State of the States: Health Insurance Exchanges
With only 34 days to go until states are required to file their Blueprints with HHS, exchange planning is coming down to the wire, as the presidential election is in full swing. This week, Idaho’s Health Exchange Working Group reviewed a slew of presentations to help them determine a course for the state’s exchange and Minnesota posted a presentation signaling the state’s exchange Blueprint outline. But first, let’s start with a public dustup in Mississippi.
According to reports by Bloomberg, in Mississippi, Governor Phil Bryant (R) and Insurance Commissioner Mike Chaney (R) have been publicly diverging on the future of the state's health insurance exchange. While Governor Bryant has asked Commissioner Chaney to slow exchange preparations, Chaney has continued to make progress. For example, Chaney submitted Mississippi's EHB selection to HHS last week even though in September, Governor Bryant asked him not do so. The upcoming Blueprint deadline has the potential to create another schism between the two. Chaney, who is in favor of creating a state-based exchange, told reporters, “I will file a blueprint for the exchange on November 16, unless I get a court order from some idiot out there trying to stop me." HHS spokeswoman Erin Shields Britt declined to comment on who has the authority to decide a state’s exchange option; however, the Blueprint guidance issued earlier this year states a, “State’s Declaration Letter must be signed by the State’s Governor.” The Governor also has an option to name a designee to sign the exchange application. It remains unclear how this process will unfold in Mississippi.
On Tuesday, the Idaho Health Exchange Working Group met to ponder Idaho’s exchange options. The group first heard from KPMG who ran through the costs associated with Idaho’s exchange options. To create a state-based exchange, KPMG estimated start up costs of $77 million and then an additional $10 million a year in operation expenses. For a federal-state partnership, the firm estimated it would cost $15.5 million to get the partnership up and running and $1.7 million in operations costs. KPMG did not offer any estimates on the costs associated with a federally facilitated exchange. The group also heard a presentation from consultant Jack Grovner, who reviewed the state’s option of creating a private nonprofit to house the exchange. In addition, Arkansas provided an overview of its experience pursuing a federal-state partnership exchange with the work group. Of note, Cynthia Crone of the Arkansas Insurance Department said the state was very confident that their Blueprint for a federal-state partnership exchange would be approved. In regards to the possible cost of running a federal-state partnership exchange, Jay Bradford, commissioner of the Arkansas Department of Insurance, said that “the feds will levy a fee for their services, and your people will pay for it in the price of their insurance.”
On the topic of Blueprints, this week Minnesota posted a presentation that reviewed the state’s Blueprint application planning. At nearly 100 slides, only the most dedicated exchange watcher will read it front to back, but the PowerPoint contains a few interesting pieces. For example, the presentation states that the exchange’s governance structure and legal authority to operate is an “Open policy area, will not be attested to as complete.” Also this week in the North Star State, Barb Juelich, finance director for Minnesota's exchange, told state lawmakers that yearly operational costs for Minnesota’s state-based exchange could run between $30-40 million. While the exchange has not determined its long-term funding plan, it is evaluating several options that will be discussed in greater detail at a meeting in two weeks.
Moving into odds and ends, California's Insurance Commissioner Dave Jones wrote the California Health Benefit Exchange urging the Board to allow stand-alone vision plans to be sold on the individual exchange. The Board's decision last month to allow stand-alone plans to be sold in the SHOP but not the individual exchange caused an outcry from some California-based vision insurance companies.
Meanwhile, across the nation in New Jersey, the Assembly Health and Senior Services Committee met on Thursday to consider health insurance exchange enabling legislation (A-3186). The committee voted in favor of the bill by a 6-4 vote and made amendments to make it identical to legislation that was approved last week in the Senate.
In Kentucky, the vice presidential debate was not the only news making headlines. The Health Benefit Exchange last week awarded a $101.5 million contract to Deloitte for the development and implementation of the exchange’s eligibility and enrollment, plan maintenance and billing system.
Finally, the Virgin Islands' Health Reform Implementation Task Force had a meeting with the two consulting firms hired to analyze whether the territory would create a health insurance exchange. To review, New Wave Telecomm will evaluate the territory’s current IT systems while the Value Advisory Group will analyze the insurance market. The task force expects to review the IT analysis by mid-December and the insurance market report in January 2013.