Title of Proposal: Commonwealth Care Health Benefits Program 
 
On behalf of: Richmond Academy of Medicine 
 
Describe the Idea or Issue:  

Premiums for individuals on the ACA have been escalating for the last several years.  This is particularly impacting those individuals who do not receive subsidies due to their income being above 400% of the federal poverty level.  In addition, these policies have particularly high deductibles and out-of-pocket maximums before the insurance coverage kicks in.  These policies also have particularly narrow networks of providers and no out-of-network benefits.  The Trump administration has contributed to undermining the ACA in several ways.  They have eliminated reimbursement for the cost-sharing reductions payments.  They have drastically reduced funding for efforts to assist people to sign up for the ACA.  They have eliminated the penalty for the individual mandate to buy health insurance.  They have not continued the reinsurance program initiated in the early years of the ACA.  All of these factors have contributed to increased premiums and last year a 4% decrease in the number of individuals to sign up for the ACA.  This will continue to result in lack of access to affordable healthcare for many of our patients and poor reimbursement for services to our physicians. 
 
In the General Assembly this year, Senator Dunnavant proposed SB 1717 the Commonwealth Care Health Benefits Program.  This bill sought to pool all the individuals in the state into one insurance pool to help bring down the risk that the current individual local markets have failed to do.  This would be a state run entity much like a large employer based healthcare insurance plan.  Or very similar to the state run plan currently provided for the state employees.  It would include a reinsurance provision and disease management as well.  Apparently while this bill passed the Senate unanimously it was left in the rules committee.  Somehow is was placed as a budget amendment into the budget with funding beginning studying this in 2020.  However we need action on this sooner as we are facing increased premiums again for 2020 unless the state takes some action to stabilize this important insurance marketplace.  This has been also studied by the Governor in the Virginia Market Stability Work Group with the same conclusions but no action.   
 
Desired Outcome:

The Richmond Academy of Medicine requests that MSV urge the state to begin work to stabilize the Commonwealth Care Health Benefits Program now, prior to the budgeted 2020 study.  Because we are facing increased premiums for 2020, action is needed now, not later. 

Background/Supporting Information:  

SB1717 from the 2019 General Assembly Session  
(Found on pages 119-120 of the Appendix)