In this week's HIX Digest: Vetoes and defaults, Republicans question United tech acquisition, state of EHBs and the open source option.
As of December 10, 17 states and Washington D.C. are establishing state health insurance exchanges, while 20 are defaulting to the federally-facilitated exchange, five are partnering with the federal government and eight remain undecided, according to the Kaiser Family Foundation's running tab.
Republican governors still undecided are perhaps under more peer pressure to reject state-based HIXs. Post-Hurricane Sandy cooperation aside, New Jersey Governor Chris Christie vetoed legislation last week that would have created a state-based exchange -- less out of spite, he said, than concerns over a lack of information on long-term costs.
Defaults to the federal exchange are concerning some state insurance industry advocates. In Tennessee, where Governor Bill Haslam said his administration would not be creating a state HIX, David Broemel, partner at the Burr & Forman lobbying and law firm, told The Tennessean: "To me, the biggest concern will be lack of accessibility to people running the exchange. They won't be the Tennesseans that we've been dealing with. It will be someone in Maryland."
Congressional Republicans question United QSSI purchase
In the waning days of a lame duck session dominated by the fiscal cliff negotiations, two Republicans in Congress are asking UnitedHealth Group for information on how the Minnetonka-based company is managing any conflicts of interest that may arise from its acqusition of the Maryland-software firm QSSI, which is building a federal data services hub for federal exchanges under a contract with the Centers for Medicare & Medicaid Services.
United acquired Burlington, Massachusetts-based QSSI through its Optum subsidiary, and Charles Grassley, the senior Republican senator from Iowa, and Michigan Republican congressmen Fred Upton, said they're concerned that the corporate family structure could lead to a situation where "QSSI could tailor the system to favor the interests of its parent company"and "maintain a monopoly of information"on consumer demographics and market trends.
Grassley and Upton are asking for a response by December 21.
State of state EHBs
With the deadline for state essential health benefit benchmark recommendations nearing (December 26), about half of the states have selected EHB benchmarks. For the rest that haven't, the state's small group plan with the largest enrollment is going to serve as the default.
Of those with EHBs, 19 states and Washington D.C. have selected small group plans, three states -- Arizona, Utah and Maryland -- have selected the state employee plan and four -- Vermont, North Dakota, Michigan and Connecticut -- have selected HMO plans.
Among states with small group plans, Oregon's EHB will be the PacificSource-Preferred CoDeduct Value, PPO, California's will be the Kaiser small group HMO and Illinois' will be the Blue Cross Blue Shield of Illinois BlueAdvantage Entrepreneur PPO. (The Kaiser Family Foundation has a database of the EHB proposals.)
Many of those states need to reconcile their EHBs with the 10 categories of EHB requirements.
The open source HIX option
Tim Yeaton, CEO of the Burlington, Massachusetts-based software consultancy Black Duck Software, is encouraging states and the federal government to build exchanges with open source software components.
Writing in the tech magazine Wired, Yeaton argues that using open source code for website and platforms, data architecture and business logic infrastructure could save exchanges time and money.
Massachusetts' Information Technology Division has recommended a mix of open source and vendor tools as one potential HIX development strategy, and Yeaton points to the use of open source software by Amazon, eBay, some automakers using the GENIVI Alliance for standard in-vehicle infotainment platforms, NASA and the Department of Veterans Affairs, which helped create the OHSERA open source electronic health record software.
HIX IT vendors are all collaborating in their own right, with multiple firms building early innovator exchanges in Oregon and Maryland, for instance.
In related news, on Monday HHS also gave conditional approval to six state HIXs, in Colorado, Connecticut, Maryland, Massachusetts, Oregon and Washington.
The Hawaii Health Connector has awarded Fairfax, Virginia-based CGI Technologies and Solutions Inc. a $53 million contract to build and maintain the state's HIX. And the Ohio House of Representatives has passed a bill that creates a framework managing a consumer outreach and navigator program for Ohio's federal-state partnership exchange.