End of the year exchanges round-up

[Greenbeard]

Lots of end-of-the-year news surrounding state health insurance exchanges, as states chart out their first steps.

California, the first state to pass legislation authorizing an exchange in response to the ACA, is moving ahead with implementing the governance portion of that exchange by starting to fill out the exchange's governing board:

Gov. Arnold Schwarzenegger has appointed two members of his administration to a board that will oversee California's implementation of the new federal health care law.

The governor announced the appointments of 51-year-old Kimberly Belshe, his cabinet secretary for health and human services, and 50-year-old Susan Kennedy, his chief of staff, on Friday to the five-member California Health Benefit Exchange.

The exchange is responsible for creating an Internet-based marketplace where consumers can shop for health insurance.

Belshe, a Republican, was director of the state's Department of Health Services under Gov. Pete Wilson.

Kennedy, a Democrat, has previously served on the California Public Utilities Commission.

Another two members of the exchange's board will be appointed by the Legislature.

Colorado, like many states, is still figuring out what design it will go with for its exchange:

More than 500,000 Coloradans who lack health insurance will use a new state-run exchange to get generous subsidies and comparison shop for a health plan — that much is a given.

What that consumer website — the centerpiece of national and state health care reform — will look like upon launch in 2014 is the next great task for medical and insurance leaders in Colorado.

Will it be a bare-bones, three-choices- and-good-luck Web page? Utah is going that route.

Or will Colorado take the activist route pioneered by Massachusetts and California, adding mandates for coverage, negotiating directly with insurers and carefully policing rates, complaints and care? Will insurance plans created by the state Medicaid office and Denver Health compete for customers alongside big names such as Kaiser, Anthem, Cigna or Rocky Mountain Health Plans?

And even before that, who creates and operates the exchange that will guide billions of dollars in health spending? A state agency controlled by the governor? A private nonprofit? A quasi-governmental board where legislators, Cabinet secretaries and insurance interests will vie for appointments?

Oregon first authorized the development of a health insurance exchange in their 2009 state reform law and they're hard at work designing it. Though they collected public input on exchange design a few months ago, a few weeks ago they set up a standing outside advisory group to offer input:

A 10-member consumer advisory group has been appointed by the Oregon Health Authority to assist staff in planning and development of a statewide health insurance exchange.

To be launched in 2014, the exchange will serve as a central marketplace for health insurance where people can compare price and quality of health plans, access subsidies so insurance premiums are affordable and enroll in health insurance.

The advisory group will provide input and feedback to make certain the exchange is consumer-oriented, meets Oregonian’s needs and will support ongoing consumer engagement and interest.

In 2011, the Oregon Health Authority is expected to develop a detailed plan for the exchange based on recommendations from the Oregon Health Policy Board.

Virginia is moving toward making the difficult initial decision of whether or not to build its own exchange:

The [Virginia Health Reform Initiative Advisory] council, chaired by Dr Bill Hazel, Virginia’s secretary of health and human resources, recommended that the commonwealth establish its own health insurance exchange in response to federal health reform.

In its report submitted to Virginia Gov. Bob McDonnell Dec. 21, the council provided a number of recommendations it said will offer the state “a comprehensive strategy for implementing health reform specific to the needs of Virginia,” according to a statement from Hazel. McDonnell tasked the council with creating an improved health system that is “an economic driver” for the state. [...]

The report suggests that Hazel’s office should collaborate with business leaders, researchers and private foundations to commission and conduct a representative sampling of Virginia employer opinions about what features they want in the exchange and what they want from health reform generally.

Creating and operating its own health insurance exchange, rather than allowing the federal government to operate it, will “preserve and enhance market place [sic] competition,” according to the report.

The council encouraged the governor and Virginia General Assembly, which begins its next session in January, to work together “to create a process to work through the various issues in detail, with broad stakeholder input.”

The council also recommended that Virginia expand Medicaid care coordination across additional geographic areas, clients, and services, including but not limited to behavioral health and long-term care services.

The group also wants the state to develop a comprehensive eligibility determination and electronic case management system that crosses the span of health and human resources. In order for Virginia to provide comprehensive care to individuals who receive care from a local and or state agency, a technology platform is needed. This technology is a necessary vehicle that will facilitate communication and shared information among providers and agencies who serve the same client, according to the group’s report.

“These leaders have come together and worked diligently to find better ways to deliver high quality health care at an affordable cost to the citizens of Virginia,” McDonnell said in a statement. “I look forward to reviewing the recommendations they have provided and finding solutions that benefit our citizens and our commonwealth.”

A similar panel in Iowa also recommended proceeding with a state exchange earlier this month:

Iowa should move ahead with a key piece of health care reform, despite challenges to the overall national program, a state panel recommended Wednesday.

The state Health Care Coverage Commission voted 10-1 in favor of having Iowa continue forming a health insurance exchange. [...]

"We want to make sure that when the bell rings, we're ready to go," said Ted Williams, a Des Moines human-resources consultant who is vice chairman of the commission.

The initial version of Iowa's insurance exchange will offer basic information about prices and coverage of health insurance policies. But organizers say the more extensive versions will offer much more, including help determining whether low- or moderate-income people qualify for Medicaid insurance or for subsidies for private coverage.

Wyoming is also leaning toward establishing its own exchange, though they're early in the decision-making process:

Wyoming took a first step Monday on a plan to provide health insurance to the 86,000 people in the state who currently have none.

A 17-member task force started work on the job of recommending a plan for a health insurance exchange, essentially a market for employers and individuals to choose insurance plans. [...]

"This is just the beginning," said Rep. Elaine Harvey, R-Lovell, chairwoman of the House Committee on Labor, Health and Social Services and a task force member. "We're learning the process, and we're trying to get everybody on the same page.”

Harvey said she lacks enough information to make a decision, but personally would rather not leave the health insurance exchanges up to the federal government.

She also questioned whether Wyoming's small population could produce a pool large enough to be effective.

"We're such a wildly independent state. People like to do their own thing," Harvey added.

These examples give a pretty good feel for the spectrum of current progress on state exchanges as 2011 begins. And if you're wondering why exchanges are still years away, presumably this sheds some light on that.

 

[Trajan]

has Maine taken any action?

 

[Greenbeard]

Every state has taken action on exchanges except Minnesota and Alaska (though Minnesota already did background research on implementing an exchange in Minnesota a few years back). Maine has a Health Reform Steering Committee that's been working on initial exchange design issues; they've recommended building a single state-wide exchange serving both individuals and small businesses governed by an outside entity (i.e. not housed in state government). The issue they were having is that the legislature was interested in being part of a multi-state exchange and the executive branch wasn't. With the turnover in government this month, we'll have to see where the new blood takes it.

 

[Oddball]

Well, all that federally mandated technocracy and bureaucracy will be sure to drive down costs!

 

[Mad Scientist]

And if you're wondering why exchanges are still years away, presumably this sheds some light on that.

In order for Obama care to be "Deficit Neutral" the gubamint needs to tax you for 14 years but give benefits for only 10. That's why they're "years away".

I hope this sheds some light on that.

 

[Trajan]

Every state has taken action on exchanges except Minnesota and Alaska (though Minnesota already did background research on implementing an exchange in Minnesota a few years back). Maine has a Health Reform Steering Committee that's been working on initial exchange design issues; they've recommended building a single state-wide exchange serving both individuals and small businesses governed by an outside entity (i.e. not housed in state government). The issue they were having is that the legislature was interested in being part of a multi-state exchange and the executive branch wasn't. With the turnover in government this month, we'll have to see where the new blood takes it.

hummm I heard they just asked for an exemption (Maine did). what does that have to do with this? anything?

 

[Greenbeard]

hummm I heard they just asked for an exemption (Maine did). what does that have to do with this? anything?

No. They asked for a delay of the medical loss ratio requirement because they essentially only have two insurers in the state right now (I've lived in cities with larger populations than the state of Maine) and they're worried the medical loss requirement will cause one of them to leave.

They're not asking for an exemption from building an exchange. Since the exchanges will have at least two national plans in them, they're expected to bring significantly more competition to Maine's insurance market than it has now. It would be fascinating to see the New England states merge their exchanges but it's not clear there's a will for that.

 

[Trajan]

hummm I heard they just asked for an exemption (Maine did). what does that have to do with this? anything?

No. They asked for a delay of the medical loss ratio requirement because they essentially only have two insurers in the state right now (I've lived in cities with larger populations than the state of Maine) and they're worried the medical loss requirement will cause one of them to leave.

at the risk of going OT, I'll just post this link then.

http://www.usmessageboard.com/healt...mption-from-provision-of-health-care-law.html

They're not asking for an exemption from building an exchange. Since the exchanges will have at least two national plans in them, they're expected to bring significantly more competition to Maine's insurance market than it has now. It would be fascinating to see the New England states merge their exchanges but it's not clear there's a will for that.

 

[Greenbeard]

No. They asked for a delay of the medical loss ratio requirement...

Until then, Maine has requested that the medical loss ratio required of its individual market plans be lowered to 65 percent.

They're not asking for an exemption from anything other than the medical loss ratio requirement. That doesn't have anything to do with exchanges.

 

[Trajan]

what could happen if Sibelius (?) says no? whats the downside to saying no for Maine citizens and insureres, the upside to saying yes..?

 

[Greenbeard]

Their claim is that one of their insurers will leave the market if the mlr is that high. Since they effectively only have two insurers they consider that very undesirable, though I suppose one of the much smaller insurers could theoretically start gaining market share. I haven't read their documents so I don't know why they think an mlr of 65% is necessary; underwriting is heavily curtailed under state law and Maine is leading the pack in terms of making use of health information technology. But if their argument is strong, they should get it. The downside of granting their request is merely that it reveals something troubling about Maine's individual market if insurers can only be expected to spend 65 cents of every dollar on actual care. I suppose that's why the reform steering committee recommending merging the individual and small group markets in the exchange.

 

[jgarden]

Instead of making the US healthcare system needlessly complicated, why not just provide basic healthcare that every American citizen automatically qualifies to receive - paid for by general revenues?

 

[RDD_1210]

Good info! Thanks.

 

[Revere]

Why should government tell private companies how much they should spend on any given aspect of their operations?

 

[RDD_1210]

Why should government tell private companies how much they should spend on any given aspect of their operations?

This is the one industry where profit margins can directly relate to peoples well-being.

 

[Revere]

Why should government tell private companies how much they should spend on any given aspect of their operations?

This is the one industry where profit margins can directly relate to peoples well-being.

What are the profit margins for health insurance? Do you know? I do.

 

[RDD_1210]

Why should government tell private companies how much they should spend on any given aspect of their operations?

This is the one industry where profit margins can directly relate to peoples well-being.

What are the profit margins for health insurance? Do you know? I do.

Yup, I do know. More then they should be when it is tied to peoples health.

 

[Revere]

Is 3% to 4% profit excessive?

 

[RDD_1210]

Is 3% to 4% profit excessive?

In this industry, yes. No one should be profiting off of someone dying or not getting the care they need. Especially when they aren't providing any service except to be a middle man.

 

[Revere]

Do you know the difference between insurance and welfare?