Policies likely for all in state, planners say

LITTLE ROCK — Some lawmakers and advocates remain concerned that rural, poor Arkansans will be left without coverage when the state’s health-insurance exchange begins operating in January, but an executive of Arkansas’ largest insurance company and exchange planners say such a scenario almost definitely won’t happen.

Concerns about swaths of the state being frozen out of the exchange first surfaced last fall when planners decided against requiring companies to offer policies in all 75 of the state’s counties. More recently, lawmakers revived the issue at a legislative hearing last month.

But Cal Kellogg, senior vice president and chief strategy officer for Arkansas Blue Cross and Blue Shield, said recently that all areas of the state should be covered in the exchange.

“There are no guarantees in life, but our operating approach has always been that we cover all areas of the state, and we’re going to offer products in all areas of the state. … Our plan at this time is that we’ll have coverage available in all the counties of the state,” said Kellogg.

At a Feb. 27 hearing, Democrats Sen. Joyce Elliott of Little Rock and Rep. Reginald Murdock of Marianna raised concerns that carriers wouldn’t offer coverage in every county, particularly in the Delta.

Recently, exchange planners recommended seven “rating” areas in the state. One of those covers much of the Delta, encompassing 13 poor counties, including Phillips, Lee, Dallas and Jefferson, and reaching south toChicot County.

Qualchoice of Arkansas President Michael Stock said at the February meeting that he couldn’t guarantee that his company would offer exchange coverage in every county. Stock said doing so didn’t necessarily make financial sense for his company.

“I was taken aback by that. I am concerned. I never would have dreamed about that being an issue,” said Elliott, who is a member of the Senate Insurance and Commerce Committee.

Elliott said recently that her fears have calmed somewhat since a Blue Cross and Blue Shield official assured her that the insurance carrier will cover every county in the state.

If the Legislature decides to cover up to 250,000 poor Arkansans through the exchange with their premiums paid with Medicaid dollars, the “remote” chance of a part of the state without exchange coverage is nearly erased, Kellogg said.

“Start throwing Medicaid into the mix, and we’ll probably have statewide access,” Kellogg said.

Medicaid will pay full premiums for the expansion group. Also, people earning slightly more than that group would be heavily subsidized by the federal government, Kellogg said. Those steady payments should make poor areas more attractive to carriers that otherwise might have avoided them for fear of being stuck with unpaid premiums and bills, he said.

“Some of the most attractive counties for somebody to go into would be those counties. It’s kind of reverse logic of how a lot of people have thought about it,” said Kellogg, who sits on two of the state’s exchange planning committees.

Last fall, some advocates for the poor voiced concerns when exchange planners decided against requiring statewide access. But if Medicaid enters the market, Kellogg said, it would almost certainly be required by the federal government to offer coverage across the state.

Planners have also said that Arkansas is hoping to be one of 31 states that receive national plans developed by the Office of Personnel Management. The state still doesn’t know if it will be chosen, but it should hear something soon, said Cindy Crone, exchange planning director.

Those federally designed plans will be available in all states within four years, she said. Planners expect about 211,000 people to sign up for coverage aside from the Medicaid expansion population, which covers those earning up to 138 percent of the federal poverty level or $15,415 for an individual.

Insurance Commissioner Jay Bradford decided not to require companies to offer coverage in each county in order to encourage competition and possibly draw new companies into the market. Crone said the working plan is to have at least two plans offered in every county.

“I don’t think there is a problem,” she said.