GOP governors mull exchange options; NAIC compiling list of questions for HHS on HIX implementation; and Conn. group urges state exchange to be an "active purchaser" in this week's HIX Digest.
Some GOP governors swimming against anti-ACA tide
After the Department of Health and Human Services (HHS) extended deadlines for state health insurance exchange blueprints until mid-December, 17 states and Washington D.C. say they intend to create an exchange, while a few are rejecting them and many more are undecided.
Following the Republican Governors Association conference last week, some of the country's 30 Republican governors are saying they'll opt for the federally-facilitated exchange, some doing so as part of a legal strategy. Some, like Iowa's Terry Branstadt, have told HHS they're interested in creating an HIX.
After two years challenging the Affordable Care Act, Florida's Rick Scott welcomed potential federal-state harmony in a letter to HHS Secretary Kathleen Sebelius. Scott said he had concerns about financing a state HIX, pointing to estimates from Illinois, where the government is some $60 billion in debt and where a joint state-federal HIX is estimated to cost up to $100 million a year.
Scott also raised concerns over rising Medicaid spending, recommending expanded managed care programs and loosening some essential health benefits requirements. He's appointing a panel of lawmakers and stakeholders to consider exchange options.
The Florida government actually created an exchange in 2008, as part of Republican legislation forming a nonprofit called Florida Health Choices, which is launching next year, after many starts and stops.
The insurance marketplace, as Florida Health Choices CEO Rose Naff calls it, has a 9-year, $72 million technology contract with Xerox. Naff said some of the small business plans sold in the exchange may not meet HHS exchange certification standards. Either way, Naff's goal is to have the marketplace sell a one or two percent share of the state's small business health plan market. The platform includes the use of brokers, and the exchange board recently waived application fees for licensed insurance agents.
Running tab of HIX unknowns
State insurance regulators with the National Association of Insurance Commissioners (NAIC) are compiling a working document of exchange questions for HHS.
The NAIC has six questions on federally-facilitated exchanges, among them: "Does the Department of Insurance have any federal requirements to meet if the state chooses to do nothing?" HHS is still set to publish regulatory guidance for the federal exchanges. The NAIC is also asking how federal exchanges might impact the state's greater health insurance market, and how health plan requirements would impact state consumer protection and insurance licensing laws.
For partnership exchanges, the NAIC is asking if state governments will be "able to deviate from the anticipated but yet to be released Standard Operation Procedures" for health plan management.
The NAIC is also curious about exchange funding, asking if states operating partnership exchanges will have to connect into the Federal Data HUB and at what cost.
Consumer group calls for active purchasing by Connecticut exchange
Among the 17 states that are set to establish their own exchange, there's a debate over whether state-based HIXs should function solely as regulators, or also as brokers or "active purchasers."
In Connecticut, where 10 percent of the population is expected to obtain insurance in 2014 through the state HIX, the nonprofit Connecticut Health Policy Center is recommending that the CT Health Insurance Exchange negotiate en-masse with insurance companies as a way to lower insurance costs for small businesses and individuals.
Ellen Andrews, Connecticut Health Policy Center executive director, wrote recently: "Because the Connecticut exchange will be far larger than any private company in the state, it seems only logical that the exchange would leverage that market strength to get better bargains for individual consumers and small businesses."
Connecticut exchange officials have said they're not considering it at the moment. Exchange CEO Kevin Counihan said recently the staff is on a "12-month 'sprint' to open enrollment in October of 2013."