Narrow Network and Insolvent Exchange Plan Leaves Cancer Patients Scampering for Options

Health Republic Insurance of New York was heralded a success story last year among marketplace insurers. With the largest market share (nearly 20%) among insurance carriers on the state health exchange in New York, Health Republic also provided its nearly 200,000 enrollees access to Memorial Sloan Kettering Cancer Center (MSKCC) and NYU-Langone Medical Center, 2 reputed cancer centers in the state that were out-of-network for most other plans. Now, closing of the Consumer Operated and Oriented Plans (co-op) plan has left about 250 patients receiving active treatment at MSKCC to hunt for new coverage before November ends.

Health Republic is 1 of 3 co-ops in the country—a non-profit health plan set up with federal subsidies offered under the Affordable Care Act. However, concerns about the company’s finances (it lost more than $130 million in 18 months) has forced the state’s Department of Financial Services (DFS) to shut the co-op, which means nearly 200,000 customers need to find alternate coverage options before November 15 to ensure they have a medical plan starting December 1.

This can spell big trouble for cancer patients for whom continuity of coverage and treatment literally spells life or death. While state laws guarantee 60 days of “continuity of coverage,” for patients at the existing treatment facility, MSKCC is urging this to be extended to a year. The problem for these patients is compounded by the fact that no other exchange plan in the state has MSKCC in its network. “Memorial would agree to accept the same reasonable rates from whoever steps in to cover them as we would get right now,” said Clifford Hudis, MD, chief of the breast cancer service and vice president for government relations at MSKCC.

Late last year, the plan did apply to the DFS for raising its premiums beginning January 2015, citing rising medical costs, declining federal support, changes to their subscriber demographic, and changes in the tax and fee structure.

Experts had questioned the sustainability of this model when it was floated. “The question is, long-term, whether or not the co-op premiums really do cover the administrative and medical costs associated with the enrollees who enrolled in the plans,” Elizabeth Carpenter from Avalere Health had said last year. “You do have to question whether or not that price is sustainable.”

Health Republic has also opted out of the Oregon market.