Montana- Health Co-Op is a Good Idea for Uninsured Montanans

Critics of the 2-year-old Affordable Care Act don't like it — we're not sure they'd like anything that might actually work during a presidential election year — but it was heartening to see that Montana was on the short list of states to benefit from the first round of funding for health care co-ops.

Montana Health Cooperative got word last week that it would get $58 million in loans over a period of time to get started in the health insurance marketplace that will be created in the state and elsewhere in the next couple of years.

...

The recent Assets & Opportunity Scorecard of the states by the Corporation for Enterprise Development said the state ranks 40th overall in uninsured rate, 48th in uninsured low-income parents and 45th in uninsured low-income children.

Some of those folks are the ones who stand to benefit by creation of the co-op.

John Morrison, former state insurance commissioner who helped form the Montana co-op and now is president of the National Alliance of Health Cooperatives, said the Montana organization "will be consumer-governed and will be responsive to consumer needs."

...

But lo and behold two years after passage of the act — and about nine months after the newly formed Montana Health Cooperative announced that it planned to seek financial assistance under the act — the state co-op joins similar organizations in seven other states as the first federal loan recipients.

...

Critics don't like the injection of government money into the health insurance system, but we'd wager most of them are either wealthy or have decent insurance mostly paid for by their employers.

The Montana Health Co-op won't be able to serve a large portion of the thousands of uninsured Montanans, but it might help create a marketplace that will be more accessible to them.


http://www.greatfallstribune.com/article/20120228/OPINION/202280306
Hat Tip: Great Falls Tribune

National- Q&A: Leveraging Health Insurance Exchanges, Part 2

In an article in the February issue of Health Affairs journal, William Kramer, executive director for national health policy at the Pacific Business Group on Health in San Francisco, discusses the potential long-term role the public health insurance exchanges could play in helping larger companies manage their health care benefits. In the second part of this interview, Business Finance asks Kramer about how the future with health insurance exchanges might play out and the CFO’s role in evaluating the potential opportunities these exchanges create.

Business Finance: In your article, you discuss a number of scenarios for employer-provided health benefits once the exchanges are up and running. Which of these scenarios is most likely to play out?

William Kramer: If I were a betting person, I would not bet a whole lot on any one scenario. I would spread my bets at this point. There are a number of plausible options available to most employers. Many employers are doing some scenario planning so that they are prepared as the situation develops. If it goes down this track, we should do X. If it goes down another track, we do Y. The best planning focuses on potential scenarios so that employers can decide what to do in each situation before it happens. As soon as the path becomes clear, the employer needs to have plans in place so that those plans can be executed quickly. I am not encouraging anyone to sit back and wait. Companies should be doing the analysis and scenario planning now because potential changes are large and the opportunities are great depending on which path opens up.


http://businessfinancemag.com/article/qa-future-role-health-insurance-exchanges-part-2-0228
Hat tip: Business Finance Magazine

Kaiser Health News: On Health Exchange, Neb. Makes Progress, Wis. and Texas Mull Next Steps

With links to other articles about exchanges...


http://www.kaiserhealthnews.org/Daily-Reports/2012/February/28/exchanges-and-other-implementation-news.aspx
Hat Tip: Kaiser Family Foundation/ Kaiser Health News

Utah- UHE: State Based Innovation

Unlike the federal plan, Utah’s health reform doesn’t rely on government mandates, and instead creates a voluntary health exchange. I emphasize that our exchange was created long before Obamacare.

The Utah Health Exchange (UHE) is among the State’s most critical initiatives right now, and has captured the attention of policymakers across the country. While health reform has become a political hot potato, especially since the passage of PPACA, Utah has lead out on the national stage, without the high costs and questionable mandates of other plans.

...

Currently, Utah State law limits the Exchange to assisting small business groups with 2-50 employees, but it will soon be available to individuals and larger groups. The reason for the limitation is to allow the Exchange to test its technology on a small scale before accommodating a wider range of Utah’s population. During this testing phase, the State has found that the Utah Health Exchange is well equipped to handle its current load — 247 employer groups with more than 6,000 covered employees — and a lot of room to grow.

The federal reform plan goes into effect January 1, 2014, meaning our Utah-specific option must be adapt to the requirements for exchanges under PPACA before then. The Governor and I believe that, with the continued support of the Legislature, the Utah Health Exchange will meet that deadline and continue to lead the country’s health reform efforts in a uniquely Utah way.


http://utahpulse.com/bookmark/17635973-Utah-Health-Exchange-State-Based-Innovation
Hat tip: Utah Pulse with YouTube Video Explaining the UHE

New Jersey- Senate Committee Clears Bill To Establish NJ Health Insurance Exchange

Legislation to create a state health insurance exchange, a competitive marketplace where individuals, families and employers will be able to purchase affordable, quality health care coverage, was approved Monday by the Senate Commerce Committee.

...

The bill would establish the New Jersey Health Benefit Exchange Trust Fund in the Department of Treasury to be the repository for monies collected from carriers and other monies received as grants or otherwise appropriated for the purposes of the Exchange. The monies in the Fund could only be used for the purpose of supporting the activities of the Exchange.

The legislation would take effect on the first day of the seventh month following enactment, but would authorize the Commissioners of DOBI and Human Services to take anticipatory administrative action in advance as necessary for its implementation. The committee approved the measure by a vote of 4-2. It now heads to the full Senate for a vote.


http://njtoday.net/2012/02/28/senate-committee-clears-bill-to-establish-nj-health-insurance-exchange/
Hat tip: New Jersey Today

Massachusetts- State Insurance Exchange Awarded $11.6 Million to Adjust to Affordable Care Act

Massachusetts will receive $11.6 million from the Centers for Medicare & Medicaid Services to move the state’s online health insurance marketplace for individuals and small businesses toward compliance under the Affordable Care Act, the federal agency announced today.

...

But the Massachusetts Health Connector, which runs the program here, has work to do adjust the state exchange to meet federal requirements, said Executive Director Glen Shor.

“We need to simultaneously continue to run these programs well and keep our population highly insured, and at the same time we need to plan for 2014,” Shor said. “These resources allow us to do both well.”

...

Shor said Massachusetts’s money will be used to prepare for the launch of the “Health Connector 2.0.” The Connector uses a three-tier system to classify health plans by cost and level of benefits. Under the federal law, it must convert to a five-tier system, including the most basic catastrophic coverage.

http://www.boston.com/Boston/whitecoatnotes/2012/02/state-insurance-exchange-awarded-million-adjust-affordable-care-act/140aA2GNj9r0uOL2wZEB2I/index.html

Hat Tip: Boston Globe/ White Coat Notes/ Chelsea Conaboy

Vermont- House Approves Plan To Create Health Exchanges For Insurance

After two full days of debate, the House has approved legislation that would change how many Vermonters get their health care coverage beginning in 2014.

House members considered and rejected more than a dozen amendments before voting 88-to-38 in favor. The vote was largely along party lines. Most Democrats voted for it, most Republicans voted against it.

The legislation would create a new consumer marketplace exchange where individuals and all small businesses would be required to purchase their policies.

Federal subsidies will be available for individuals with incomes less than $45,000 a year, and for households with incomes of less than $92,000.


http://www.vpr.net/news_detail/93540/house-approves-plan-to-create-health-exchanges-for/
Hat Tip: Vermont Public Radio

New Hampshire- NH Should Create its Own Exchanges

An exchange focuses competition on price. And the exchanges are intended to bring sunlight and transparence to the world of health insurance.

Exchanges will be designed as a place where individuals, small employers and eventually larger employers can shop and compare health insurance options.

The law requires that all states have an exchange in place by 2014. States can create their own or choose to let the federal government set the design.

Our New Hampshire Legislature and Executive Council have been stalwart in putting obstacles to a state-designed and implemented exchange.

This year, the Legislature has chosen to table a Senate bill that would set a process for a New Hampshire-designed exchange and made a committee recommendation to pass a leadership-sponsored bill (HB 1297) that New Hampshire “shall not plan, create, participate in or enable a state exchange for health insurance.”

Insurers, providers and small businesses support the concept that New Hampshire design an exchange that is unique to us, one best for New Hampshire. So why isn’t it happening?

Although Republicans can take credit for initiating the idea of an exchange – the conservative Heritage Foundation first touted the idea – many Republicans, and most certainly those extreme members of the Legislature, find all things “Obamacare “objectionable, apparently whether good policy or not.

Let’s look for the silver lining. If our Legislature persists on its current path, the federal government will design an exchange for us. Perhaps given the lack of leadership in our Legislature, that might turn out to be a good thing.


http://www.nashuatelegraph.com/opinionperspectives/951510-263/nh-should-create-its-own-exchanges.html
Hat Tip: Nashua Telegraph

Kaiser Health News: States, Governors Have Different Views On Exchanges, Impact Of Health Law

News outlets also offer status checks on the measure's high risk insurance polls.
With links to other articles.


http://www.kaiserhealthnews.org/Daily-Reports/2012/February/27/health-law-implementation-and-states.aspx
Hat Tip: Kaiser Family Foundation/ Kaiser Health News

National- Many States Take a Wait-and-See Approach on New Insurance Exchanges

States are lagging in the creation of health insurance exchanges, the supermarkets where millions of consumers are supposed to buy subsidized private coverage under President Obama’s health care overhaul.

Many states are waiting for a Supreme Court decision or even the November election results, to see whether central elements of the new law might be overturned or repealed. But that will be too late to start work. By Jan. 1, 2013, the Obama administration will decide whether each state is ready to run its own exchange or whether the federal government should do the job instead.

Republican governors and state legislators across the country are split. Some want to set up rudimentary exchanges with limited features — as a defensive tactical maneuver — rather than cede control to Washington. More-conservative Republicans do not want to do anything at all.

After a great deal of bickering and bargaining, the insurance exchanges emerged as a centerpiece of the 2010 health care law, crucial to achieving Mr. Obama’s promise of affordable coverage for all Americans.

The issue was a major topic of discussion over the weekend at the winter meeting of the National Governors Association here, and it is expected to come up Monday when governors meet with Mr. Obama at the White House.


http://www.nytimes.com/2012/02/27/health/policy/a-wait-and-see-approach-for-states-on-insurance-exchanges.html?_r=1
Hat tip: The New York Times

CO-OPs- Montana: What is a Health Co-Op, and How Does it Work?

Come 2014, Montana will have a new health insurance company, funded with $58 million in loaned seed money from the federal government.

This company is the Montana Health Co-op, which will be owned by its "members," or customers, and run by the same — as it sells health insurance to individuals, small businesses and maybe even some larger businesses.

...

The co-op, which they'll spend the next 18 months putting together, will survive because it can create a good, affordable insurance product that focuses directly on patient needs and not profit, they say.

"When you have a member-governed organization that directly elects from their ranks a board of directors, it guards against any kind of inefficiencies," said John Morrison, the former state insurance commissioner and a co-op board member.

...

So how will this co-op actually work? And can it survive, prosper and pay back its loans?

Within a week or so, the Montana co-op gets the first installment of its $6.7 million start-up loan from the feds: $730,000, to fund its budget for the next six months.

...

The current board members have an extensive background in health care, insurance, law, marketing, public policy and private business.

Eric Schindler, a board member and Helena insurance executive, says the co-op will solicit proposals from contractors to process its claims, organize provider networks, run wellness and pharmacy programs, and perform functions that any good insurer must do.

It will get a license to operate from the state auditor's office — like any other insurer — and expects to be ready by October 2013 to start selling policies. It must offer policies on the new health insurance "exchanges," which are Internet marketplaces for insurance that begin in 2014, and plans to sell its products elsewhere, too.

The federal loans cannot be used to market their products or to finance any standalone clinic or medical staff that the co-op might want to establish.

Yet the co-op can get financing from private sources for those and other expenses, and Schindler says it already has talked to banks about this "outside capital."

...

The board "is going to be very vigilant at all times, on how to save money, from provider networks to administrative costs, to the way in which benefits are structured to discourage utilization," Morrison said. "What you have is faith that they're looking after their own interests."


http://billingsgazette.com/news/state-and-regional/montana/what-is-a-health-co-op-and-how-does-it/article_3bbeba9c-48d2-5ffe-95bb-832894a7c400.html#ixzz1nbTJP6rx
Hat tip: Billings Gazette

Nebraska- Liability Questions Delay Health Exchange Plan

A Nebraska bill which intends to establish the functions required by the Federal Affordable Care Act drew testimony this week that has many legislators taking a more cautious approach, according to State Sen. Mark Christensen.

During this morning's McCook Area Chamber of Commerce legislative conference call at the Keystone Business Center, Christensen said that LB 835 has thus far received majority support, but recent testimony has raised concern over where the liability would be placed if the state establishes its own healthcare exchange prior to the federal government establishing one.

"For now it is going to stay in committee, a lot of information was received and it is now a matter of studying the information and visiting with our Washington representatives to see if it is accurate," said Sen. Christensen.

Christensen said the testimony included claims that Congress did not have the funding to actually establish the exchanges if the state did not do it on its own.

It was also said that several states that had already passed similar legislation found they needed a multitude of other bills to help manage the healthcare exchanges, and those bills had been held up for various reasons.


http://www.mccookgazette.com/story/1818892.html
Hat tip : McCook Daily Gazette

National- Q&A: Leveraging Health Insurance Exchanges, Part 1

William Kramer, executive director for national health policy at the Pacific Business Group on Health in San Francisco, discusses the potential long-term role the public health insurance exchanges could play in helping larger companies manage their health care benefits:

Business Finance: The state health insurance exchanges created by the health care reform law are slated to be up and running on January 1, 2014. Initially, the exchanges will be open only to small businesses and individuals purchasing health insurance. However, starting in 2017, these exchanges could be open to larger employers. Could this be a game changer for large companies looking to manage their benefits more effectively?

William Kramer: There are two ways that the exchanges could be a game changer. First, if the exchanges are able to align with the purchasing strategies of large employers, they might provide a critical mass and send a consistent signal to healthcare providers about what needs to be done to improve the quality and affordability of our healthcare system. Regardless of whether employers actually use the exchanges, the exchanges, by working in alignment with large employer purchasers, could help drive quality and affordability.

Second, if the exchanges provide an alternative way for people to access health benefits even if employers continue to provide financial support for coverage, employers could offload some of the administrative hassle involved in managing health benefits onto the exchanges. In addition, employers could also offer a wider range of choice to their employees through the exchanges, while employees gain the benefit of greater portability of their coverage.


http://businessfinancemag.com/article/qa-leveraging-health-insurance-exchanges-part-1-0223
Hat tip: Business Finance Magazine

Kaiser Health News: Officials Debate Whether, How To Set Up Health Exchanges

Lawmakers in Maryland, Nebraska and Kansas consider bills to advance or block the marketplaces. California officials wrestle with the nitty gritty of implementation.

Post contains links to articles on each state.


http://www.kaiserhealthnews.org/Daily-Reports/2012/February/22/state-implementation.aspx
Hat tip: Kaiser Health News

National- Another 10 States Get Federal Grants Totaling $230M for Health Insurance Exchanges

Federal officials say another 10 states are getting a total of $230 million to set up new health insurance markets under President Barack Obama’s overhaul.

Seven of them — Colorado, Massachusetts, Minnesota, Nevada, New Jersey, New York, and Pennsylvania — have either adopted a plan or are making substantial headway.

...

In two states announced Wednesday — Kentucky and Tennessee — it’s not clear whether policymakers will follow through. In Arkansas, officials concede that Washington will have to take the lead.


http://www.washingtonpost.com/business/another-10-states-get-federal-grants-totaling-230m-for-health-insurance-exchanges/2012/02/22/gIQAXjtaTR_story.html
Hat tip: Washington Post/ Associated Press

Idaho- Rep. Proposes Hands-off Policy on State Insurance Exchange

The debate over establishing a state-based health care exchange just got more heated.

As a Mini-Cassia lawmaker prepares a bill that would set up Idaho's first health insurance exchange, Rep. Bob Nonini introduced Wednesday a proposal encouraging Idaho's private insurance companies to form their own exchange.

...

Nonini described himself Wednesday as an outspoken opponent of the federal health care reform. He said he'd reviewed a yet-to-be introduced state exchange plan developed by Rep. Fred Wood, R-Burley, and had major concerns about the costs to the state and consumers.

"As I've gone through and dissected it, I find that every part of if[sic] drives up health care costs," Nonini said. Nonini also didn't like government interference in the insurance business.

Wood's proposal to set up a state exchange by January 2013 would cost the state $5 million, but wouldn't spend any of the $20.3 million the federal government granted the state to set up its exchange.


http://magicvalley.com/news/local/govt-and-politics/nonini-proposes-hands-off-policy-on-state-insurance-exchange/article_1c035a34-5d85-11e1-a534-0019bb2963f4.html#ixzz1nB3upyFv
Hat tip: Magic Valley Times-News

Minnesota- State Health Insurance Exchange Gets a $26M Boost

Minnesota has received a $26 million federal grant to help build a health insurance exchange, a one-stop marketplace where individuals and small businesses will be able to purchase health coverage among various policies.

...

The federal money will allow the state to move ahead on creating the building blocks of the exchange -- particularly the high-tech backbone needed to run an online site and call center where consumers and businesses can buy private insurance and where low-income Minnesotans can sign up for public programs.

The money will go to designing "what's under the hood of the engine," said Commerce Commissioner Mike Rothman, whose department will oversee the exchanges. "It's putting the operations in place to be able to turn the switch and say, the exchange will work."

The state is in the process of assessing competitive bids from vendors who want to build the exchange website, Rothman said.

Minnesota is one of 10 states to get a share of $229 million in awards announced Wednesday by the U.S. Department of Health and Human Services. The state received two smaller planning grants last year worth $5.2 million.

...

Last week, three powerful Republican House committee chairmen signed on to a DFL bill to establish a health insurance exchange. The bill is based on a framework hammered out by a task force of health care industry and community members. Republicans have declined to be part of the task force, which Rothman chairs.


http://www.startribune.com/business/140088523.html
Hat tip: Star-Tribune

National- Crunch Time For Health Exchanges

The Obama administration announced Wednesday that it’s sending $229 million to 10 states to set up health insurance exchanges, where individuals will buy subsidized health coverage come 2014. So far, the federal government has spent nearly $1 billion to get the exchanges up and running by 2014.

This year will be a pretty important one for states on health exchanges. All 50 are eligible to apply for multimillion-dollar planning grants, and, so far, 33 have received them (you can see which ones in the map above from Kids Well Campaign). To establish the new marketplace, however, nearly all states need to pass laws creating new legislative authorities. There, progress has been slower: Only 15 states have passed exchange legislation.

A state has to have made enough progress on setting up an exchange by January 2013 to be certified by the Obama adminstration as able to launch a marketplace the following January.


http://www.washingtonpost.com/blogs/ezra-klein/post/crunch-time-for-health-exchanges/2012/02/22/gIQArPAzTR_blog.html
Hat tip: Washington Post/ Wonkblog/ Sarah Kliff

Oklahoma- Committee Calls For Insurance Exchange

A legislative committee recommended Wednesday that Oklahoma create its own health insurance exchange so the federal government doesn't establish one for it instead.

Rep. Glen Mulready, R-Tulsa, said the exchange is a proactive choice, though he said he is hopeful the federal health care law will be overturned through litigation or the election of a different president.

Mulready told The Associated Press he does not believe in the federal government's ability to impose an exchange cost effectively, and a state-based plan would give Oklahoma more control to decide the role of agents and brokers, as well as inviting more carriers and competition.

...

The recommendation was included in a report by the Joint Committee on Federal Health Care Law. Republicans outnumber Democrats on the panel.

Oklahoma was to receive $54 million in federal funds to set up an exchange, but after resistance last year from tea party groups opposing the health care law, Gov. Mary Fallin rejected the money.

Sen. Sean Burrage, a Democrat on the committee, said in a statement that Fallin should have taken the money, and that establishing an exchange in 10 months is a "huge undertaking."


http://www.cbsnews.com/8301-505245_162-57383252/committee-calls-for-okla-insurance-exchange/
Hat tip: CBS News

Insurance Industry- With Many States Behind Schedule, CMS Is Likely to Set Low Bar for Certification

While HHS collectively has awarded $729 million to help states stand up an insurance exchange, many states will run out of time long before they run out of cash. As a result, HHS is expected to set the bar low when evaluating certification applications for state insurance exchanges, industry observers tell HEX.

The reform law requires HHS to certify state exchanges no later than Jan. 1, 2013. But with many states still waiting for their legislatures to act, or for the Supreme Court to rule on the constitutionality of the reform law, overall development of state exchanges is woefully behind schedule.

In November 2011, CMS issued a 14-page draft certification application, which states must submit this fall. But HHS has said little about what the certification process will look like. And given that a majority of states won’t be fully ready for certification — either by choice or circumstance — HHS is expected to help states make progress, rather than reject applications that fall short, according to a source who has worked with CMS’s Center for Consumer Information and Insurance Oversight (CCIIO) but asked not to be identified. HHS will most likely allow conditional approval with an action plan for states that don’t meet all of the certification requirements, she tells HEX.


http://aishealth.com/archive/nhex0212-01
Hat tip: AIS Health/ Inside Health Insurance Exchanges

Nebraska- Health Insurance Plan Debate Begins

The road to Nebraska creating its own health insurance exchange could be a long one, as indicated Tuesday by nearly three hours of testimony before lawmakers.

Lawmakers began discussion on two bills that would form the Nebraska Health Benefit Exchange Act, a plan offered as an alternative to the federal health insurance plan now being scrutinized by the U.S. Supreme Court.

The bills up for debate in the Banking, Commerce and Insurance Committee were introduced to meet the requirements of the federal Affordable Care Act, which calls for states to have an operating exchange by 2014.

...

Supporters said Nebraska needs to act immediately to avoid federal control. Opponents said the state should wait for the Supreme Court decision this summer.

...

Sens. Rich Pahls of Boys Town and Jeremy Nordquist of Omaha each have introduced a bill that would meet the requirements of the federal Affordable Care Act.


http://www.cbsnews.com/8301-505245_162-57382305/nebraska-health-insurance-plan-debate-begins/
Hat tip: CBS News

New Hampshire- A Federal vs State Health Insurance Exchange-Does It Matter?

New Hampshire lawmakers, gave back the $ 1 million in planning grants to the federal government in order to establish a state based exchange. Legislation that would have set up a state based exchange has stalled. Beth Roberts, Vice President of Regional Markets at Harvard Pilgrim Healthcare, is disappointed.

"Why not control our own destiny?" she says. "What we need in New Hampshire is different than what another state in the nation needs. By defaulting to a federal exchange we are allowing the federal government to come in define what New Hampshire needs for us rather than building an exchange at the state level allowing us to define that ."

But opponents of a state based exchange say whether or not the state controls the process--ultimately the federal government will have the final say.

"Whether we have a federally implemented exchange or a state implemented exchange the federal government writes all the rules," says Charlie Arlinghaus who runs the Josiah Bartlett Center. "We're essentially just a puppet government."

Republican Rep. Andrew Manuse of Derry has sponsored legislation that would prevent New Hampshire from creating its own health insurance exchange.

"By not establishing a state exchange were saying to the federal government, you passed this mess of a law now you have to figure out how to make it work. Don't rely on the states to fix this law," says Manuse.


http://www.nhpr.org/post/federal-vs-state-health-insurance-exchange-does-it-matter
Hat tip: New Hampshire Public Radio with audio link

CO-OPs- National: Feds Loan $638M for Health Co-Ops in 8 States

Health care cooperatives that are being launched in eight states announced Tuesday they will receive a total of $638 million in loans from the Obama administration under the federal health insurance law.

...

Critics, led by House Republicans who voted last year to repeal the health care law, immediately questioned the administration's decision. The House Ways and Means Committee called the loans a political reward to a friendly constituency.

Republicans noted that the recipient that received the largest loan - more than $340 million - was going to a group connected to the Freelancers Union, a nonprofit that serves independent contractors that are a growing segment of the workforce. Members are eligible for health insurance through a company owned by Freelancers.

...

"Freelancers Union clearly met the legal standards under the statute and federal regulations," said Brian Cook, a Centers for Medicare and Medicaid Services spokesman. "They are not an insurer, they are a nonprofit union of independent workers, sole proprietors, and entrepreneurs who do not receive insurance through an employer."

...

The new federal awards were announced for co-ops serving Montana, Iowa, Nebraska, New Jersey, New Mexico, New York, Oregon and Wisconsin. "It will be consumer-governed and will be responsive to consumer needs," said John Morrison, who is helping set up the cooperative in Montana.

http://hosted.ap.org/dynamic/stories/U/US_HEALTH_CARE_COOPERATIVES?SITE=NCKIN&SECTION=HOME&TEMPLATE=DEFAULT
Hat tip: The Associated Press

CO-OPs- Iowa & Nebraska: Health Insurance Co-Op Awarded Loan in Iowa

The Centers for Medicare & Medicaid Services just announced that a nonprofit entity in Iowa and Nebraska, Midwest Members Health,known under the Affordable Care Act as a Consumer Operated and Oriented Plan (or CO-OP), has received a loan award from the Department of Health and Human Services. More information can be found here: http://www.healthcare.gov/news/factsheets/2012/02/coops02212012a.html

...

All CO-OPs receiving loans were selected on a competitive basis through external and independent expert objective reviews and approval by CMS officials with private insurance expertise. Non-profits receiving the loans include: Freelancers CO-OP of Oregon, New Mexico Health Connections, Montana Health Cooperative, Midwest Members Health, Common Ground Healthcare Cooperative, Freelancers CO-OP of New Jersey, and Freelancers Health Service Corporation. Starting in 2014, these CO-OPs will operate in Oregon, New Mexico, Montana, Iowa, Nebraska, Wisconsin, New Jersey, and New York.

Today’s awardees will receive start-up and solvency loans to fund start-up activities required to become a health insurance issuer and enable them to meet State licensure, solvency and reserve requirements. Start-up loans must be repaid in 5 years and solvency loans paid back within 15 years. Like other plans, CO-OPs will meet State and federal standards for qualified health plans to sell coverage through the Exchanges and the State’s Small Business Health Option Programs (SHOP Exchanges).


http://thegazette.com/2012/02/21/health-insurance-co-op-awarded-loan-in-iowa-midwest-members-health-will-start-new-health-insurance-company/
Hat Tip: The Gazette

National- Four Months After Leaving HHS, Ario Remains Bullish on Exchange

It’s been four months since Joel Ario left HHS’s Office of Health Insurance Exchanges, a department that he headed after it was created in fall 2010. The office is part of CMS’s Center for Consumer Information and Insurance Oversight (CCIIO).

...

HEX: What do you see as the biggest barriers health insurers will face in developing and selling qualified health plans through state exchanges?

Ario: The transition to guaranteed issue in the individual market will be challenging. It is the
heart of the law and is the key to covering everyone, but it will require insurers to change their business models. In essence, they will have to compete for individual business the way they compete for [administrative services only] business in the large group market. With large employers, insurers do not identify the most costly people and put them in a separate
risk pool. They work with employers to manage costs of the overall pool…healthy and sick. Risk selection is deep in the DNA of insurers, and they are very worried about the 2O14 transition. But Massachusetts shows it can work if everyone cooperates. The bottom line is that the alternative to implementing this law is a whole lot more uncertain and there are potential downsides for insurers.

...

HEX: One of the chief complaints I hear from states and health plans is that regulations have been too slow in coming out. What are the challenges in finalizing regulations?

Ario: The core proposed rules came out last summer, but it was a long road to get to those and I’m sure it has been another long road to go from those proposed rules to the final ones. But I do think those rules need to come out this spring. They’re expected to be out in February. Carriers have told me that their drop-dead date for knowing the final regulatory landscape is June, which is 18 months out from the start date for exchange-based coverage. Plans have said that while 18 months isn’t ideal, it still gives them a manageable timeline. Defining essential health benefits was the most difficult piece of this for the federal government. And much of this responsibility has now been given to the states.


http://aishealth.com/sites/all/files/marketplace_pdf_samples/samplehex.pdf
Hat tip: AIS Health/ Inside Health Insurance Exchanges

CO-OPs: Montana- Secures $58M for New Non-Profit Health Insurance Agency

Montana has secured more than $58 million dollars toward the creation of a new non-profit health insurance agency, the Montana Health Cooperative.

The federal Affordable Care Act of 2009 created the new type of non-profit health insurer, known as Consumer Oriented and Operated Plans (CO-OP).

...

The CO-OP program offers low-interest loans to eligible nonprofit groups to help set up and maintain these issuers; to date, a total of seven non-profits offering coverage in eight states have been awarded $638,677,300.

The press release states that Montana has been awarded $58,138,300 for the Montana Health Cooperative, which is "sponsored by a coalition of small businesses and community leaders and plans to add a strong primary care capacity to Montana's rural and medically underserved communities. Montana Health Cooperative will provide health insurance coverage statewide."


http://www.krtv.com/news/montana-secures-58m-for-new-non-profit-health-insurance-agency-/
Hat tip: KRTV

Nebraska- Center for Rural Affairs Supports Health Insurance Exchange Bill

Today the Center for Rural Affairs provided supportive testimony at a hearing before the Banking, Commerce and Insurance Committee of the Nebraska Unicameral regarding LB 835, also know as the Nebraska Health Benefit Exchange Act.

“This legislation would set Nebraska on a path to meet the state’s responsibilities set forth in the Affordable Care Act to provide a vehicle for Nebraskans who currently struggle to obtain affordable health care coverage to purchase affordable, quality, comprehensive health insurance,” said Jon Bailey, Rural Research and Analysis Director at the Center for Rural Affairs.

According to Bailey, the Nebraska Health Benefit Exchange that would be established by the bill is crucial for many in rural Nebraska. Rural Areas of the state have more residents who are either self-employed or employed in small businesses. Incomes in rural areas are generally lower and more rural residents are without health insurance. Many rural families - especially farmers and ranchers - purchase health insurance in the individual market and employer-supported health insurance is generally less available in rural communities.


http://www.journaldemocrat.com/ag_news/x740680048/Center-for-Rural-Affairs-supports-Health-Insurance-Exchange-Bill
Hat tip: Syracuse Journal-Democrat

National- Mixed Messages On Federal Exchanges Funds

The Obama administration might have handed Congress a guide to defunding a key part of the health care reform law — without taking away a penny that the administration already has at its disposal. Without doing anything at all, in fact. The president’s fiscal 2013 budget requests an additional $864 million to build the federal health insurance exchange, which will operate in states that don’t set up these new insurance markets on their own by 2014. Precisely how many states that will include is still an open question. The budget request caught many observers by surprise — especially Republican critics who suspected all along that the administration had lowballed estimates. HHS had long maintained that an earlier $1 billion appropriation in the health care law would be enough to set up a federal exchange and pay for other implementation tasks (Feder, 2/21).


http://www.kaiserhealthnews.org/Daily-Reports/2012/February/21/health-law-implementation-news.aspx
Hat tip: Politico Pro, Kaiser Family Foundation, Kaiser Health News

Insurance Industry- Creating Effective Insurance Exchanges

For the first few years, these exchanges will be open only to individuals and small businesses (limited to businesses with 50 or fewer employees or, at the state's discretion, 100 or fewer employees) purchasing health insurance. Starting in 2017, the exchanges could be open to larger companies with more than 100 employees.

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The experiences of this group will greatly influence the experience larger employers will have in the future if they choose to use the exchanges in 2017 and beyond.

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For example, some basic offerings include a single point of entry for employers, readily available information that shows how one health plan differs from another, a single application, a call center or easy-to-use Web site, and a single premium payment for each employer. He also suggests that exchanges can provide added value by providing support for wellness programs, COBRA coverage, and flexible spending accounts.

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Other states looking to create options with lower administrative overhead and greater cost efficiencies might also consider merging individual and small-business exchanges. With more members, exchanges have more clout in the marketplace and could use the resulting leverage to offer plan options that provide more value at a better cost than small businesses are used to seeing. For example, he notes that in Massachusetts the Network Health Plan with its low-overhead has accumulated 40% of total exchange enrollment.


http://businessfinancemag.com/article/creating-effective-insurance-exchanges-0221
Hat tip: Business Finance Magazine

Hawaii- Program needs objectivity but also insurers' expertise

The federal government gave states the choice to create their own HIEs or to opt out and use the federal program. Hawaii, like many other states, chose to create its own: the Hawaii Health Insurance Exchange, also known as the Connector. Last year Senate Bill 1348 passed, enabling official formation of the Connector. An interim board of directors was selected, and the board hired an executive director.

The board comprises representatives from the following sectors: government, health insurers, health care provider groups, hospitals, labor, Native Hawaiian health, federally qualified health centers, business, health information and consumers.

Of particular note is that the health insurance plans and the government have the greatest number of representatives on the board. This month the governor submitted his nominations for the permanent board of directors, and it should be noted that he proposes to remove hospital representation from the board and increase the number of health insurance plans represented to four: HMSA, Kaiser, Ohana Health Plan and Hawaii Dental Service. The majority of other sectors are now represented by only a single seat or organization.

SB 2085 and HB 2114 seek to prevent organizations that have a direct financial interest or benefit from serving as voting members of the Connector board due to conflicts of interest. The bill was submitted with the view that despite conflict-of-interest rules, health plans can't be expected to act in the best interest of consumers or the state when they have financial interests tied to their actions.

Advocates of these bills say that the ability of health plans to vote on which plans are offered to consumers is like the electric company sitting on the Public Utilities Commission and voting on its own rate increases.

Proponents of the bills also cite recommendations by the U.S. Department of Health and Human Services that health plans be used in an advisory capacity only. They claim that as voting members of the board, health insurance plans have direct conflicts of interest because they will be financial beneficiaries of the exchange. Given that anywhere between 50,000 and 100,000 people in Hawaii are uninsured, there are literally millions of dollars at stake. Twenty-one states have language prohibiting inclusion of health plans on insurance exchange boards, and an additional six states are considering such language.


http://insurancenewsnet.com/article.aspx?id=330841
Hat tip: Insurance News/ Honolulu Star-Advertiser

Nebraska- Lawmakers to Debate Health Insurance Exchange

Lawmakers will begin work Tuesday on the state's version of health insurance reform as they take up two bills to create the Nebraska Health Benefit Exchange Act.

The bills, which will come before the Banking, Commerce and Insurance Committee, are expected to get plenty of attention in the coming weeks as the Legislature passes its half-way point for the session.

Sen. Rich Pahls of Boys Town and Sen. Jeremy Nordquist of Omaha each have introduced a bill that would meet the requirements of the federal Affordable Care Act, which calls for states to have an operating exchange by 2014. In the event that a state doesn't have a plan in place, the federal Health and Human Services Department has the authority to create and operate a health benefit exchange.

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Pahls and Nordquist said their proposals are works in progress and will likely evolve over the next few weeks. They acknowledge their bills are similar.

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The Center for Rural Affairs argues that state health insurance exchanges are crucial because many people in rural areas don't have health insurance. Many others must buy health insurance on the individual market, which is usually more expensive than policies that larger employers can offer their workers.

"It is our preference that we build this health network this session," Depew said. "If the state doesn't act, it will be up to the federal decision. I prefer that we build our own."


http://www.theindependent.com/news/state/neb-lawmakers-to-debate-health-insurance-exchange/article_3861a0fe-da61-5c0d-a8dc-f3567b4bd786.html
Hat tip: The Independent

Opinion- Iowa: Utah or Massachusetts? No, it’s Iowa

We met recently with two groups pushing for establishment of health insurance exchanges in Iowa. One of the 2010 federal Affordable Care Act’s central requirements is for each state to establish an exchange, where individuals, businesses and organizations can select from a variety of insurance options. It’s supposed to encourage competition among insurers and give consumers more affordable choices.

Both the Iowa Health Alliance and the Iowa Health Advocates want the Iowa Legislature to authorize work on an exchange sooner than later. They argue that waiting until July for the U.S. Supreme Court ruling on the ACA’s mandate that every individual must have health insurance coverage is too late.

We agree. Legislators have to authorize a plan by Jan. 1; otherwise, the federal government will do it for us. Yes, depending on the November election outcome, Congress could throw out the exchange requirement, as well as any other or all parts of the ACA regardless of how the high court rules on the mandate.

But waiting because of the uncertainties doesn’t seem wise.

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Each plan provides some lessons. But Iowa should not get hung up on any other state’s model. Our exchange’s governing body should be transparent, independent and represent both consumer and business interests. We also see merit in having the insurance industry serve in an advisory capacity only to avoid conflicts of interest.

Bottom line: Devise a plan to fit Iowans’ needs.


http://thegazette.com/2012/02/19/utah-or-massachusetts-no-its-iowa/
Hat tip: The Gazette

Opinion- Idaho: Will Playing Politics Really Pay Off?

Two months ago, state legislators by and large declared health insurance exchanges would become the big issue of this session.

Now, as a bill on the matter finally emerges, the question becomes how the Legislature will treat this issue in an already-shrill election year: politically, or in the practical way it deserves?

For several months, Rep. Fred Wood, R-Burley, and Sen. Dean Cameron, R-Rupert, have worked on legislation that would establish a state-operated health insurance exchange, one of the provisions of the federal health care reforms dubbed “Obamacare.”

Meanwhile, Idaho is one of many states that has sued over Obamacare and now awaits a decision this summer from the U.S. Supreme Court. Idaho Falls state Rep. Janice McGeachin is throwing down as many roadblocks to the process as she can, this week proposing the Legislature create a committee to ponder the issue for a while. House opposition has led Gov. C.L. “Butch” Otter to drop plans to use federal funding to help start the exchange, putting more pressure on an already-tight state budget. Otter worries the state doesn’t have enough time to set its exchange up by the federal due date anyway.

The clock is ticking. What’s a legislator to do?

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Legislators trying to ignore the health reforms should ask themselves this: If Idaho’s lawsuit doesn’t go their way, will the state be prepared to make the best of the federal law? Or in attempting to reject a perceived federal overreach, are they setting the state up to possibly lose both its court case and any control over its insurance exchange?

Right and wrong are always in the eye of the beholder. For some in Boise, it’s apparently hard to see much of anything at all.


http://magicvalley.com/news/opinion/editorial/our-view-will-playing-politics-really-pay-off/article_29e72c7c-9fed-59ad-948a-2c86a5849c6f.html
Hat tip: Magic Valley Times-News

Insurance Industry- Reform Law Could Fuel Self-Funding

Starting in 2014 under the Patient Protection and Affordable Care Act, companies with 50 or more employees either must offer health care coverage or pay a per-employee fee to the government. While smaller companies will be able to purchase health care benefits via state insurance exchanges created in response to such legislation, health care benefits experts expect many employers with 100 or more employees will opt to self-fund rather than buy commercial coverage.

Although self-funded benefits will be subject to many of the same coverage requirements imposed on insured plans, such as providing coverage for what the Department of Health and Human Services deems are “essential benefits,” the cost of self-funded benefit plans will continue to remain lower than that of insured plans because self-funded plans are not subject to state benefit mandates or premium taxes that add to plan costs, experts say.

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Because self-insured plans are governed by the federal Employee Retirement Income Security Act, self-funded employers also will continue to have the flexibility to make value-based plan design changes that deter employees from using expensive health care providers or nonessential services, or to encourage healthy behaviors, experts say. By contrast, insured programs will continue to be standardized to meet state insurance regulations, which do not permit such modifications, they say.

“Moving into 2014, there's one more reason to move to self-funding,” said Mark Whiting, a principal with consultant Mercer L.L.C. in Kansas City, Mo. “PPACA may be enough to push a client that's been teetering on the edge to move to self-funding.”


http://www.businessinsurance.com/article/20120219/NEWS05/302199999?tags=%7C74%7C278%7C305%7C339%7C342
Hat tip: Business Insurance

Colorado- Q&A: Setting up State's Health Insurance Exchange

Patty Fontneau, the CEO and executive director of what is formally called the Colorado Health Benefit Exchange, has only been on the job since December. Before joining the exchange, Fontneau served as chief operating officer for the law firm Holme Roberts & Owen LLP, and chief administrative officer for IMA Financial Group Inc., and has served on many Denver-area nonprofit boards.

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Colorado’s plans have been scarcely less controversial than the federal version, however. The Colorado exchange was created last year in a bipartisan bill cosponsored by House Majority Leader Amy Stephens, R-Monument. The bill didn’t spell out how the exchange would work, but set up a board appointed by the governor to fill in the details and the board hired Fontneau to run the new enterprise.

Stephens has since come under fire from fellow conservatives for what opponents nicknamed “Amycare” and the exchange has been a central issue in the primary contest between Stephens and Rep. Marsha Looper, R-Calhan. Looper sponsored a bill that would repeal the state’s exchange law if the Supreme Court finds the Affordable Care Act unconstitutional, although the measure appears unlikely to go anywhere in the Democrat-controlled Senate.
None of this controversy is lost on Fontneau, but she says she’s focused on getting the exchange up and running....

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Q: It’s a year and a half before your launch date. What are you working on now?

A: We just released a request for proposals for the service and technology platform that will drive the exchange going forward. That will be the technology, including the website, where people will go to find information on different plans, as well as the call center. In addition to that, we also released a separate RFP that focuses on the program management office, which is an extension of staff to help implement the technology.

Q: What’s the exchange going to look like? How will it work?

A: Service is our top priority as we are moving forward with developing and designing this. There are vendors that have experience in this. There are private exchanges. They are not starting from scratch — they have created models and they have created the interfaces for customers to design and to use.

We are also working with the board on setting up the development of the organization — all the work that is required in order to start a company. That’s a part of this process to determine what the longer-term vision of this is going to be.


http://www.gazette.com/articles/-133551--.html
Hat tip: Colorado Springs Gazette

Opinion- Texas: Lagging on Health Exchanges

In Rick Perry's Texas, nearly 1 in 3 working-age residents has no health insurance, so there's a price to pay for his pride and politics.

Count the millions of federal dollars being left on the table, because the governor refuses to begin work on a healthcare exchange. As important, count the opportunity costs -- the missed chances to create a better health insurance market for millions of Texans who need individual and small-company plans.

A frequent criticism of the 2010 healthcare law is that it forces a cookie-cutter solution on all. Not so with health exchanges, the online shopping sites envisioned as a Travelocity for health insurance.

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Even conservative stalwarts like Mississippi and Utah have already taken steps to avoid the federal option.

While Perry complains about being fed-up with Washington, others are seizing the moment and the money. Thirteen states have established exchanges, tackling issues such as the makeup of governing boards, mandated benefits and which insurers to allow into the mix.

Twenty-eight states and the District of Columbia have received first-level grants to establish their programs. Federal payouts include $1.6 million to Tennessee, $21 million to Missouri and $39 million to California.

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But even if the law were overturned, shouldn't Texas be working on its own exchange? And on the feds' nickel?

This is different from many health law requirements. Most conservatives oppose the large expansion of Medicaid, the federal mandate to buy coverage and the premium rebates that insurers must pay if they spend too much on overhead.

But exchanges are a bet on free markets, rather than regulators. As tools, they can let consumers and insurers determine much of what happens in the marketplace.

Texas has been an innovator in electric deregulation, and its power-to-choose website has revolutionized the way people buy electricity here. They can easily compare plans, prices, complaint records and the share of power that comes from renewable energy. Retailers tout their service and inducements like frequent-flier miles.

If not for the politics, Texas could be a leader in developing a similar system for health insurance. In the 1990s, it created an insurance exchange for small businesses. That failed, because insurers outside the exchange offered lower-price coverage to healthy customers; in effect, that confirmed the problems of so-called adverse selection.


http://www.star-telegram.com/2012/02/18/3744532/perrys-texas-is-lagging-on-health.html
Hat tip: Fort Worth Star-Telegram

National- Health Policy Conference has Panel on State Exchanges

California policies and policymakers were evident throughout the conference from California Health Benefit Exchange board member Kim Belshé serving on a panel examining state health insurance exchanges to Molly Coye, chief innovation officer for the UCLA Health System, moderating a panel on "Using Evidence to Build a Learning Health Care System."

Belshé, California's HHS secretary during Republican Gov. Arnold Schwarzenegger's administration, prefaced her remarks about building an exchange and health care reform in general by saying, "This is not an undertaking for the faint of heart. I usually say it's not for sissies." Belshé added, "But Academy Health is a more refined group, so I'll say faint of heart."

California, the first state to authorize and embark on building a reform-driven exchange, is much further along in the process than many states, especially Iowa. Iowa Insurance Commissioner Susan Voss, serving on the panel with Belshé, said she's considering drastic measures to get things moving in her state.

"I'm thinking about tequila as part of the essential benefits package," Voss said. "Get everybody in a room with a table full of tequila shots and maybe we'll get somewhere."

Voss, who has served as insurance commissioner under three governors, said political differences -- and now judicial uncertainty -- have stalled efforts to start an exchange.


http://www.californiahealthline.org/features/2012/polarization-evident-at-national-health-policy-conference.aspx#ixzz1mgDlUop1
Hat tip: California HealthLine

Vermont- Health Bill Builds Risk Pool, Limits Choice

Business lobbyists are turning up the heat on the administration of Vermont Gov. Peter Shumlin to detail the costs of the governor's ambitious health insurance plan, now that three possible benefit packages have been made public.

"You should be as transparent as you can so that we can understand the changes that may be coming," said Jim Harrison, president of the 600-member Vermont Grocers' Association. "Give people some estimates now."

Meanwhile, a House committee voted Thursday to support a bill to begin implementing the health care agenda passed in broad outline last year. It still must be voted on by the full House and then the Senate.

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The bill approved by the House Health Care Committee would require that all Vermont individual health insurance subscribers and all employers with 50 or fewer employees get insurance through the exchange. Those smaller employers would not be required to offer insurance to their workers. The requirement would take effect in January 2014.


http://www.cbsnews.com/8301-505245_162-57380211/vt-health-bill-builds-risk-pool-limits-choice/
Hat tip: CBS News

CO-OPs- Federal: IRS Provides More Guidance On Health Insurance Cooperatives

The IRS issued temporary rules on the recognition of healthcare cooperatives under Section 501(c)(29) of the IRC. See Reg. 13507-11, T.D 9574, Federal Register, Feb. 7, 2012, for more details. The IRS also issued a revenue procedure for the issuance of determination letters and rulings. See IRS Rev. Proc. 2012-11 scheduled for publication in Internal Revenue Bulletin 2012-7, Feb. 13, 2012.

The proposed and temporary rules provide that "qualified" nonprofit health insurers must apply for tax-exempt recognition with the IRS. The effective date of exemption will be the later of the date of application or March 23, 2010, the date of the enactment of the Patient Protection and Affordable Care Act.

As it has with other provisions of the act, the IRS looks to the rules that are being promulgated by the Centers for Medicare & Medicaid Services (CMS). See Legal Update dated March 15, 2011, " IRS Issues First Guidance on Exempt Health Insurance Entities."

Qualified Organizations

Once the Consumer Operated and Oriented Plan (CO-OP) qualifies under the CMS plan and CMS acts, then the CO-OP can apply for IRS tax exemption under Section 501(c)(29).

CMS issued final rules in December 2011 for eligibility to be part of the CMS program. These rules provided guidelines for the compensation of the board of directors, financial solvency requirements and loan requirement terms.

Revenue Procedure 2012-11

The IRS has provided additional rules in a revenue procedure for applications for tax exemption, including rules precluding private inurement of earnings to shareholders or individuals. Under these rules, private inurement will not result from the lowering of premiums, the improvement of benefits or the improvement of the quality of healthcare. There will also be proscriptions on substantial legislative activities and a prohibition on political activities.

The revenue procedure will require a copy of the notice of award issued by CMS together with the executed loan agreement accompanying the CO-OP's application for exemption.


http://www.mondaq.com/unitedstates/x/164758/IRS+HRMC/IRS+Provides+More+Guidance+On+Health+Insurance+Cooperatives
Hat tip: Mondaq

Opinion- Nebraska: Insurance Exchanges Need to Work for Rural Nebraskans

The Nebraska Legislature will soon be debating the merit of the development of a health insurance exchange in Nebraska. Rural places and their residents have unique circumstances that must be considered and addressed in the development of Exchanges. It is important to note that rural patients face the most daunting of health care challenges: they are older, poorer and sicker. Rural America is less healthy due to too much smoking, drinking and eating, and too little exercise, education, jobs and income.

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Health insurance exchanges must assure rural relevant risk sharing. We understand and support the value in the pooling of risk amongst insurers that occur amongst qualified plans for sales both inside and outside of the exchange. By pooling risk across a larger portion of the population relative to the individual market, exchanges will spread risk and create a much more stable market place. Exchanges can both reduce premium costs for residents and attract a greater volume of health plans to the market. In the past, many health plans have competed on who was best at avoiding sick people. The elimination of medical underwriting is hugely important to this principle, but it could be lost if the individual mandate and accompanying tax credits is eliminated as a consequence to adverse action by the courts.

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We realize that some have argued that national health plans are antagonistic to individual state exchanges and much prefer to compete within the context of a single set of rules determined by the Federal government as default for those states who do not establish an exchange by 2014. However, we believe that there are many high-value in-state insurance products that have developed and that these products will better continue to flourish with state-based exchanges. We believe the quality of products will increase more if exchanges facilitate a consistent set of metrics that are the focus of any incentives by health plans within the exchange.

The Nebraska Rural Health Association sees the exchanges as a critical tool for expanding access to health insurance coverage, while fostering value-based competition among private plans to promote quality and efficiency. Exchanges are particularly important in rural communities as they are in general more dependent on the individual and small group markets. To the detriment of rural communities, many have seen these markets as being less functional than the market for larger employers.


http://www.journaldemocrat.com/ag_news/x440451529/OPINION-Insurance-Exchanges-Need-to-Work-for-Rural-Nebraska
Hat tip: Syracuse Journal-Democrat

Illinois- Who Should Control Illinois’ Public Health Insurance Exchange?

As Illinois and other states rush to implement federal health insurance reforms, consumer advocates say lawmakers shouldn’t allow insurers to make all the decisions.

Illinois must create a board to oversee the state’s federally-mandated public health insurance exchange by late June if the state wants to access hundreds of millions in federal funds, says Jim Duffett, executive director of the Illinois-based Campaign for Better Healthcare. But Duffett warns that filling the governing board with insurance providers would mean expensive and restrictive choices for consumers.

“If you can’t regulate and negotiate with the insurers, they’re going to be able to charge whatever they want and be able to dictate the terms,” Duffett says.

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Duffett wants the governing board that oversees Illinois’ public exchange to include health experts, consumers, small business representatives, and possibly a representative from the office of the Illinois attorney general. Duffett says insurance providers have no place on the board. He likens the board to a jury, with insurers being attorneys who must convince the jury.

“We want a board that is racially, geographically, culturally diverse,” Duffett says. “We think by having a board like this, it will bring balance. Needless to say, there’s not a consumer lobby that has as many political contributions and as much influence as the insurance industry.”

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Meanwhile, insurers have told the Illinois Health Care Reform Implementation Council, created by Gov. Pat Quinn to oversee federal reforms, that they should have a seat on the board to ensure the public exchange is competitive yet still viable for private insurers.


http://www.illinoistimes.com/Springfield/article-9684-healthy-exchange.html
Hat tip: Illinois Times

Kansas- Conservative Kansas Republicans Look To Defund Implementation of Exchange

The growing ideological rift in the Kansas Republican Party has engulfed the implementation of the federal health care reform law, leaving the future of the state's role in Obama's health care reform program hanging in the balance.

Conservative Republicans in the Kansas House of Representatives are leading an effort to defund the state's share of the implementation of a health care exchange, saying that the state should not be taking any action to implement the law until after the U.S. Supreme Court rules on the case later this year. The move -- which the state's moderate Republican insurance commissioner is objecting to -- is being done in accordance with a resolution adopted by the Kansas Republican Party last year.

"It is the GOP's intent to say 'no more,'" said state Rep. Pete DeGraaf (R-Mulvane). "Until [health care] gets decided, the Republicans in Kansas have strongly spoken."

DeGraaf said he and other House Republicans want Insurance Commissioner Sandy Praeger to stop implementing the health care exchange, a component of the health law that requires states to create programs and websites to allow for consumers to compare and contrast health insurance plans. Praeger has sought to create the program, saying that the law's passage by Congress and President Obama binds her to start working on the state exchange until the court makes a ruling. A Supreme Court ruling is not expected until late June.

"We are telling her to cease and desist," DeGraaf said.


http://www.huffingtonpost.com/2012/02/16/health-care-reform-kansas-republicans_n_1282450.html
Hat tip: Huffington Post/ John Celock

Georgia- Legislators Seek Action on Georgia Insurance Exchange

Sen. Nan Orrock, D-Atlanta, and Rep. Pat Gardner, D-Atlanta, urged the General Assembly on Thursday to take action on legislation (House Bill 801 and Senate Bill 418) that would establish a new health insurance marketplace in Georgia.

The legislators said Georgia needs to move forward with setting up a marketplace to help small business owners and individuals buy health coverage. State-based insurance exchanges are a key part of the national health care law.

Gov. Nathan Deal has said he doesn't want Georgia to move forward with planning for a state-based exchange until the Supreme Court decides whether the health law is constitutional. But Orrock and Gardner said Georgians need the marketplace now and that the state could end up with a federally run exchange if the state does not act.


http://www.ajc.com/news/georgia-government/legislators-seek-action-on-1351566.html
Hat tip: Atlanta Journal-Constitution

Vermont- Health Care Exchange Bill Clears Committee

The complicated and controversial health care bill cleared a House committee Thursday after weeks of tinkering and some close votes.

Eight members of the committee voted to approve the bill with the two Republicans on the committee, Jim Eckhardt and Patti Komline voting against.

For nearly a month, members of the House Committee on Health Care wrestled with legislation that lays the ground work for a health benefits exchange.

The confusion surrounding the exchange and the intersection between federal and state law created confusion both in and outside the state house.

“It’s frustrating to know there’s a lot of it we don’t understand,” said Paul Poirier, a Barre Independent who voted for the bill.


http://vtdigger.org/2012/02/16/health-care-exchange-bill-clears-committee/
Hat tip: Vermont Digger/ Alan Panebaker

Opinion- Maryland: Health Exchanges Will Benefit Maryland Families

It's no wonder Maryland families are so hard pressed to find good, affordable health insurance — premiums have outpaced earnings, and the field of insurance options is confusing. Even if a family is fortunate enough to have coverage, it's hard to know if what you're paying for is going to be there for you when you need it. That's why our Health Care for All Coalition is so excited about Gov.Martin O'Malley's health care bill (SB 238). By setting up a competitive insurance marketplace for private health insurance, also known as an exchange, this bill will give Marylanders more choice, more control and more peace of mind about their health care.

In Maryland, the average premium for family coverage in an HMO went up 42 percent in just six years, from $9,573 in 2004 to $13,613 in 2010. At the same time, the median family income declined 2 percent (adjusted for inflation). As a result of this disparity, 14.5 percent of non-elderly Marylanders, or 720,000 people, are uninsured. Given the recent economic turmoil, this would have been even worse but for the expansion of health care coverage in recent years to more than 300,000 Marylanders, funded in large part by a lifesaving increase in the state tobacco tax.

Fortunately, the federal health care law known as the Affordable Care Act has created a tremendous opportunity for states to make health care more affordable by creating exchanges that are better marketplaces for private health insurance. The O'Malley administration's bill takes advantage of this opportunity and leads the country in implementing a stronger, redesigned health care system.


http://www.baltimoresun.com/news/opinion/oped/bs-ed-health-exchange-20120215,0,731307.story
Hat tip: Baltimore Sun

National- Sebelius Sees Exchanges Bolstering Employer Coverage

A year and a half before HHS plans to begin enrolling people in state and federal health insurance exchanges, it remains unclear how many employers will drop their employee coverage due to that option, said HHS Secretary Kathleen Sebelius. In testimony before the Senate Finance Committee Wednesday on the administration's fiscal 2013 budget proposal, Sebelius said she expects the coming insurance marketplaces to bolster employer-sponsored coverage by allowing those companies to buy coverage there.


http://www.kaiserhealthnews.org/Daily-Reports/2012/February/16/reform-implementation.aspx
Hat tip: Modern Healthcare/ Kaiser Family Foundation/ Kaiser Health News

Minnesota- House: Bipartisan Health Exchange Bill Faces Long Odds

Legislators in the state House and Senate introduced bills this week to create a health insurance exchange in Minnesota, but the actions don't signal a breakthrough on the contentious question of how to comply with the federal overhaul of the nation's health care system.

A bill introduced Thursday in the House of Representatives by Rep. Joe Atkins, DFL-Inver Grove Heights, featured bipartisan support in the form of co-sponsorship from Rep. Greg Davids, R-Preston and two other Republicans.

But Davids was clear in saying he thinks the federal legislation is a "scourge," adding that he hopes it will be overturned this year by the U.S. Supreme Court. More broadly, Davids said he wasn't aware of any broad change of heart among Republicans who last year blocked legislation on the subject.

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On Wednesday, Sen. Tony Lourey, DFL-Kerrick, introduced a bill in the Senate that's the companion to the Atkins legislation. Both bills embrace recommendations from an advisory board on health exchanges that was created last year by Gov. Mark Dayton, a Democrat.

But Lourey said he currently has no Republican co-sponsors for his bill. Senate Republicans have not introduced any health exchange legislation of their own.


http://www.twincities.com/legislature/ci_19980461
Hat tip: Pioneer Press

Insurance Industry- California: Making a Place for Small Businesses in Exchanges

Small businesses know the power of collectives.

From agricultural co-ops to trade associations, small businesses frequently pool their resources and increase their buying power, leveraging better deals for their members.

That's the very idea behind the Small-Business Health Options Program.

State-based exchanges will go online in 2014, aiming to offer more affordable health insurance options in the individual market. At the same time, states will also create exchanges for small businesses. The Affordable Care Act leaves it up to states on whether these exchanges will be combined or run separately.

A series of articles last week in Health Affairs, supported by the Commonwealth Fund, lays out the benefits, pitfalls and possibilities of SHOP exchanges.

As Editor-in-Chief Susan Denzter noted, "These insurance stores for the small-group market ... sound simple in concept, but as [the articles] make clear, they are anything but."


http://www.californiahealthline.org/road-to-reform/2012/making-a-place-for-small-businesses-in-exchanges.aspx
Hat tip: California Healthline/ California Healthcare Foundation

Wyoming- Rate of Exchange for Health Care Options Increases as Wyoming's Deadline Nears

Wyoming lacks a system for consumers to shop for insurance with the lights on. But that could change in 2014, when the state's first insurance exchange is expected to begin operating.

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Despite the possible benefits, the success of a Wyoming exchange is hardly certain. Skeptics wonder whether the marketplace could succeed in a rural state with a small population. Designers must also convince a right-leaning Legislature to adopt a program that's most associated with President Barack Obama and federal health reform.

...

She[Rea] believes an exchange has the potential to improve the system here. But she's pessimistic lawmakers will establish a program that benefits their constituents.

"All someone in the Legislature has to say is, 'It's going to cost too much,'" she said. "Rather than looking at how citizens can have access to good, affordable health care."

...

When Congress passed the Affordable Care Act in 2010, it made exchanges a key part of health reform. The law requires Wyoming to open an exchange by the start of 2014. States that don't meet the timeline risk a federal takeover.

Federal health reform remains controversial in Wyoming. But even critics of the reform law see potential in exchanges, said Anne Ladd, chief executive officer of the Wyoming Business Coalition on Health.

...

An exchange would also reduce the number of uninsured people in Wyoming. Between 38,000 and 41,000 people are expected to enroll in the marketplace by 2016, according to one estimate from a state consultant. More than 60 percent will be people who currently go without coverage.


http://trib.com/news/state-and-regional/rate-of-exchange-for-health-care-options-increases-as-wyoming/article_f8a2de54-8ace-542e-aad2-26b138fb78bf.html
Hat tip: Casper Star-Tribune

Alaska- Takes Biggest Step Yet Toward Exchange

Alaska has opposed the federal health law so adamantly that it is the only state that chose not to even apply for a $1 million grant the federal government was passing out to states to plan a health insurance exchange. But that doesn’t necessarily mean there won’t be an online marketplace to buy insurance in Alaska.

Last month, the administration of Gov. Sean Parnell, a Republican, hired Public Consulting Group to study the state's options for setting up an exchange. The state is spending $200,000 on the contract with the Boston-based firm.

The state-based exchanges will allow consumers to easily find and compare health insurance plans online. The Affordable Care Act establishes the exchanges as one-stop shopping for individuals and small businesses to buy insurance and to qualify for subsidies or Medicaid.

Josh Applebee, Alaska's deputy director for health care policy, described the reasoning for hiring the consultant.

"The biggest problem, I think, is we don't have enough information to decide," Applebee said. "Are we going to do a state exchange? Are we going to do a partnership with the federal government? Are we going to let the federal government run the exchange themselves? If we do the state exchange, what does it look like? What kind of form is it going to take? How much is it going to cost? All of these questions need to be answered."

States have until Jan. 1, 2013 to submit their exchange plans to the federal government for certification; if a given state doesn't do so, the feds can set up the exchange for that state. The exchanges are supposed to be working by Jan. 1, 2014.

In addition to Alaska, Public Consulting Group is advising 13 other states on how to implement an exchange. Applebee says the state will benefit from that experience, but the company will also have to take Alaska's unique characteristics into account.

"Certainly we deliver health care [over greater distances] than any other state and in different ways than any other state," Applebee said. "So they can bring they're experience with them, but they also need to apply that to whatever happens here in the state."

A few states—including Massachusetts and Utah--have exchanges in place and more than a dozen have made significant progress. Applebee says Alaska is benefiting from taking a slow approach: "We're learning from other state's mistakes and we're taking advantage of other state's successes. And I think that's an advantage we have in our timeline."

Meanwhile, state Sen. Hollis French, a Democrat from Anchorage, is hoping to convince other lawmakers to pass his bill establishing an exchange. "Once you realize you're going to get an exchange imposed upon you from Washington, it only makes sense to try to create one that works for Alaskans," French said.

Despite the fact that they are both moving in the same direction, Parnell does not support French's bill, and French does not support the administration's work.

"I think the governor is making a mistake by circumventing the legislature and going without our input," French said.

It's unclear how much support French has among his colleagues in the legislature. He expects to bring his bill to the Senate floor for a vote soon.

Sen. Cathy Giessel, a Republican from Anchorage, said she will not vote for it. She agrees with the administration's approach studying exchange options. Asked to speculate on how the bill will fare, she says the focus right now in Juneau is on just one thing: oil taxes. "It's really sucking the air out of the room, so I don't know what chance this has of actually getting all the way through the process," Giessel said.

But French is optimistic. He says other aspects of the Affordable Care Act are controversial, but the health care exchange is not.

"This is really about just trying to find an affordable insurance policy for the citizens of the state, and most people can agree that's a good thing," French said. "They may disagree about how you get there, but it’s a pretty rare person who doesn't want to see more people covered by insurance."

The Parnell administration expects the consultant's study and recommendations to be ready by the end of March or early April. That is just in time for oral arguments in the Supreme Court case against the Affordable Care Act. The high court is expected to rule in June, and Applebee says the state of Alaska will be waiting for that ruling. "We'll know at that point how to proceed," he said.


Reprinted with permission: Kaiser Health News. Thanks!

http://www.kaiserhealthnews.org/Stories/2012/February/14/alaska-exchange.aspx
Hat tip: Kaiser Family Foundation/ Alaska NPR/ Kaiser Health News/ Annie Fiedt

Idaho- Likely to Spurn Federal Cash for Exchange

Opposition from House conservatives has ended Gov. C.L. "Butch" Otter's plans to use a $20.3 million federal grant for a state-run Idaho insurance exchange required by the federal health care overhaul.

Instead, discussions between legislators, Otter and the insurance industry have shifted toward a state exchange created without federal money, but that's still sufficient to reassure U.S. Department of Health and Human Services officials that Idaho isn't blowing them off.

They're walking a thin line between keeping a federal exchange from being imposed on Idaho that could disadvantage the state's insurers, while still letting "Obamacare"-loathing legislators tell constituents they didn't bend to Washington, D.C.

"My major concern personally is accepting federal funding," said Rep. Lynn Luker, R-Boise. "It would lock us in to what they want us to do."

...

Consequently, Sen. Dean Cameron, R-Rupert, and an insurance agent, says a smaller, undetermined sum - scratched from somewhere in Idaho's tight budget - will likely be sufficient to at least get started. He said the important thing for Idaho is to not cede an exchange to the federal government, whose version he believes will disadvantage Idaho insurers and offer products that are more-expensive for consumers.

"It would make it easier to use the federal funds," Cameron said. "But I haven't spent much time thinking about that, because I have to deal with the realities of the day."

House Minority Leader John Rusche, D-Lewiston, and a former health insurance industry executive, said letting the federal money slip through Idaho's fingers simply to win House conservatives' support is a costly political bargain.


http://www.idahostatesman.com/2012/02/14/1993986/idaho-likely-to-spurn-federal.html
Hat tip: Idaho Statesman

Connecticut- Health Foundation Raises Red Flags on CT Health Exchange

The Universal Health Care Foundation on Tuesday raised fresh concerns about Connecticut's health insurance exchange including strongly cautioning the state against adopting the exchange currently run by the Connecticut Business & Industry Association.

The Foundation, which has been a strong advocate for a state-run health plan, also raised objections to the Health Insurance Exchange Board's lack of small business and consumer representatives and is looking for new seats to be added to the board.

...

Additionally, the UHCF also raised concerns about the recommendation by national benefits consulting firm Mercer, which was hired by the state to analyze the insurance market, that the Connecticut Business & Industry Association run the SHOP exchange for small businesses.
...

The Mercer recommendation, which was first reported by the Hartford Business Journal, urged the state to consider leveraging CBIA's experience with its Health Connection's exchange by utilizing it as a statewide vehicle.

...

Foundation officials say there would be too many potential conflicts of interest if CBIA ran the exchange.

...

The Foundation also raised concerns about CBIA's lobbying role, saying the business organization represents the state's private sector health care industry and has consistently opposed non-profit or public alternatives being added to the market.


http://www.hartfordbusiness.com/news22668.html
Hat tip: Hartford Business Journal

CO-OPs- Oregon: New Health Care Model Makes Doctors Visits/ Prescriptions Affordable for Uninsured

We’re not waiting for political things to happen,” says Morgan Butler, membership services community organizer for Patient Physician Cooperatives Portland. “We’re creating our own thing, which seems to work a lot better and a lot faster.

“We want people to know they can have a primary care provider right now. And they won’t have to wait months for an appointment.”

Patient Physician Cooperatives Portland (PPCPdx) is not an insurance policy. It is a nonprofit that brings together physicians and patients outside of the traditional insurance model. To join the co-operative, patients pay $18 a month.

...

Just seven months old, PPCPdx is up and running with 30 health care providers and 80 members. On the providers list, so far, are two medical doctors and two family nurse practitioners, along with chiropractors and naturopathic doctors, acupuncturists and massage therapists.

Carr says most doctors haven’t yet heard about the co-op; word is just beginning to spread in medical circles. She was keen to sign up as a provider because she already sees many patients who have no insurance and pay cash for services.

“It made a lot of sense to me to sign up with this plan,” she says. “It’s a pretty reasonable model of care. When I was starting out I thought a lot about how I wanted to practice, and this fits nicely with giving providers work and giving patients a good opportunity for access to health care.”

...

Former health industry executive Don McCormick launched Patient Physicians Cooperatives in Houston, Texas, 8 years ago. After working with physicians groups for 40 years, he agreed to help a clinic reorganize, and came up with the idea of a co-op. The Houston co-op now offers services from 49 diverse doctors. And in Hickory, N.C., the Apollo Healthcare Cooperative, opened in 2009, has grown to 600 members and offers a seven-day a week urgent care clinic.

...

Size matters, however, when it comes to what the co-ops can offer. The Houston co-op has partnered with hospitals, an imaging center and specialists, as well as with individual doctors. It also offers a low cost insurance that covers hospital care.

Portland’s co-op needs to add members so it can offer these kinds of valuable extra benefits, Butler says.

Low-cost legal services are available now, and other optional extras can be added, as the number of members grows.

“I’d like to have 300 members signed up, because at that point we can do a whole lot more,” he said. “We have a lot more buying power and people will start coming to us.”

Butler says he gets a lot of questions about how co-ops work, when people get a serious illness such as cancer.

“If you do get cancer, we will advocate for you to get Medicare rates for your treatment,” he says. “We can help you apply to state of the art cancer centers, like the Anderson Clinic in Houston. And if you are signed up with a primary care provider, you will have a far more personal care experience.”

...

Butler sees the co-op as a good step toward making medical care available to everyone. “Some people say they won’t get involved with anything less than a single-payer system, he said. “But anyone who knows how health care is set up, knows that we couldn’t put in a single-payer system tomorrow if we wanted to. Patient/Physician Cooperatives can be part of that transition. We are definitely part of the solution.”


http://theskanner.com/article/New-Health-Care-Model-Makes-Doctors-Visits-Prescriptions-Affordable-for-Uninsured-2012-02-13
Hat tip: The Skanner/ ppcpdxcoop.org

Editorial Note: This legal framework was created outside the provisions of the ACA.

Texas- Slow to Move on Health Care Reforms

Texas is almost alone among the nation's largest states in failing to start work on a key piece of the Affordable Care Act, as legislators and state agencies follow Gov. Rick Perry's dictum to delay action until after a Supreme Court ruling and the November election.

"Politics superseded good policy," state Rep. Garnet Coleman, D-Houston, said of the inaction on creating an exchange to help small businesses and individuals buy health insurance.

Texas is one of nine states - other than Florida, the others are mostly small, with relatively few uninsured residents - identified by the Kaiser Family Foundation as having made "no significant progress" toward establishing an exchange. A Perry spokeswoman said there are no plans to change that.

"(Perry) feels the health care bill is unconstitutional and misguided," spokeswoman Lucy Nashed said. "There are no plans to implement an exchange."

But analysts say the delay makes it more likely the state will miss a Jan. 1, 2013, deadline for proving a state exchange is on track. If it's not, the federal government will impose its own exchange.

...

State Rep. John Zerwas, an anesthesiologist and Richmond Republican, unsuccessfully pushed a bill to create an exchange last year. "It was the desire of the governor to take a wait-and-see position, in light of the fact that it was being challenged (in court), and in consideration to what might happen in November," Zerwas said.

He and other officials said Perry could create an exchange by executive order;Nashed said Perry has no plans to do so.

Zerwas said he believes an exchange could help the uninsured, especially those who own or work for a small business.

"The problem with an exchange is, it got synonymous with Obamacare and it was tainted," he said.


http://www.chron.com/news/houston-texas/article/Texas-slow-to-move-on-health-care-reforms-3313025.php
Hat tip: Houston Chronicle/ Kaiser Family Foundation