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The Idaho Legislature will not get its wish for a health insurance exchange website built by and for Idahoans. Not in the first year, anyway.
The Legislature’s decision simply came too late.
Federal law requires creation of a marketplace for health insurance coverage by Oct. 1 for every state. If states don’t do it, the law says, the federal government will.
But it takes time to develop a website with the security features required to accept and verify the confidential information people must enter when signing up for federally subsidized health coverage. Social Security numbers, for instance. Adjusted gross income from the most recent tax return. Names and ages of family members. Account numbers to be used in paying for the insurance. John Webster, SR
On July 26, shortly after getting its board appointed and hiring a few staff members, Idaho’s brand-new exchange awarded a contract for the development of its website. The winning contractor? Public Consulting Group, based in Boston.
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Gov. Butch Otter and Idaho Health Insurance Exchange Board Chairman Stephen Weeg are defending Idaho's work toward a state-based insurance exchange, after a Wall Street Journal article today pointed to decisions by Idaho and New Mexico to make use the federal government's computer platform for the exchange's initial launch as a sign that the two states are no longer committed to state, rather than federal, exchanges.
At its May 9 meeting, the Idaho exchange board voted to move on "parallel tracks" toward setting up its own IT platform for its health insurance exchange, and exploring the benefits of using the federal government's platform temporarily, until Idaho's is ready to go. Today, the board voted to take the same step for the "SHOP" portion of the exchange, which stands for Small Business Health Options Program, and is the portion of the exchange that will serve small businesses, while the rest is for individuals purchasing insurance plans.
Asked by other board members to clarify the step, Weeg said, "We’ve made a decision to use the federal government’s contractor that operates the platform to be our contractor for our platform for a short period of time, while we can get our platform fully developed." He and other board members stressed that only Idaho insurance products would be sold under Idaho rules on the state exchange, regardless of whether it uses the federal IT platform.
Otter and Weeg distributed a guest opinion to Idaho newspapers today entitled, "Implementing state insurance exchange requires moving quickly, creatively," in which they stressed that Idaho's still looking at a state - not federal - exchange. "Once again - and despite misleading headlines and the drumbeat of those who oppose anything short of nullifying a federal law that's already been found constitutional - our efforts will not result in a partnership or a federal exchange," the two wrote. "Idaho is building and will have a consumer-friendly state-based exchange run by Idahoans for Idahoans." Click below to read the full opinion piece.
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.”
OLYMPIA — A proposal to allow the state and local school districts to have their part-time workers get medical insurance through "Obamacare" barely cleared the Senate today.
Senate Bill 5905, which allows the state and school districts to bargain with their part-timers to be switched to the coming health insurance exchange, passed on a 25-23 vote, but only because some Republicans who normally oppose the federal Affordable Care Act voted to support it. Many Democrats, who generally support the exchange, said they were opposed to allowing state and school workers to be pushed into an untested and at this point incomplete system.
The bill attempts to save the state money by moving part-time workers out of the state-sponsored health insurance systems if the workers will agree to get their own insurance through the exchange, which will be set up to help individuals and small businesses find affordable coverage. They'll be offered raises to cover some of the increased costs of that insurance.
The exchange won't be operating until late this year.
"The exchange is not functioning yet," Sen. Karen Keiser, D-Kent, said. "We can't make the decision today… Next year, let's look at it again."
But the Senate budget proposal relies on $127 million in savings by shifting part-time workers in state agencies, public schools and state colleges and universities to the exchange.
As votes were counted and the measure appeared in jeopardy, several senators, including Mike Padden, R-Spokane, switched from no to yes.
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 faces a major leadership test when Idaho lawmakers convene their legislative session on Monday: convincing many from his own party that it’s in the state’s best interest to run its own health insurance exchange, when many want no part of “Obamacare.” Otter’s tried before to convince recalcitrant fellow Republicans to do something they didn’t want to do, notably failing in 2009 to get them to raise state taxes to fund major road improvements. He tried vetoes. He tried arm-twisting. But his own party didn’t budge.
Otter said Friday that he’s committed to creating the exchange, which would provide Idahoans an online place to shop for health insurance plans and access government subsidies, only with legislative support. “I think it is a states’ rights issue, that we should be at the table,” the governor declared. “I thought that with the wolves or the grizzly bears, I thought that with the caribou, I thought that with the sage hen and almost every other issue that has come up. If we stay at the table, I think we can make a difference. We did make a difference in most of those negotiations.” You can read my full story here at spokesman.com.
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.
HHS gives states more time on health insurance exchanges, not clear if Otter will decide tomorrow or delay…
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.
Gov. Butch Otter's health insurance exchange working group has voted overwhelmingly in favor of a state-based health insurance exchange, opting for the model of using a private non-profit group set up by the state to run it. The recommendation now goes to Otter, who must notify the federal government of which way the state will go by Nov. 16. If the state does nothing, it gets a federally run health insurance exchange and loses state regulatory control over its health insurance industry. Rep. Lynn Luker's substitute motion to hold off on any decision for a year was overwhelmingly rejected. Only two members, Luker and Wayne Hoffman, dissented in the panel's decision.
Rep. Lynn Luker, R-Boise, has offered a substitute motion at the Health Insurance Exchange Working Group to defer a decision for one year; Wayne Hoffman seconded his motion. Luker said he wants to "defer this decision 'til after the election, 'til after we see what the federal government does with implementing a federal exchange, which we're probably going to get anyway given our level of preparation, and that we reconsider this in a year." If the substitute motion fails, Alex LaBeau's original motion is still on the table.
Rep. John Rusche, D-Lewiston, said opting for a federal exchange would mean much higher health insurance costs for Idahoans, "charging the citizens of the state of Idaho $120 million more for basically the same insurance they're getting now."
Panel member Tom Shores said, "I think the problem is we've waited long enough. We couldn't get the Legislature to do anything." Waiting again, he said, would be "folly." John Watts said, "I just don't know why we'd want the federal government to control absolutely everything if we have an option to avoid that."
As the Health Insurance Exchange Working Group ponders Alex LaBeau's motion to support a state-based health insurance exchange, Wayne Hoffman, a group member, spoke out in opposition, comparing the state's relationship with the federal government to "the relationship of an abuser to a spouse. We keep getting beat up by the federal government and we keep running back to the federal government, and we have done it time and time again." He said, "I think the best interest of the state is to continue to resist this constitutionally dubious federal law. … The only way you're going to get the federal government, Congress and the executive branch to reconsider the law is just to resist its implementation."
LaBeau said, "We're all paying for everybody's health care as it is, whether it's thru Medicare and Medicaid, your property taxes or your insurance. The other important thing to remember, in a small state like Idaho, this is going to impact small employers." He said small employers - those with 50 or fewer employees - are 96 percent of Idaho's employers, and they employ half of Idaho's workers. "That's a substantial number of Idahoans that are going to be impacted by the decision that is made here today." LaBeau called for a state-based exchange, using a private non-profit model, "because it's the most flexible." He said a state-based exchange is the only way Idaho can protect small employers from big jumps in their costs and maintain Idaho's regulatory role over its insurance industry.
Panel member Kevin Settles said, "We need to get past arguing the legality of the law. The Supreme Court settled the issue." He said, "We can make something good out of this. … With the state-based non-profit exchange, we can make it reflect Idaho." He noted that Idaho's current insurance premiums are among the lowest in the nation.
As Gov. Butch Otter's health insurance exchange working group holds its final meeting today, to settle on its recommendation to the governor, a group calling itself the Idaho Health Exchange Alliance has swelled to 316 members around the state, pressing for a state-based insurance exchange, rather than allowing the federal government to run an exchange for the state. The members include insurers and insurance agencies large and small, construction and manufacturing firms ranging from Oppenheimer Companies and Contractors Northwest to General Pneumatic Tools LLC and Madison Roofing, the Boise Metro Chamber of Commerce, the Idaho Academy of Family Physicians, Idaho Forest Group, the Twin Falls Canal Co., two auto-body repair businesses, the Idaho Association of Commerce and Industry, the Idaho Hospital Association and the Idaho Mining Association.
The alliance has sent a letter to the working group saying, "Our members encourage you to support the creation of a state-based health insurance exchange. Such a strategy is far superior to ceding design and control of something as important as health insurance to the federal government;" you can see the full letter here.
Meanwhile, the Idaho Main Street Alliance and the Idaho Community Action Network have scheduled a news conference this morning at 9:30 in room WW53 of the state Capitol, prior to the working group meeting, calling for an exchange plan that "works in the best interst of Idaho's small businesses and families, not cater(s) to insurance CEOs." That group wants to make sure big insurers don't dominate the new exchange's board. "We need an exchange that will negotiate on our behalf, using our bargaining power to get the best plans at the best prices," said Main Street Alliance leader Christina McNeil. "Small businesses deserve nothing less, and we should demand nothing less."
The working group meeting is from 10 a.m. to 3:30 p.m. today in the Capitol Auditorium; you can see the agenda here, and watch live online here.
Here's a news item from the Associated Press: BOISE, Idaho (AP) ― With a looming deadline approaching, insurers are making a last-ditch plea to Gov. C.L. "Butch" Otter for a nonprofit, state-based insurance exchange in Idaho as part of President Barack Obama's health care overhaul. On Tuesday, Idaho's advisers said the state likely has too little time ― and too much work still to complete ― to establish a state-run exchange by 2014. But insurance companies including Blue Cross of Idaho, Regence Blue Shield and PacificSource urge the state not to default to a federal exchange, like many states are doing. Jack Rovner, an attorney working for the insurers, says Idaho can still develop a state-based nonprofit to manage this online insurance marketplace. Insurers fear a federal exchange would invite regulation from Washington, D.C. Idaho must announce its intentions by Nov. 16.
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.