evergreen Health. “It’s very clear from working with the other CO-OPs that each one is in such a different situation. Our markets are all completely different.”

One mistake CoOportunity seems to have made, HEX reports, was reliance on a $125.6 million infusion from CMS through the Affordable Care Act’s risk-corridors program, which was designed to shield carriers that wind up with a disproportionate share of high-cost enrollees. Reimbursements, however, won’t be distributed until August, and the expected amount could be slashed in half due to a provision in a recently enacted spending bill that requires the risk-corridors program to be budget neutral. When Iowa regulators forced the insurer into rehabilitation, HEX found, CoOportunity had just $17.2 million in cash and assets, or about $143 per member.

Of the ten CO-OP executives HEX interviewed, several executives say they aren’t relying on risk-corridor payments; others say they have countered high-risk individual enrollees by promoting coverage to the off-exchange group markets, which tend to be younger and have lower risk than the individual market. Evergreen’s Beilenson — who admits that his CO-OP got off to a slow start last year with just 450 individual policies — says his firm isn’t expecting much from the risk-corridors program, which is aimed only at individual qualified health plans (QHPs). Moreover, Evergeen’s individual exchange enrollment for 2015 hit 2,000 six weeks after the open-enrollment period began, and another 500 individuals signed up outside of the exchange. Beilenson expects individual enrollment will double by the end of the open-enrollment period next month, and small-group enrollment to double by the end of the year.

Visit http://aishealth.com/archive/nhex0115-01 to read the article in its entirety, including full commentary from the nine other plan executives interviewed by HEX.

To view the rehabilitation order placed against CoOportunity, visit http://www.iid.state.ia.us/node/9885312.

About Inside Health Insurance Exchanges
Inside Health Insurance Exchanges provides hard-hitting news and strategies on public and private health insurance exchanges, written for business leaders with health plans, pharma companies, hospitals and health systems, brokers and agents, and exchange managers and vendors. The newsletter delivers reliable intelligence on this critical cornerstone of health reform — the players and their partners, product designs and enrollment results, employer perspectives and much more. Visit http://aishealth.com/marketplace/inside-health-insurance-exchanges for more information.

About AIS
Atlantic Information Services, Inc. (AIS) is a publishing and information company that has been serving the health care industry for more than 25 years. It develops highly targeted news, data and strategic information for managers in hospitals, health plans, medical group practices, pharmaceutical companies and other health care organizations. AIS products include print and electronic newsletters, websites, looseleafs, books, strategic reports, databases, webinars and conferences. Learn more at http://AISHealth.com.

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