Pennsylvania- Questions Raised About Proposal for State Exchange

Advocates for health insurance reform are taking a dim view of a draft proposal for the state's health insurance exchange, saying it could keep the playing field tilted in favor of insurance companies and against consumers.

Speaking at a conference call Friday, Antoinette Kraus, project director of Pennsylvania Health Access Network, a coalition of organizations supporting consumer-friendly health reform, said the draft proposal distributed by the state Insurance Department, if enacted, would not change the status quo.

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But the department's draft proposal, dated Jan. 30, would allow "multiple exchanges" that could be operated by private contractors, Kraus said. The exchanges would not necessarily be regional operations, she said.

The 32-page draft says an office set up to oversee the exchange could "authorize one or more entities… to operate exchanges in the marketplace." The draft suggests that exchanges could be solely directed to providing insurance opportunities to individuals, with others providing insurance opportunities to small businesses.

http://articles.mcall.com/2012-02-06/health/mc-pennsylvania-insurance-exchange-draft-20120205_1_insurance-exchange-health-insurance-insurance-department

Hat tip: The Morning Call

Opinion- Ohio: State, Businesses Should Embrace Health Care Exchanges

With less than two years before health care reform becomes fully operational, Ohio has not begun to set up its exchange, and instead, the administration has chosen to let four federal start-up funding opportunities slip away.


http://www.cantonrep.com/opinion/letters/x458334583/State-businesses-should-embrace-health-care-exchanges
Hat tip: The Repository

Minnesota- Future of health care: Comparison shopping

"Today, it's very difficult to shop for insurance, particularly on the individual market," Ario said. "If you're young and healthy, there are good deals. If you're not young and especially if you have a health condition, you're probably not going to get much help out of the individual market today."

The fate of the exchanges is wrapped up in a looming Supreme Court ruling, election-year politics and policy battles over how they will work.

But Gov. Mark Dayton is moving ahead on establishing a Minnesota model, even as legislators prepare dueling bills. Just last week, Dayton embraced the guiding principles recommended by his 15-member health insurance exchange advisory task force.


http://www.startribune.com/business/138720099.html
Hat tip: Star Tribune

Idaho-'Health Care Gurus': Idaho Needs to Return the Exchange Money

A pair of health policy experts Thursday talked about state and federal health exchanges and they have a single message for Idaho lawmakers: Give the money back and wait.

John Graham, health care studies director for the Pacific Research Institute, a California-based think tank, and Christie Herrera, with the American Legislative Exchange Council, held meetings with lawmakers Thursday to urge them to hold off on any decisions about a state-based health exchange. Graham and Herrera were sponsored toBoise by the Idaho Freedom Foundation.

http://www.idahoreporter.com/2012/health-care-gurus-idaho-needs-to-return-the-exchange-money-and-wait-on-the-idea/
Hat tip: Idaho Reporter

Exchange IT- ONC Chief Mostashari Expects Big Year Ahead for Exchanges

Health information exchange will ramp up significantly in 2012 because the necessary elements of interoperability will be in place, ONC[Office of National Coordinator] chief Farzad Mostashari, told the Health IT Policy Committee at a meeting Feb. 1.

The health information exchange strategy means finally bringing together the standards, identity authentication certificates, governance for rules of the road, and the availability of directories or digital provider phone books.

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These will enable providers to exchange information whether through a simple transaction for a referral or sharing a test with another provider or a more complex query for patient data.

More work will need to be done, “but I think we really do have the pieces coming together for a big win on interoperability in exchange in 2012,” Mostashari told the panel.


http://www.healthcareitnews.com/news/mostashari-expects-big-year-ahead-data-exchange
Hat tip: Healthcare IT News

Minnesota-Health Task Force Makes Recommendations

A health insurance exchange advisory task force handed its recommendations to DFL Gov. Mark Dayton on Monday, stressing the need to find a Minnesota solution in establishing a state insurance exchange.

But the recommendations were drawn without Republican input, the governor explained. “They declined to participate (in the task force),” Dayton said.

Dayton insisted the task force was not steered by the administration, but just the opposite. “They’re the ones leading us,” he said.


http://erstarnews.com/2012/02/03/health-task-force-makes-recommendations/
Hat tip: Elk River Star News

Missouri-Mo. Senate Passes Health Insurance Measure

Missouri senators have approved a measure that would require approval from lawmakers or voters before the state makes efforts to set up health insurance exchanges.

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Legislation approved by the Missouri Senate would bar Gov. Jay Nixon from creating an insurance exchange by executive order. The measure was approved 25-8 and now moves to the Missouri House.


http://www.semissourian.com/story/1811852.html
Hat tip: Southeast Missourian

Montana-Doctor Sees CO-OPs as One Solution to Health Care Mess

The chairman of the fledgling Montana Health Cooperative laid out a dismal picture of the American health care system during a presentation in Billings on Wednesday.

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Roberts, president of the Western Montana Clinic in Missoula, thinks one answer is health care co-ops. The Affordable Care Act of 2010 authorized the creation of health care cooperatives, and Congress ultimately appropriated $3.4 billion to provide them with start-up loans.

The Montana co-op is being organized by a group of doctors and people with experience in health insurance, state and local government, private business, labor and education.

Like co-ops elsewhere in the country, the Montana organization would be owned and operated by its members and would provide health insurance to individuals and small employers who have trouble finding affordable coverage.

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Roberts declined to say how big a loan the Montana co-op applied for, but he estimated start-up costs at $5 million. Larger future loans would be “solvency loans,” which the co-op would have to park in a bank in the form of required reserves.

He said the co-op hopes to begin offering coverage by January 2014, elect a full board of directors by 2016, repay its start-up loans by 2018 and pay off all its loans by 

2028.

http://billingsgazette.com/news/local/doctor-sees-co-ops-as-one-solution-to-health-care/article_4aab42e0-e53c-5b88-a5c4-6fd042b22c62.html
Hat tip: The Billings Gazette

Kaiser Health News- States Under Pressure as Health Law Deadlines Approach

The health law's biggest changes don't take effect until 2014, when states and insurers must be ready to begin signing up an estimated 32 million people in Medicaid and private insurance. But a successful rollout in two years hinges on critical decisions that states must make – and take quick action on – this year.

It will be difficult for many states to meet fast-approaching deadlines, and some may not make it, says Brett Graham, a managing director at Leavitt Partners, a consulting firm working with states on implementation of the law.

Time is short, and states are missing key pieces of how-to guidance from the federal government about everything from what various insurance exchange options will look like to which benefits must be included in health plans, he says. To make matters worse, states are competing for a limited pool of information technology vendors to help them get started.

"It's a pressure cooker," said Graham. States are "in a position where they have to act with imperfect information."

One of the most pressing tasks for states this year has to do with the creation of exchanges, through which individuals and small businesses can buy insurance starting in 2014.

On Jan. 1, 2013, the Department of Health and Human Services will certify which states will be ready to run exchanges on their own. To win certification, a state must enact laws to fund the continuing operations of an exchange. While the federal government is providing financial help up front for the creation of exchanges, states will assume the cost once they are underway. HHS can issue a conditional certification for those states that are making progress but need more time.

Only 14 states plus the District of Columbia have made legislative progress toward creating an exchange, according to a Jan. 22 Robert Wood Johnson Foundation reportprepared by the Urban Institute. Another 21 states have demonstrated interest, and 15 have made little headway.

While some states are aggressively moving forward, "at the other end are states that say, 'no way, no how, we're not doing it.' Montana, Texas, Louisiana, Florida, they are not going to build it and they're playing a game of chicken," said Graham. "They’re waiting for the Supreme Court," hoping it will effectively kill the health law in June when it rules on challenges to its constitutionality.

Most states, though, are undecided about whether to build their own exchanges and are moving forward in varying degrees. Even some states that are part of the Supreme Court challenge are moving forward: Colorado, Washington and Nevada have created exchanges.

Originally, the only alternative to a state exchange was a fully federal entity. HHS has since offered to partner with states. That way, a state could retain overall control of an exchange while passing certain responsibilities to the federal government.

But creating a full or partial federal exchange also could be problematic: Some health care analysts question whether the task will be any easier for the federal government. It faces the same short timeline as states this year, and while Obama administration officials say they have the money to fund exchange activity, some health care analysts say they aren't so sure.

Most state legislatures are scheduled to adjourn for the year by March or April, before the Supreme Court rules, according to the National Conference of State Legislatures. Reconvening after the ruling would be difficult in an election year.

Insurers Need Long Lead Time

Insurers, which will offer coverage to individuals and small businesses through the exchanges, also are worried about the timetable. Until they know more about required benefits, for example, health plans say it's difficult to develop new products, negotiate with doctors and hospitals and invest in information technology.

"Open enrollment has to be ready to go by Oct. 1, 2013, so in January of 2013 we have to submit our products and rates for [state] approval," said Alissa Fox, senior vice president of the Blue Cross and Blue Shield Association. If health plans make changes before the federal government issues its specific requirements, they might have to start over, and that can be costly and time consuming, she says. "We want to change our claims processing system once, our enrollment system once."

Last fall, Blue Cross urged HHS to release all outstanding regulations by the beginning of 2012 to give states and insurers sufficient time to make decisions.

That hasn't happened. Among other things, states urgently need guidance on how the federal government would partner with states on exchanges or run its own exchanges, says Joy Johnson Wilson, health policy director for the National Conference of State Legislatures. "No rule, no concept," she said. "Soon is good."

Chiquita Brooks-LaSure, director of coverage policy at HHS, said that working with states is a "top priority … As we get similar questions from states, we will put out guidance to answer general questions. We’re going to continue to be responsive."

On Jan. 25, HHS provided more details about the kinds of benefits insurers will be required to offer consumers and small businesses beginning in 2014. The agency had been under pressure to provide more information after releasing a general "bulletin" in December giving states broad flexibility to design benefits.

State legislators are particularly eager to learn how they can divvy up responsibilities with the federal government in the case of a federal or partnered exchange. One of the most important questions is who decides whether low-income people are eligible for Medicaid or federal subsidies to buy insurance in an exchange. The Medicaid program is being expanded to include people with income higher than currently allowed.

Graham sees a possible clash of federal and state budget interests over Medicaid, which states help fund. For the first two years Washington will pay 100 percent of the costs for the newly eligible, but the federal contribution will taper off to 90 percent beginning in 2020.

"If the federal government wants someone to be covered, it may say that person is eligible for Medicaid," Graham said. "A state that already has a significant budget crisis won’t want to expand Medicaid. Who owns the process?"

Krista Drobac, director of the health division at the National Governors Association, says states want authority over eligibility. "It's hard to control your program design if you're not responsible for determining eligibility and enrolling people," she said.

That's why states are beginning to lay the groundwork for information technology, she says. They're scrambling to sign technology vendors, who are in short supply.

Drobac says states have enough information to get started, even while missing details. But officials are worried.

"We're down to the wire," said Wilson. "When the bill passed in 2010, 2014 seemed a long way away. But when you back into what it takes to get the program up and running, it's a very short timetable."


Reprinted with permission: Thanks! 
http://www.kaiserhealthnews.org/Stories/2012/February/02/states-health-law-deadlines.aspx
Hat tip: Kaiser Family Foundation/ Kaiser Health News/ Marilyn Werber Serafini

Opinion- Pieces From Around the U.S.

Iowa- "Let the Feds Create Iowa's Health Exchange"
The health reform law relies on “exchanges” in each state to connect Americans with insurance. Starting in 2014, people will be able to shop in these marketplaces to buy insurance coverage. Many will get help from the government to pay for it.
States are supposed to build their exchanges or the federal government will do it for them.
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It was a reminder that special interests will work hard to benefit themselves, and they are circling again this year.
Granted, the federal government is vulnerable to the same types of influences. Yet executive branch officials are comparatively less likely to be swayed by special interests. They don’t receive campaign contributions. They don’t have to pander to voters.
http://www.desmoinesregister.com/article/20120202/OPINION03/302020041/1094/SPORTS0206/?odyssey=nav%7Chead
Hat tip: Des Moines Register


New Hampshire- "We Must Reject Health Exchange"
The New Hampshire House will take up legislation soon that would prohibit a state health insurance exchange and force Washington to repeal, replace or amend Obamacare.A health insurance exchange is a bureaucratic set of state-regulated and standardized health care plans in the United States, from which individuals may purchase health insurance eligible for federal subsidies. Under Obamacare, states must implement these exchanges by Jan. 1, 2014, or the federal government will do it for them.State health insurance exchanges are really the meat and potatoes of Obamacare, and also the structure that would enable enforcement of the individual mandate.
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Health insurance exchanges involve the total takeover of the health-care market by the federal government, whether through a voluntary state health insurance exchange or a default federal exchange.
http://www.concordmonitor.com/article/308394/we-must-reject-health-exchange?SESS4e64e70cbb755cdd78e4464b1ef34cc9=google&page=full
Hat tip: Concord Monitor


Idaho- "Gov. Otter Gives Up the Fight, Before it Even Got Started"
The health exchange issue has put Gov. Butch Otter in the middle, flanked by two of his natural constituencies.
On one side are the business interests that have reliably supported Otter throughout his political career. They believe, adamantly, that a state-run health exchange is a must — because it provides small businesses with a marketplace where they can shop for affordable insurance.
On the other side are some of the most conservative members of the Legislature. They believe, adamantly, that an exchange is simply an extension of a federal government takeover of health care, especially since it would be bankrolled by $20.3 million from the federal health care law.
Otter seems to be taking the easiest possible way out.
Last week, he told reporters that the health exchange issue is all but moot because the state probably doesn’t have enough time to put together the framework of a plan to meet a January 2013 federal deadline.
http://www.idahostatesman.com/2012/01/29/1972803/otter-gives-up-the-fight-before.html
Hat tip: Idaho Statesman

Exchange IT-What Percentage of U.S. Adults Want To Keep Reform Law's Online Insurance Exchanges?

Nearly 60% of U.S. adults surveyed in January want to keep in place the federal health reform law provision that calls for setting up online, state-based health insurance exchanges, compared with 16% who wish to repeal the provision and 25% who are not sure, according to a new poll from Harris Interactive/HealthDay.

By comparison, 51% of U.S. adults surveyed in November 2010 wanted to keep this provision of the law, while 17% wanted to abolish it and about one-third were unsure.

http://www.ihealthbeat.org/data-points/2012/what-percentage-of-us-adults-want-to-keep-reform-laws-online-insurance-exchanges.aspx
Hat tip: iHealth Beat

Further analysis:

http://consumer.healthday.com/Article.asp?AID=661099
Hat tip: Health Day

Minnesota- State Starts Work on Health Care Plan

The debate over health care is set to heat up in Minnesota.

A group tasked with developing an online health insurance marketplace where people can compare health insurance plans made recommendations to Gov. Mark Dayton this week.

But Republican legislators opposed to recent health care reform legislation declined to take part in the process.

The Minnesota Health Insurance Exchange Advisory Task Force was assembled by Minnesota Department of Commerce Commissioner Mike Rothman. He appointed 15 members that represent a wide range of interests including consumers, legislators, health care providers and health insurers.


http://www.mndaily.com/2012/02/02/state-starts-work-health-care-plan
Hat tip: Minnesota Daily

Tennessee- Rep. Casada: Leaving Exchange to Governor “Viable Option”

Tennessee’s legislature could take a hands-off approach to setting up a state insurance exchange, as part of the federal healthcare law. A conservative lawmaker says his peers might simply leave the details to the governor.

Franklin Republican Glen Casada says many of his colleagues find it “unpalatable” to switch on part of the federal healthcare overhaul. Casada says in talks with constituents, he lays it out as a choice between the lesser of two evils:

“I think some Tennesseans think that if the state rejects the health insurance exchange, then we have effectively stopped Obamacare, and that couldn’t be further from the truth. The health insurance exchange – it’s federal law, it will be implemented. So now the question is: Does Tennessee do it, with our policy and procedures, or do the feds do it with their policies and procedures?”



http://wpln.org/?p=33647
Hat tip: Nashville Public Radio

Connecticut- Lawmakers Face Tough Policy Decisions On Basic Health Plan

Over the next few months the legislature will have to tackle some tough policy questions about whether to create a State Basic Health Plan for about 74,000 low income adults, who make too much money to qualify for Medicaid.

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Some of those unknowns still remain because the plan would largely be based on the “Essential Health Benefits Package,” which the Insurance Exchange Board has yet to develop.

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He said the Exchange Board first has to set the “Essential Health Benefits Package“ before the department is able to decide whether there would be enough subsidies to support such a plan.

“In that light, while it’s premature for us to have a position for or against the BHP, the administration is certainly considering it in the context of the Exchange and other health reform efforts,” Dearborn said.

But some advocates are sold on the idea of a State Basic Health Plan and Tercyak is one of them.

He said with the exchange still being largely private insurance many of the people who would be in this plan instead of that plan will protect private insurance companies from seeing their costs increase.

“The basic health plan helps protect the insurance companies,” Tercyak said. “So that there plans in the exchange can be reasonably priced.”

http://www.ctnewsjunkie.com/ctnj.php/archives/entry/lawmakers_face_tough_policy_decisions_on_basic_health_plan
Hat tip: Connecticut News Junkie

Virginia-Bills to Create Health-Care Exchanges Halted

Legislators and insurance lobbyists urged a House of Delegates committee to approve a bill Tuesday that would create a health-care exchange to comply with federal law, but the panel decided to wait.

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Bill Hazel, Virginia’s secretary of Health and Human Resources, said the federal regulations haven’t been written yet to say how the exchanges should be designed, or what insurance protections they will provide.

“This is clearly an unsettled issue, and … I cannot recommend that we go ahead with an exchange,” Hazel said.

http://www2.newsadvance.com/news/2012/feb/01/bills-create-health-care-exchanges-halted-ar-1654086/
Hat tip: Lynchburg News and Advance