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CPBJ Extra Blog

When will we see the 2015 marketplace rates?

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Possibly you, like me, have begun to wonder when we will see the 2015 rates for the Obamacare individual marketplace in Pennsylvania.

Probably you, like me, remember that last year we didn’t see them until the marketplace opened on Oct. 1; I recall that particularly well because I was so desperate to finally get those numbers and the general site wasn’t doing a good job of delivering them, and then there was some kind of obscure data dump that made a list available and I did a story on it, and then I subsequently got requests from several of you for the link, which you had misplaced but wanted, because you didn’t know where else to find that information.

Let us now take a break from that sentence.


Anyway, this year the marketplace won’t open until Nov. 15, and the prospect of having to wait that long inspired me to dash off a question to Pennsylvania Insurance Department spokeswoman Rosanne Placey. I am happy to report that her reply was prompt; I am less happy to say that she didn’t tell me what I wanted to hear (which is that they had already been posted).

Here’s what she did say:

“At this point, I believe the expectation is that we would not release anything until open enrollment begins Nov. 15. HHS/CMS is slated to have QHPs finalized (including rates) as of 9/4/14. However, given how everything has gone in the past year, the feds and insurers may still be in negotiations beyond that. So we would not have anything in final form until all of that has been signed off by the feds.”

QHP stands for “qualified health plan,” which is what is offered on the Obamacare individual marketplaces. And “impatient” stands for me, as I steel myself for another long, long wait.

Speaking of long waits, anyone know when we’ll get the final word on Gov. Corbett’s Healthy Pennsylvania Medicaid expansion alternative waiver request?

I thought not.



Because contraceptives have been in the news so much lately, I suspect you’ll be interested in research from the IMS Institute for Healthcare Informatics that says the total number of women with oral contraceptive prescriptions increased from 8.3 million in 2012 to 9.1 million in 2013. The number of women who filled those prescriptions with no co-pay also increased, from 1.2 million in 2012 to 5.1 million in 2013. IMS said found the oral contraceptives accounted for the largest increases in prescriptions dispensed with no cost sharing.

The Obamacare requirements that free preventive services including contraceptives be in non-grandfathered plans took effect for plan

years starting on or after Aug. 1, 2012. According to the U.S. Department of Health & Human Services, about 76 million Americans in private health insurance plans -- roughly 30 million of them women -- are newly eligible for one or more free preventive health care services because of Obamacare.

Also, these are two good reads on the subject:


The Hospital and Healthsystem Association of Pennsylvania has announced a partnership with VisiQuate Inc., a locally founded and owned software-as-a-service provider. According to a news release, the partnership will consist of HAP endorsing and promoting Visiquate’s solutions to its members.

I liked this description of what those solutions can entail: “Each night, member clients send VisiQuate complex data, and each morning that member client receives actionable insights to guide their day.”


This goes in the “Weep for the Actuaries,” files, folks: The American Academy of Actuaries’ Medicaid Work Group has posted its first letter since November 2012, and if it doesn’t make your head spin, you’re not reading it closely enough. It’s about Obamacare’s health insurance providers fee, and, according to the IRS, the first payments will be due Sept. 30.

And now, having mentioned the IRS, I must show you its entry titled “Calculating the (HIP) Fee,” which totally belongs in a file bearing the label, “Punctuation: Ever heard of it?”

“The annual fee for each covered entity is equal to an amount that bears the same ratio to the applicable amount as the covered entity’s net premiums written for health insurance of United States health risks during the data year taken into account bears to the aggregate net premiums written for health insurance of United States health risks of all covered entities during the data year taken into account.”


Capital BlueCross, Hamilton Health Center and PinnacleHealth are partnering with Dauphin County on a program called Bridges to Care. Launched in April, the program’s mission is to identify, enroll and coordinate health care services for Harrisburg-area children up to age 19 who are uninsured or medically underserved. The program also provides family-centered support to parents or guardians of these children.

According to the organizations, nearly 1,000 children and more than 6,700 adults in the City of Harrisburg are not receiving adequate health care or do not have health insurance. So far, the program has already connected 20 people to “much-needed” health care.

“With the availability of the Children’s Health Insurance Program and Medicaid, there is no reason why children in our area are without health insurance or are not getting their well-child check-ups,” said Jeannine Peterson, CEO of Hamilton Health Center. “However, the complexities of the health care system and other socio-economic challenges that many low-income families face are often barriers to signing children up. Thanks to Bridges to Care, trained, certified professionals who work for the three sponsoring organizations are available to provide personalized help to these families.”

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