Capital Health Plan Sitting Out Of Federal Insurance Exchange, But For How Long?

Nov 15, 2013

There’s more than one insurance company in North Florida, but you wouldn’t know it just by looking at the federal government’s health insurance exchange website.

Many Floridians are now finally able to log on to after weeks of delays due to problems with the site. They’re finding that in North Florida there are nearly 30 plans available, however, “they’re all, unfortunately, all versions of Blue Cross, Blue Shield, and that’s fairly alarming that there is no competition," says Donna Gillette.

Gillette is a mental health specialist, in private practice for nearly three decades. For much of that time, she’s been insured through Tallahassee-based Capital Health Plan, a Health Maintenance Organization, or HMO, for short. CHP has long been regarded as one of the best HMO’s in the nation, so Gillette was shocked when she received a series of letters from CHP, first telling her that they were dropping her insurance plan, and then, offering her the ability to renew for an additional year—at a higher rate. That led her to shop around:

“I wasn’t going to be able to continue with them because of the increase in their premium, which was 110-130-percent of my income, so I was looking forward to Obamacare," she said.

“We don’t want anyone to have to leave the plan if they don’t want to," said CHP President John Hogan, who says the company is trying to find ways to keep as many people on its plans as possible.

CHP insures many small businesses.  Under the Affordable Care Act those businesses are classified as organizations with two or more employees. Gillette is a business of one and therefore, is being steered to the individual market. The only provider of that kind of insurance in more than 30 predominantly rural Florida counties is Florida Blue, which has a controlling stake on CHP’s governing board.

“There is a lot of companies throughout Florida that actually offer the type of coverage mandated by the exchanges and so that would be the question—not for us, but, they’ve selectively decided to be in some areas and not in other areas, and for the way the exchanges are set up now, that’s where you’d think the competition would come from," said CHP Chief Medical Officer Nancy Van Veesem on why the company is sitting out of

CHP has opted not to compete in the individual market because it has not done so ever before. The company would also have to figure out a way to expand its services beyond its seven county region, and offer individual plans. CHP President John Hogan says those plans could cost more than what the company already provides, with fewer benefits. CHP Medical Director Estrelitta Redmon says when people see deductibles, no matter how big or small—they tend to delay care. CHP’s model is based on the opposite -- prevention:

“When patients have a higher out-of-pocket cost initially, they’ll delay  the preventive care and end up with rescue care, and that’s something our model really doesn’t support.”

Emergency care is more expensive and HMO’s are aimed at controlling costs. As an HMO, CHP doesn’t have deductibles. Members pay a fixed amount of money per month and receive services,. A CHP plan is the equivalent of a platinum plan on the federal government’s healthcare exchange website. And Hogan says offering less for more, is not what the company is about. But at the same time, he isn’t ruling out the federal government’s exchanges either.

“Things that may not be permitted today, the way the regulations are being interpreted, maybe they will be permitted in the future.”

Meanwhile, CHP customer Donna Gillette is weighing her options – or, more correctly, her option. She’ll pay about $700 dollars a month for an unsubsidized plan, $500 dollars less than what she was paying under CHP coverage.