In this week's HIX Digest: Tennessee Tea Party groups rally against a state-run HIX, the OPM proposes multi-state plan rules, New York aims for integrated eligibility systems and advocates wait for tobacco cessation coverage details.
Tenn. Republican Gov. leans toward state-HIX amid Tea Party resistance
Among Republican governors that postponed health insurance exchange decisions until the elections, Tennessee Gov. Bill Haslam has been noncommittal but is leaning towards the state option, diverging from Virginia, Texas and Oklahoma, which chose the federally-facilitated HIX, as a way to minimize state involvement and what they see as state financial liability.
Joining other moderate Republicans settling for their least-worst option, Tennessee's former U.S. Senator, Bill Frist is urging state lawmakers to adopt the state-run HIX, and Haslam, talking daily with stakeholders and federal officials, is leaning in that direction, as Nashville Public Radio reported. He and the other roughly two dozen undecided governors have until December 14 to declare their intentions.
Meanwhile, there is still some resistance to state-run exchanges. Tennessee Tea Party groups have planned a rally at the capitol this week, and Haslam's office has received thousands of letters and phone calls from Tennesseans opposing the state's creation of an exchange, according to Nashville Public Radio.
OPM publishes multi-state plan rule proposals
The Affordable Care Act directs the U.S. Office of Personnel Management (OPM) to contract with at least two health plans (one a nonprofit) to offer multi-state health plans, with goal of bringing high quality individual and small group health plans to every state via HIXs.
The OPM, which administers the health benefits program for some 8 million federal employees and their families, has published proposed implementation and administration rules for multi-state plans, which have to be available in at least 31 states in 2014.
OPM is tasked with finding a balance between finding high-quality insurance products to offer in the plans, while also avoiding any distortions of state insurance markets that might come with the introduction of the new plans, according to health policy analyst Timothy Jost -- lest the multi-state plans "destabilize insurance markets and encourage adverse selection."
Dissecting the 122 pages of proposed rules in a Health Affairs blog post, Jost, a Washington and Lee University law professor and a noted ACA supporter, wrote that the OPM has "attempted to be sensitive to state concerns" by establishing 13 level playing field criteria for the plans to meet and laying out a formal dispute resolution process.
New York integrating Medicaid and HIX application
Donna Frescatore, director of the New York Health Benefits Exchange, says the state is creating an "integrated front door" where New Yorkers can apply for HIX insurance programs as well as Medicaid. In an interview with the National Academy for State Health Policy, Frescatore, formerly the New York Medicaid director, said state health officials are building a shared eligibility system for the HIX, Medicaid and other public assistance programs, in large part by transitioning eligibility systems from local offices to a central center.
Frescatore also told the Academy that HIX officials are currently testing website designs for consumer usability in navigating provider participation, quality rankings, costs and subsidies. "We're also talking to health plans about offering a product in each 'metal' tier that has standard cost sharing provisions so that people can easily compare plans," Frescatore said.
Lung Association: states should expand tobacco cessation coverage in EHBs
With wide variation in current offerings for private and public health plan coverage of tobacco cessation programs, the American Lung Association is urging state governments to define comprehensive cessation coverage for Essential Health Benefit (EHB) standards.
In its proposed EHB rules, the Department of Health and Human Services has not yet specified what coverage insurers must include as part of cessation coverage, which is included in the ACA's preventive services coverage with no cost sharing.
Still waiting for the federal government to specify cessation coverage requirements, the American Lung Association is hoping state policy makers will craft robust medication and counseling therapies as part of benefits rules in state HIXs and Medicaid expansions.
Paul Billings, senior vice president of advocacy and education, said in a media release of the group's annual report that the "complex web of state and federal coverage for effective quit smoking programs and treatments prevents too many from getting the help they need."