Consulting firm KPMG has offered some estimates of the costs for a state-based health insurance exchange: $77 million to set it up, and $10 million a year for operations. A partnership or “hybrid” exchange, in which the federal government would handle some aspects and the state others, would have a lower startup cost of about $15.5 million, and operating costs of about $1.7 million a year. Costs for the federally run option, as far as Idaho, couldn't be estimated. “There are grant funds available under all these scenarios,” said Sandy McBride of KPMG. Nevada, for example, received a $75 million federal grant for start-up of its exchange; Washington has received $152 million.

Gov. Butch Otter's health insurance exchange working group is meeting today in the Capitol Auditorium and will meet again in its final meeting on Oct. 24; you can see the agenda here and listen live here (a lunch break is planned from noon to 1 MT). Otter will have to declare by Nov. 16 whether Idaho will set up its own state-based exchange; default to a federally run exchange; or go with a partnership between the two. States do have the option to change their choice on that same date each year thereafter, presenting a fourth option: Start with a partnership, and transition toward a state-run exchange over time; a state-run exchange would allow Idaho to continue to control the regulation of its health insurance market.

Rep. John Rusche, D-Lewiston, said of the consultant's report today, “I think that they're saying what some of us have been saying for a while: That by dawdling, we've taken options off the table.” He said, “I'm not surprised - I'm disappointed.” But he noted that not all the information is in yet as far as whether Idaho could pull together some form of state-run exchange. “There are people that are still hopeful,” he said. Click below for a full report from AP reporter John Miller.

Consultant Jack Grovner was asked by Gov. Butch Otter's health insurance exchange working group to look into whether Idaho could pursue a privately run model and still meet federal requirements under the health care reform law. The answer: Yes, if it comes through a state-established private non-profit corporation. That's a subset of the state-run exchange option; Idaho must decide whether to go with a state-run exchange, default to a federally run exchange, or go with a partnership between the two.

Rovner found that Idaho has a precedent for a private, non-profit model: Its Idaho Health Data Exchange, a non-profit created in 2008 to carry out the initiative started by President George W. Bush in 2004 to move toward a nationwide tech infrastructure for exchange of medical data. The Idaho Health Data Exchange, incorporated by state Health & Welfare Director Dick Armstrong, was designated by Otter in 2009 as the entity carrying out that initiative for the state, qualifying it to receive federal grant funds.

A similar model could be adopted for an Idaho state health insurance exchange, Rovner said; Hawaii already has gone that route. The non-profit could receive federal grant funds for set-up, but not for operations; the state could set it up so that the exchange would have to be self-sustaining through fees or assessments, and would receive no state taxpayer funding. Hawaii's private, nonprofit exchange already has received a $62 million federal grant for set-up.

“What Idaho did on that health data exchange is really the perfect template,” Rovner said. “This is an option that will work, if you're interested in it - it's legal.” Rovner will make a presentation to the working group this afternoon; you can read his memo here.

Sen. John Goedde, R-Coeur d'Alene, has been promoting the idea of a private option, but possibilities he raised earlier, including “renting” an existing exchange structure, or essentially contracting out the service to a private firm, haven't proven workable under federal requirements. Goedde called the private non-profit model “intriguing,” and said it may offer a path that's more politically appealing in Idaho. “I think we need to take a look at every viable option we've got,” Goedde said. “Idaho, I think, traditionally has been a state where they feel less government is better. And if we can move something into a nonprofit arena as a viable option, certainly we need to consider that.”

Last month, hopes for a private model dimmed after State Insurance Director Bill Deal addressed lawmakers on the Health Care Task Force; but Deal said he was addressing the prospect of using an existing outside firm. “Basically what I was saying was if you go out to the marketplace today, you cannot find a not-for-profit or even a for-profit organization that has all of the pieces that could come in and hire them to run an exchange,” he said. “There's just not one out there.”

Rovner said a private non-profit could be established by executive order, and wouldn't necessarily require legislative action. However, Deal said, “That's a political issue. … This has been such a controversial issue in Idaho,” that it might be better for lawmakers to weigh in. “I just think in the long haul, it would be a cleaner method of getting to a conclusion of what that exchange should look like.”

Legislation that was prepared last year, but never acted on, called for a quasi-governmental entity to oversee a state-run Idaho exchange, rather than a private non-profit. Deal said either way, a board would have to be set up and all the details determined as to how the exchange would work, and timelines are tight for that. “That isn't going to be set up like magic no matter what,” he said. “The timeline is our enemy.”

Gov. Butch Otter's health insurance exchange working group is meeting today; you can watch live here. First up, the panel is hearing a cost analysis report from consulting firm KPMG. Among the conclusions, KPMG project manager Robert Mitchell told the panel: “We believe it's impractical for Idaho to try to build your own exchange by Oct. 1, 2013.” He added, “There is a whole lot to be done.”

Other states that are much farther along still are wrestling with details, he said. Idaho faces a Nov. 16 deadline to tell the federal government whether it wants to go with a state-run exchange; a federally run exchange; or a partnership between the two. If it makes no decision, the state defaults to a federal exchange. A partnership could allow the state to maintain control of plan management and/or customer outreach components, and then, in the future, move toward a state-run operation, Mitchell said.

Gov. Butch Otter's health insurance exchange working group meets today from 10 a.m. to 3 p.m. in the Capitol Auditorium; Idaho Public Television will video-stream the meeting live here. The agenda includes speakers, via teleconference, from the Cato Institute and ALEC, along with health law consultant Jack Rovner; you can see the full agenda here. A second working group, looking into a potential Medicaid expansion, is scheduled to meet again in mid-September; both groups will present recommendations to Otter in the fall as to how to proceed under the national health care reform law.

After hours of presentations, including extensive information about federal requirements and about what other states are doing, the governor's Health Insurance  Exchange Working Group has wrapped up its first meeting and set another for late August, likely the 29th or 30th. “We really want to move forward with this committee and get those recommendations to the governor as soon as we can,” said working group Chairman Bill Deal, director of the Idaho Department of Insurance.

Among the key points covered today: If Idaho were to do nothing or fail to meet the federal government's mid-November deadline to decide what it'll do on a health insurance exchange, it'll get a federally run exchange. One mid-way step, if the state isn't in a position to meet the deadline, is to propose a partnership in which the feds would facilitate the exchange, but the state would take on certain duties, possibly as a transition toward a fully state-run exchange in a future year.

“I hope this meeting today was of benefit to you to get started with this,” Deal told the working group. The group is dividing up a list of 14 questions to research in the weeks before its next meeting. Said Deal, “We're going to move as fast as we can.”

There's a capacity crowd of more than 60 in the audience this morning as the governor's Health Insurance Exchange Working Group gathers for its first meeting. “Our challenge is to find some solutions,” state Insurance Director Bill Deal told the audience, adding, “We also extend a welcome to all of you who have chosen to join us this morning. We've got a good crowd, and that is good.”

The agenda for today's meeting, which runs from 10 a.m. to 3 p.m. in the west conference room of the J.R. Williams Building across from the state Capitol, includes overviews of the Supreme Court's health care decision; the Idaho insurance market; insurance and market reforms in the health care act; legal requirements, deadlines and options for a health insurance exchange; and discussion of next steps for the panel. “Today I think our goal of this working group is to establish the foundation for future meetings,” Deal said. The 13-member panel includes lawmakers, representatives of Idaho's major insurers, lobbyists, a business owner, a physician and an insurance agent.

Deal said the panel won't take any public testimony today, but is offering the public the opportunity to submit questions on cards, which will be answered via email. Audio streaming also is being offered for those who want to listen from afar; there's a link on the Department of Insurance website here.

Deal said thus far, there are 15 states planning for state-run health insurance exchanges; one planning for a partnership exchange; seven that have decided against a state-run exchange; and the rest, including Idaho, still are weighing options.

Idaho Gov. Butch Otter has named the 26 members of two working groups he's appointing to explore issues surrounding a state health insurance exchange and a possible Medicaid expansion under the national health care reform law; state Health & Welfare Director Dick Armstrong will chair the Medicaid expansion group, which will hold its first meeting Aug. 6; while Idaho Department of Insurance Director Bill Deal will chair the exchange group, which is still working to schedule its first meeting. The groups include people from both the public and private sectors, including several state lawmakers; click below for the full list. Both groups will report back their findings and recommendations to Otter by fall.

Nearly two weeks after the U.S. Supreme Court upheld the national health care reform law, Idaho Gov. Butch Otter has issued his reaction. “Like nearly everyone else, I was surprised by the U.S. Supreme Court’s ruling,” he writes in an op-ed piece distributed to Idaho newspapers and media. “Rather than vindication for Idaho’s legal challenge to Obamacare or clarity about a path forward, the court’s decision left me and many others with more questions than answers.”

Otter said he's not ready to join those GOP governors who already have declared they won't implement either a health insurance exchange or a Medicaid expansion, hoping instead that President Obama will be defeated and the law will be overturned in the future. “I can’t fault them for that approach and I share their desire for that outcome, but I can’t yet join them in putting all our policy eggs in that basket,” Otter writes. “My priority remains finding Idaho solutions that make quality health care more accessible and affordable for all Idahoans. To that end, rest assured I will continue working for market-based solutions while resisting tax increases and imposition of more unnecessary government bureaucracy. But I also will not put Idaho citizens in the position of hoping and working for the best outcome without also preparing for the worst.”

The governor said he's putting together working groups to research the issues surrounding the exchange and the Medicaid expansion and Idaho's options; the groups will give him their findings and recommendations by fall. Click below to read his full op-ed; meanwhile, three Democratic state representatives, Reps. Phylis King, Sue Chew and Shirley Ringo, have sent out an op-ed piece hailing the benefits of the court decision for Idaho women, from expanded coverage for preventive services to closing the “donut hole” for seniors on prescription drug coverage; you can read their piece here.

Idaho Rep. Raul Labrador has joined Sen. Jim DeMint, R-S.C., Rep. Michele Bachman, R-Minn., and a group of other national lawmakers in signing a letter urging all 50 states' governors not to implement health care exchanges as required under the national health care reform law that last week was upheld by the U.S. Supreme Court.

“I urge Governor Otter to not implement an expensive, intrusive, punitive health exchange on the businesses and people of Idaho,” Labrador said in a statement. “I urge all Governors to let Congress finish the job the American people sent us to do, to fully repeal Obamacare and replace it with common-sense free market solutions.”

In Idaho, businesses interests, including the state's health insurers and the Idaho Association of Commerce and Industry, have been calling for setting up a state-run exchange to avoid having a federal exchange imposed on the state; in this year's legislative session, lawmakers declined to act, betting instead that the high court would overturn the law, but it didn't. Click below to read Labrador's full statement; here's a link to the letter.

The Legislature's Health Care Task Force has voted 11-1 to endorse the draft legislation for an Idaho health insurance exchange, and to “send it to a germane committee to let them determine whether it's best for the state or not,” in the words of Sen. Joyce Broadsword, R-Sagle, who made the motion. The sole “no” vote came from House Health & Welfare Chairwoman Janice McGeachin, R-Idaho Falls; you can read my full story here at spokesman.com.

“I am not opposed to the idea of setting up an exchange in our state, but I do have some concerns with this legislation the way it's drafted,” McGeachin said. “I have … offered to sit down with the director of insurance about some of my concerns. I'm not opposed to the idea of an exchange in Idaho, but I do have some particular concerns with the way this bill is drafted.”

Rep. John Rusche, D-Lewiston, said, “As always, the devil's in the details and the plan of operations is really going to say whether this is successful and meets the needs of Idaho. But as far as the framework, I think it's probably as good as we can get. I support the committee's endorsement.” Sen. John Goedde, R-Coeur d'Alene, said as he cast his “yes” vote, “I'm going to vote to support this, but I would be open to looking at amendments that might improve it.”

The Legislature convenes on Monday.

State Insurance Director Bill Deal said the proposed health insurance exchange legislation would set up a “state-operated, market-driven health insurance exchange.” Part of what that means has to do with a Dec. 16 bulletin from HHS that said states can decide the “benchmark plan” or minimum level of benefits required in any plan to be sold on their exchange, though they'd still have to meet 10 general criteria listed in the federal law for essential benefits. If states don't set up their own exchanges and the federal government steps in, it would make that decision for the state, even to the point of specifying which insurers could sell plans on the exchange.

Tom Donovan, deputy insurance director, said the bulletin makes clear that states can choose to let the market drive their benchmark plans, essentially allowing any legally qualified insurer to sell its plan on the Idaho exchange. That's the approach the Idaho legislation takes.

Idaho State Insurance Director Bill Deal is presenting the draft legislation for a state health insurance exchange to the Legislature's joint Health Care Task Force; the room's about a third full, with lots of lobbyists in attendance. The nine-page bill includes an emergency clause, making it effective upon passage.

Among the questions from the lawmakers: Rep. Fred Wood, R-Burley, noted that federal law says a majority of the board overseeing the exchange can't come from the insurance industry. With the legislation specifying three carriers and three producers on the board, he said, that means the two lawmakers, who would be appointed to the board by the speaker and Senate president pro-tem, couldn't be “associated with the insurance industry,” he said. Deal confirmed that, saying, “Correct.”

The board would have 13 members, 11 of them voting. Nine would be appointed by the governor, with confirmation from the Senate. Those would include three representing different health carriers; two representing producers; one representing “individual consumer interests;” and three representing employers of varying sizes. The two non-voting members would be the directors of the state departments of Insurance and Health & Welfare.

During the state Legislature's Health Care Task Force discussion this morning on health insurance exchange legislation, Rep. Carlos Bilbao, R-Emmett, said he's visited lots of senior centers and nursing homes in his district in the past few months, and has found people there both concerned and confused about the exchange and what it would mean. State Department of Insurance Director Bill Deal responded, “First of all, if you're at your senior citizen centers, you're dealing with a different group of people.” People age 65 and over qualify for Medicare and aren't a part of the exchange. “The exchange goes up to (age) 64,” he said.

Task force Co-Chairman Rep. Gary Collins, R-Nampa, noted that for seniors, Senior Health Insurance Benefits Advisors, or SHIBA, offers guidance on how to navigate the various coverage options under Medicare; SHIBA's website at the state Department of Insurance says, “We offer free and unbiased information, counseling, and assistance regarding senior health insurance. We do not sell insurance, recommend policies, agents, or specific companies. It is our goal to provide you with up-to-date and objective information to assist you in making informed buying decisions.”

Deal said the idea under the proposed Idaho health insurance exchange is that uncompensated “navigators” would fill the same role for those ages 64 and under that SHIBA does for seniors with Medicare.

The Idaho Legislature's Health Care Task Force got a detailed rundown this morning from Bill Deal, director of the Idaho Department of Insurance, on the latest draft of legislation to establish a health insurance exchange in Idaho. Deal said the latest draft, from Dec. 9, has been developed by Gov. Butch Otter's health care council, a drafting committee from the Department of Insurance, and “innumerable recommendations that have come from people interested, and many of those have been incorporated.” The department also has been holding public meetings around the state on the plan; a recent one in Idaho Falls drew more than 60 people.

The plan envisions a resource for Idaho purchasers of individual and small employer health benefit plans, that would include listings of all the qualified plans available along with their costs and benefits, and uncompensated “navigators,” who could be anyone from chambers of commerce to unions, who could help purchasers sort through the various plans. The exchange would be overseen by a 13-member board, including three representatives of health insurance companies, two of insurance agents or “producers,” one of individual consumers, and three representing various sizes of small employers in Idaho. The governor would appoint the board. An advisory panel of providers, including physicians, pharmacists and so forth, would advise the board, and the board would designate at least one of its members as a liaison to the provider advisory committee.

Rep. John Rusche, D-Lewiston, said, “I think the advisory committee is a good approach.” But, he said, “I have had feedback from several people that the governance board seems to be very heavy with the insurance industry … (and) light on purchaser or citizen input.” Deal said the board will be an administrative body, and it'll be important for members to have management experience and know a lot about information technology, since the whole exchange will be tied to an online portal. The board, he said, won't be reviewing the financial stability or market conduct of insurance providers - that duty will remain where it is now, with the Department of Insurance.

The Health Care Task Force likely will meet again, possibly the first week of the legislative session, to review the final version of the legislation.

Seven states that are suing to overturn the national health care reform legislation are among 13 that today were awarded grants under the law, the Associated Press reports. Idaho is among the seven; the grants are for planning work to help set up state insurance exchanges. Three more plaintiff states in the lawsuit already got the grants. Click below for a full report from the AP in Washington, D.C.

The Health Care Task Force, a joint committee of seven state senators and seven state representatives, meets Tuesday starting at 9 a.m. at the state capitol, with an agenda that includes an update on the problems with the Molina system; the latest from the National Conference of State Legislatures on states' efforts to comply with national health care reform legislation; and both an update and a panel on the Idaho health insurance exchange, including information from state Insurance Director Bill Deal on where things stand, and opinions from 10 interested groups, from IACI and the American Cancer Society Cancer Action Network to the Idaho Chamber Alliance, the Idaho Association of Health Plans and the Idaho Freedom Foundation.

You can see the full agenda here, and listen live here.
  

The Idaho Association of Commerce & Industry, a lobbying group that represents the state's biggest businesses, has sent a letter to Gov. Butch Otter praising his decision to apply for federal grant funds to start an Idaho health insurance exchange, and laying out its ideas on how an exchange should work. In the letter, IACI President Alex LaBeau said the group's support for seeking the grant funds is “based on two very practical reasons: (1) to protect Idaho's citizens from higher taxes, and (2) to safeguard Idaho's ability to control its own destiny when developing an exchange, which we believe is a conceptually sound policy idea.”

He added, “Your wise decision gives Idaho control of its own destiny. By not requesting the grant money, Idaho would have lost its ability to work in the best interests of small business and individuals. The result of the loss of control would have dictated that Idaho be forced to turn over precious resources to the federal government, in the form of potentially higher taxes and fees, which would put an already delicate economy further in jeopardy.” You can read the full letter and proposal here.

Here's a link to my full story at spokesman.com on Gov. Butch Otter's decision today to give the go-ahead for Idaho to apply for nearly $31 million in federal grants to start an Idaho health insurance exchange. Otter remains a firm opponent of the national health care reform legislation that he dubs “Obamacare,” and the state is continuing to press its lawsuit seeking to overturn the law. But Otter said the idea of health insurance exchanges has been around since long before the legislation and was “co-opted” by the national law; he said Idaho's been looking into it since 2007.

Exchanges are envisioned as places or portals where people or small businesses could go to find health insurance they can purchase, see if they're eligible for federal subsidies, and compare costs and benefits. Plans offered on the exchanges would have to comply with guidelines. The state exchanges are a centerpiece of the national health care reform legislation; they'd be designed to let Americans who lack insurance get easier, more affordable access to it. In Idaho, 17 percent of residents lack insurance, but that figure soars to 31 percent for those age 18 to 34.

Idaho Gov. Butch Otter announced today that he's decided to allow the Idaho Department of Health & Welfare and the Idaho Department of Insurance to apply for federal grant funding to start an Idaho health insurance exchange. “It’s a difficult choice, but one I find far preferable to submitting to a federally established insurance exchange, with all the loss of control over our own destiny that entails,” Otter said. He said the exchange will be designed to make health coverage more accessible and affordable for Idahoans; click below for his full announcement.

The Idaho House Health & Welfare Committee has scheduled an interim meeting for Sept. 29. to talk about health insurance exchanges. The meeting will from from 8-10 a.m. in the Capitol Auditorium; the committee is also inviting members of the Senate Health & Welfare Committee, the House Business Committee, the House and Senate commerce committees, other interested legislators and the public to attend. The group will hear an overview of other states' efforts to establish exchanges, an update on Idaho's proposed approach, and a presentation from the Heritage Foundation. A full agenda will be posted at the Legislature's website.