As Idaho works through the early stages of organizing its new state-based health insurance exchange, neighboring Washington is much farther down the road, and now has released the rate proposals from health insurance companies that plan to sell coverage on its state exchange. The big surprise: Expected large price increases didn’t materialize. Instead, most consumers who purchase insurance through the Washington exchange would pay less than they do now, and get more coverage. Only those under age 30 would face higher costs, and they’d have options for lower-priced catastrophic coverage. In addition, those who qualify for subsidies based on their income would pay less than the newly announced rates.

“We’re pleasantly surprised with the individual rates we’ve seen so far,” said Washington state Insurance Commissioner Mike Kreidler. “In many cases, people will get better benefits and pay less – especially if they qualify for subsidies.” Meanwhile, Idaho’s exchange is just getting organized. So far, the 19-member exchange board has met twice, elected officers, hired an executive director and established six subcommittees on everything from information technology to operations. It will function as an independent, quasi-governmental agency; it is working on plans to issue requests for proposals to establish its online portal and make the exchange operational by Oct. 1. You can read our full report here at spokesman.com.

Amy Dowd has accepted the job offer, and will be the executive director of Idaho’s new state-based health insurance exchange. “She’s accepted, she’s very excited, she’s eager and ready to go,” reported Stephen Weeg, interim exchange board president. “She’s happy to be back in Idaho, and she’s told her husband it’s time to find a place to live.”

Dowd, currently a health care consultant with Ernst & Young in Portland, was one of three key consultants who helped develop Idaho’s initial blueprint for a state-based exchange in 2010-11, working as a contractor for the state Department of Insurance. She also formerly worked as a health care consultant and for Blue Cross Blue Shield in New York, and early in her career, from 1993 to 2000, was an IT project manager and lead analyst for information systems and Web development projects for Idaho Power.

The 19-member exchange board interviewed Dowd for an hour today in executive session before deciding to offer her the job; she previously was one of five candidates interviewed by state officials who selected her as the finalist. “She’s one of the people that can hit the ground running,” said board member Margaret Henbest. “She has a strong project management background, a strong insurance background. She has state relationships in Idaho.”

Board member Zelda Geyer-Sylvia noted that the Department of Insurance “gave her very high marks for the work she had done before.” Board member Kevin Settles said, “She’s got a great skill set for our needs right now.” Said board member Frank Chan, “I believe she was very well qualified, and I’m looking forward to working with her. I can’t wait ‘til she gets on board and just hits the ground running.”

Amy Dowd, a health care consultant with Ernst & Young LLP in Portland, Ore., has been selected as executive director of Idaho’s new state-based health insurance exchange. The exchange board this morning voted unanimously to offer Dowd the job, which will pay in the range of $175,000 a year.

Dick Armstrong, Idaho Department of Health & Welfare director, said in anticipation that the state-based exchange would be established, “We began to do some searching of individuals that would be qualified as executive director. I used standard procedures that I use with Health & Welfare’s HR department.” Five individuals were interviewed, he said, “in preparation for this moment.”

As for the salary level, Armstrong said, “I felt comfortable that the market is going to demand the $175,000 level. There is a high risk involved here … it does come with risk for the individual. So that’s where I came to make the recommendation to the governor’s office, based on those processes.”

After the board’s unanimous vote to make Dowd the job offer, Stephen Weeg, interim chairman of the exchange board, said, “I will proceed now and get hold of Amy today and start the negotiation, and hopefully we have someone on board and starting to help us out tomorrow.”

The 19 board members of Idaho’s new state-based health insurance exchange got a surprising welcome soon after they were appointed – anonymous calls to each of them, threatening that they’ll each individually be targets in a lawsuit. “I got a call from a guy who did not want to identify what firm he worked for,” said Stephen Weeg, the board’s interim chairman. “He just wanted to give us all a notice that within three months’ time we would all be sued for being on this board – I think he called everybody on this board, just to let us know that we were already in trouble.”

Weeg said his first reaction was, “Wait a minute – we’re just doing what the law requires.”

Rep. Kelley Packer, R-McCammon, a board member, said, “I actually chuckled, because I thought, you know, we’re here trying to provide a service.” She said she was disappointed that opponents of the exchange would “stoop to these tactics,” and said, “I did call the speaker and let him know. He said, ‘Don’t worry – the state will have anybody on the board covered and indemnified.”

Weeg said the board will make sure it has good legal counsel and board member indemnification. “But it was somewhat of a surprise welcome to the board. It was quite a reminder for me of how much attention is being paid to what we do and how we do it.” You can read my full story here at spokesman.com.

The board of Idaho’s new state-based health insurance exchange board opened its first meeting this morning in the Lincoln Auditorium in the state Capitol; it is being video streamed live online here. “We have a challenge ahead of us,” said interim exchange board chairman Stephen Weeg, the retired head of a community health center, Health West, in eastern Idaho. “There was a huge amount of work on the part of a lot of people … to see Idaho create its own health insurance exchange. And the little task that we have before us is between now and October, get a business started and make an exchange operational and make it work for the citizens of Idaho.”

The 19-member board is scheduled to meet from 8:30 to 4 today, and tomorrow until noon. Today’s agenda includes overviews of the law that set up the exchange and Idaho Open Meeting Law requirements; a review of the exchange’s scope and requirements and the roles of the state departments of insurance and health and welfare; and setting of key tasks and time frames. Tomorrow morning at 9, the board is scheduled to go into executive session for a telephone interview with a candidate for executive director of the exchange.

The exchange will provide a voluntary marketplace for Idahoans to compare and buy health insurance plans online and access new government subsidies. David Hensley, Gov. Butch Otter’s chief of staff, told the board, “We’re going to be counting on each and every one of you to make this successful. … One of the most critical things to the governor is the openness, accountability and transparency of this board. He believes that we are directly responsible to the people of Idaho.”

Weeg encouraged all the board members to be active participants, saying, “My sense on this is that we'll need the collective intelligence of all of us and best work from all of us in order to make this work.”

Gov. Butch Otter today announced the members of the 19-member board of Idaho's new state-based health insurance exchange, including 14 he appointed; two non-voting ex-officio members, the directors of the state departments of Insurance and Health & Welfare; and three lawmakers appointed by legislative leaders. The legislators named to the board were Sen. Jim Rice, R-Caldwell; Rep. Kelley Packer, R-McCammon; and Rep. John Rusche, D-Lewiston.

The governor's appointees include a doctor, a nurse, employers, health insurers, and three consumer representatives. “I’m grateful that people with the talent, experience and ability to serve effectively on this board accepted the challenge,” Otter said in a statement. “We have decided to build and operate a voluntary, state-based health insurance exchange rather than defaulting to total federal control. The folks who have agreed to serve on the board will be our eyes, ears and most importantly the voices of Idaho in this process.” Click below for the governor's full announcement.

The Milk Producers of Idaho have come out in favor of Gov. Butch Otter’s proposal for a state-based health insurance exchange in Idaho. “The board strongly felt that it is important to have decisions regarding health insurance coverage in Idaho to be determined by Idahoans and not federal bureaucrats,” said Brent Olmstead, the group’s executive director. “Whether we like it or not, the Supreme Court has upheld the PPACA. It is the law and simply ignoring it is not a viable option.” You can read the dairy group’s full announcement here.

Idaho Gov. Butch Otter was notified today that the U.S. Department of Health & Human Services has “conditionally approved” Idaho’s plan to operate a state-based health care exchange. “We got a phone call from HHS informing us of that decision,” said Jon Hanian, Otter’s press secretary; the call came yesterday afternoon, and was followed by a letter today  from HHS Secretary Kathleen Sibelius to Otter. “It shows that despite an extremely difficult timeline, staff did a pretty good job of pulling all the various required components together,” Hanian said. “If we get approval from the Legislature, then we have HHS’s approval to go ahead and move forward with the plans we submitted. … It means that we’d eventually probably have their full approval for running it on our own, which is what the governor identified as the reason we’re doing this.”

Otter convened a working group that studied the issue for months, before overwhelmingly recommending that Idaho opt for a state-based exchange to enable residents to shop for health insurance plans and access government subsidies, rather than let the federal government run Idaho’s exchange. The exchanges are required under the national health care reform law, but Idaho had been exploring the idea well before the law passed.

Sibelius, in a news release today announcing conditional approval for state exchanges in Idaho, California, Hawaii, Nevada, New Mexico, Vermont and Utah, said, “States across the country are working to implement the health care law and build a marketplace that works for their residents.” Nineteen states and the District of Columbia have now been conditionally approved to partially or fully run their own exchanges.

Here's a link to my full story at spokesman.com on Gov. Butch Otter's announcement today that he's recommending a privately operated, state-based health insurance exchange in Idaho as the best option for Idaho to maintain control over how health care reform operates in the state. Said Otter, “I know the earnest and well-intentioned debate will continue,” as lawmakers consider the exchange legislation he'll propose in January.

The Idaho Health Exchange Alliance, a coalition of more than 400 insurers,  businesses, individuals and trade associations in Idaho, applauded Gov. Butch Otter's decision today to recommend that lawmakers approve a privately operated, state-based health insurance exchange. “We're very grateful that Gov. Otter has shown Idaho the way forward on this issue,” said Heidi Low, executive director of the group.  “A state-based exchange will help Idaho have more control over Idaho's health insurance costs and keep Idaho in the driver's seat on health insurance issues.” You can read the group's full statement here.

Meanwhile, Wayne Hoffman, executive director of the Idaho Freedom Foundation, decried the governor's announcement, issuing this statement: “I have a great deal of respect for my friend, Gov. Otter. However, I strongly disagree with his decision. More than 20 states have indicated that they will not implement a state exchange. States are opposed because they understand that Obamacare depends entirely on states to implement it. States are opposed because they know that a state exchange affords almost no flexibility and makes states co-owners of the looming disaster in medicine: higher insurance premiums, more expensive medical care, reduced accessibility and worse patient outcomes. Gov. Otter's decision makes the national effort of resistance much more difficult and more likely the law will remain in place, at great cost to Idaho families, businesses and our nation's economic vitality. Idaho Freedom Foundation will do everything it can, along with other opponents of Obamacare, to make sure Idaho never implements this destructive law.”
  

Among lawmakers reacting to Gov. Butch Otter’s health care exchange announcement today is Sen. John Goedde, R-Coeur d’Alene, who spoke from Denver, where he’s attending an education meeting. “ I think the governor did the right thing in the face of certainly a lot of opposition,” said Goedde, who served on Otter’s working group. “I don’t think that we have any choice - we’re going to establish  a state-based exchange, or we are going to get the federal exchange by default.”

Goedde, a longtime insurance broker, said Idaho’s health insurance premiums are among the lowest in the nation, in part because Idaho has so few state mandates on what insurance plans must offer. If the state were lumped in with other states in a federal exchange, “There’s no question in my mind … it’s going to drive the cost of insurance up.”

Some Idaho  lawmakers have been outspoken in opposition to doing anything required by “Obamacare,” and ideological groups like the Idaho Freedom Foundation have been lobbying hard against a state-based exchange, even as Idaho business groups and insurers  pushed for it.  Last year, the Idaho Legislature took no action on an insurance exchange, gambling that the U.S. Supreme Court would overturn the law. Instead, it upheld it.

“I’m just proud of our governor,” Goedde said. “He knows he’s going to be taking heat, but he did the right thing.”

Rep. Vito Barbieri, R-Dalton Gardens, has been among the most outspoken opponents of a state exchange. “My inclination is to resist,” he said after the governor’s announcement. “The bottom line is if the federal government is going to control it, they should run it. I’m just not inclined to believe that the Legislature should just rubber-stamp this, but there’s a lot of new people there and we’ll have to see how they go. I’m just not going to be able to go along. I don’t think it’s good for my state, I don’t think it’s good for my constituents, and I’m absolutely convinced that my constituents do not want it.”

House Minority Leader John Rusche, D-Lewiston, a retired physician and former health insurance excecutive, said, “Idaho’s a low-cost health insurance state. And if we’re pooled with the national average, you can expect that you’d be paying the national average.” He estimated that Idahoans pay $500 to $1,000 less in annual premiums than the nation as a whole, mainly because of few state manda and low utilization rates. Putting Idaho into a federal exchange would force Idahoans to pay national rates, he said.

“It’s the better decision,” Rusche said of Otter’s announcement.  He added, “The politics of this are going to be really interesting.”

Gov. Butch Otter’s recommendation for a state-run health insurance exchange matches that of his working group that studied the issue for months – it’d be a privately operated, state-based exchange. Jon Hanian, Otter’s press secretary, said the privately run feature was a “better option” because it can get up and running more quickly than a traditional state agency. But, he said, “Let’s be honest. There was very little in these options that he liked. … But I think given all the work that the working group did and the fact that this decision kind of preserves some options and preserves flexibility for Idahoans, I think that’s why he came down where he did on this.” He added, “It’s going to be a work in progress.”

Health insurance exchanges, under the national health care reform law, will provide an online marketplace where consumers can shop for the plans, rates and features they want, and also access government subsidies if they qualify for them. States have the option of setting up their own exchanges, partnering with the federal government, or doing nothing and allowing the federal government to operate their state exchanges.

Said Otter, “All the criticisms of the exchange mandate that I and many others have expressed remain valid and troubling. The law is governed by an evolving set of increasingly complex rules and requirements. It is onerous, unwieldy and fraught with unknowns. That makes it all the more important to remember that my decision today can be rescinded if the Legislature disagrees or withdrawn by me if circumstances warrant – a real possibility on such a constantly moving target. But with what we know today, this is our best option.”

Otter will propose legislation when lawmakers convene in January to set up the new exchange. “We will have details about it in the State of the State,” Hanian said, the message the governor delivers to a joint session of the Legislature on its opening day, Jan. 7.

Idaho Gov. Butch Otter announced today that he's notifying the federal government that Idaho will opt for a state-run health insurance exchange, subject to legislative approval. “This is not a battle of my choosing, but no one has fought harder against the mandates and overreaching federal authority of the Affordable Care Ac,” the governor said in a statement. “No one has more consistently and clearly demanded that Idaho retain the authority and flexibility to chart our own path forward. There was a judicial process for challenging Obamacare, and the presidential election was at least in part a referendum on its enactment. But despite our best efforts, the law remains in place, and almost certainly will for the foreseeable future. There will be a health insurance exchange in Idaho. The only question is who will build it.”

He added, “Our options have come down to this: Do nothing and be at the federal government’s mercy in how that exchange is designed and run, or take a seat at the table and play the cards we’ve been dealt. I cannot willingly surrender a role for Idaho in determining the impact on our own citizens and businesses.” Click below for his full announcement, including a Q-and-A about the decision.

Idaho Gov. Butch Otter has decided to delay a decision on how to proceed on a health insurance exchange in Idaho, now that HHS chief Kathleen Sibelius has agreed to give governors more time; a decision had been due today, but now the deadline has been pushed back to December. Click below for Otter's full announcement.

“I have my working group’s recommendation, and I have been listening carefully to stakeholders and citizens about this important choice,” Otter said. “This extension gives us more time to get answers from HHS about what the federal requirements will be.” Otter noted that he consulted with other GOP governors at a Republican Governors Association meeting in Las Vegas this week from which he just returned today. “I don’t want us buying a pig in a poke,” he said, “so with this extension I’m hoping we’ll get answers to the questions and concerns we’re hearing from legislators and the public.”

In response to a request from the Republican Governors Association, U.S. Secretary of Health & Human Services Kathleen Sibelius has sent out a letter giving governors extra time to make their decisions on how to proceed on health insurance exchanges - a decision for which the deadline was looming tomorrow. Last week, Sibelius gave governors until December to file the “blueprint” that will flesh out the details of the decision, but didn't move the Nov. 16 deadline for a “letter of intent” declaring the state's decision. If states don't opt to set up their own, state-based exchanges or enter partnerships with the federal government, the feds will take over and operate the exchange for those states.

Idaho Gov. Butch Otter has been considering the decision, and convened a working group that studied the issue for months, then recommended overwhelmingly that the state go with a state-based exchange operated by a private non-profit. Otter is at the RGA meeting in Las Vegas today, where the issue was among the discussion topics, and his office just received Sibelius' letter late this afternoon. Otter's press secretary, Jon Hanian, said, “I think over the next 24 hours you should know whether or not we're going to make some decision tomorrow or take additional time.” You can read Sibelius' letter here.

The Idaho Community Action Network, a statewide non-profit advocacy group with more than 2,000 members, issued a report today calling strongly for Idaho to expand its Medicaid program to cover the working poor. That also was the unanimous recommendation of a 14-member working group appointed by Gov. Butch Otter, which studied the issue for months.

“It's the right choice for Idaho - it's going to save us money, and it's going to save lives,” said Terri Sterling, the group's organizing director. “When you think about the families this is impacting right now, it's very sad across the state. … I have interviewed lots of these families, and it's so heartbreaking and heart-wrenching to hear some of these stories.”

ICAN's report, “Invest in a Healthy Idaho,” calls a Medicaid expansion “a prescription for ending the drain on state and county resources and creating financial stability for Idaho's patients.” It highlights the stories of several Idahoans who lack health insurance, including Aaron Howington, who works, but much of his income goes to child support payments; he lives in a camper in the back of his pickup truck, can't afford health insurance and makes too much to qualify for Medicaid. “Without good health, I may not be able to continue working,” he said. “I don't know what I would do then. The Medicaid expansion would allow me to get the care that I need to stay healthy and keep my job.”

States have the option of expanding Medicaid, the state-federal program that provides health insurance to the poor and disabled, to cover the working poor under the national health care reform law, largely at federal expense; a decision from Otter and state lawmakers on which way to go is pending.  In Idaho, an expansion would save the state hundreds of millions over the coming years, because the state currently covers the catastrophic medical bills of indigent residents entirely with county property taxes and state general funds.

Kelly Anderson of Boise said she hopes the state chooses expansion. “Right now I have several bills that are in collection due to not having insurance and needing medical care,” she said. “Once they expand the Medicaid and cover people that aren't covered, I think you'll see a whole lot less emergency room visits that don't get paid for because people can't afford them, and I think you'll see a healthier country.” Said Alecia Clements, an ICAN state board member, “I have good insurance, thanks to God, but a lot of Idahoans don't.” If Idaho doesn't expand the program, she said, “It's going to cost us anyway, even more - I hope that our legislators understand that.”

ICAN was formed in 1999 through a merger of the Idaho Citizens Network, a citizens' advocacy group focusing on the concerns of low-income residents, and the Idaho Hunger Action Council.

Corey Surber, chair of the governor's Medicaid expansion working group, said, “At this point I'm sensing consensus, but I'd like to do one more check.” She asked working group members, if they didn't agree with Option 3 - expand Medicaid - with the identified caveats about benefit design, personal accountability and the like - to turn on their microphone lights. None did. That means it's unanimous - the group is backing Medicaid expansion for Idaho.

Still to be finalized is the group's formal report to Gov. Butch Otter, which will be word-smithed and completed over the next few days. You can read my full story here at spokesman.com.

Here are some of the working group members' comments as they debate options for Medicaid expansion in Idaho:

Sen. Patti Anne Lodge, R-Huston, said, “This would be good for our people in Idaho. But we also …  don't know what the future's going to hold, and we don't know what the federal government is going to  do with its $16 trillion deficit and the fact that they're going to be putting bigger burdens on the states.” She said, “I'm not quite there totally. I know it's good for Idaho, but I'm very concerned about what this burden is going to place upon our people.”

Dr. Ted Epperly said he's “strongly in favor” of expanding Medicaid in Idaho. “Really what we have an opportunity to do here is shape a new health care system and a new insurance program. … I love a benefit redesign that really puts a lot of personal accountability and incentivization onto patients for their health.” He added, “I think we need to focus on what we can control, and what we can control is what we do here in Idaho with this program. … It's a real opportunity for us.”

Dan Chadwick of the Idaho Association of Counties said, “The CAT program, the county indigent program, has run its course. It's time for it to end in this state because it has not done its work. It's becoming financially and administratively unsustainable.”

Tom Faulkner said Idaho's now paying 100 percent of the costs for health care for the working poor from its state general fund and from county property taxpayers. “If we could have 90 percent to 100 percent of that paid by the federal government, why wouldn't we do it?”

Beth Gray said, “The data that's been presented today seems to me to be overwhelmingly compelling.”

Gov. Butch Otter's Medicaid expansion working group is now considering what recommendation to make to Otter. Member Mike Baker spoke out in favor of expansion. “There's financial benefits, there's the opportunity to do something right here,” he said. “From the state perspective, you look at the numbers, you look at the things we've learned through these discussions, and I think it's great - a great opportunity for us to put together a different model.” He said he hoped Idaho could develop an appropriate benefit plan that would fit the state and the targeted population, and provide the appropriate incentives.

Rep. Fred Wood, R-Burley, said he's concerned about “how to control costs and how to bring the best medical care at the cheapest cost to patients in that population. And that we do get away from the perverse incentives in the American health care industry that are going on today, we get away from fee for service medicine, we get away from the old traditional managed-care concept.  We actually have to get a system whereby the consumers and the providers … actually own the system, as opposed to feeding off the system. If we're going to go down that road, then I can wholeheartedly endorse the concept.” But, he said, “If we're going to just have another entitlement program … then no, you don't have my support, nor do I think you'll have the Legislature's support.” Said Wood, “We aren't just signing a blank check. That's not what we're about. We're about doing it right or we're not going to do it.”

Gov. Butch Otter's Medicaid expansion working group is receiving a report from consulting group  Milliman this morning on the potential impacts to the state. “On a purely financial basis, it would make sense to expand,” Justin Birrell of Milliman told the working group. “You save $6.5 million if you expand. It would cost you $284 million if you don't.” That's over a 10-1/2 year period starting in the second half of state fiscal year 2014. Added the firm's Ben Diederich, “The state and local offsets are what's very unique to Idaho.”

That's because of how Idaho currently funds health care for the indigent; through the state's medical indigency/Catastrophic Health Care program, the money comes entirely from the state general fund and from local property tax money. This afternoon, the working group is scheduled to decide on its recommendation to Otter on what the state should do; under the national health care reform law, states have the option of expanding their Medicaid programs largely at federal expense.