Pennsylvania is considering HIX options amid HHS's deadlines. New Jersey lawmakers have passed HIX legislation that has some insurers concerned, and the D.C. exchange wants to be the only venue for small biz and individual plan sales.
Pennsylvania, like other states, uncertain, except about brokers
Among the 27 states that missed the federal deadline to submit essential health benefits was Pennsylvania. The state is home to a fairly large insurance market, with 12 million residents, and along with other states, it's likely to miss the Nov. 16 federal deadline for submitting state-run health insurance exchange (HIX) blueprints.
Tom Corbett, the state's Republican governor, had tepidly supported the idea of a state-based exchange and, absent support from state lawmakers, he asked Pennsylvania Insurance Commissioner Michael Consedine to explore HIX options under the Affordable Care Act.
Consedine, like several other state insurance regulators, turned to the federal government, talking with members of Congress and asking the Department of Health and Human Services for guidance in about two dozen policy areas that left him confused or that he contested.
For one thing, Consedine questioned why the states were asked to set essential health benefits in the first place, since the ACA gives that authority to the HHS secretary.
For another, the fact that HHS still needs to clarify dozens of HIX rules means "States are missing details regarding fundamental aspects of exchange operation, like application requirements, citizen and income verification and appeals processes," Consedine told the House Ways and Means Committee.
And the timeline seems unfeasible, he said, since Pennsylvania, like other states, had put off ACA implementation decisions and planning until the Supreme Court decision in June. Consedine said the state has not used any of the $33 million it received in federal HIX grants.
"For us to have something up and running by next year will be very challenging, if not impossible, given that we have no legislation," Consedine told the Pittsburgh Post-Gazette. "We're not going to rush to build something that doesn't work."
Although the deadline for submitting state HIX blueprints is Nov. 16, HHS has suggested that states may still be able to run their own exchanges if they can submit acceptable plans by the end of the year.
One thing Consedine does know is that he and the Corbett administration would like to see a role for insurance brokers. Consedine told a meeting of the Greater Philadelphia Association of Health Underwriters in early October that brokers would be key to any exchange the state creates.
New Jersey HIX legislation concerns insurers, biz groups
Across the Delaware River in New Jersey, the state assembly is set to vote on a HIX bill, passed by the state senate, that has some insurers and business groups concerned about the regulatory authority granted to the exchange board.
Under the bill, the New Jersey Health Benefits Exchange would be housed under the Department of Banking and Insurance, with a 10 member board of directors that could broadly decide which plans to allow in the exchange.
"That component would screen otherwise valid plans that are more expensive than others, and we want the consumer to make that choice, not the board," Wardell Sanders, president of the New Jersey Association of Health Plans, told an assembly committee, as NJBIZ reported.
As Sanders put it, the board could essentially decide that "We're not going to let you offer your product on our exchange because your rate increase of 'x' amount is too much."
A representative from New Jersey Business & Industry Association said the exchange advisory board and the board of directors needed more small business and broker representation.
The bill awaits a vote in the state assembly. Republican Governor Chris Christie vetoed a HIX bill in June, and has said he will wait until the outcome of the November elections to decide whether to sign or implement any HIX legislation.
D.C. exchange rule for individual and small biz market draws criticism
Some business groups and Republicans are lambasting a plan by the D.C. Health Benefits Exchange Authority executive board to effectively bar Washington D.C.-based individuals and small businesses from buying insurance outside of the exchange.
In early October, the D.C. exchange authority's executive board voted unanimously to approve its insurance working committee's recommendations, including adopting federally-administered risk adjustment and reinsurance programs, merging the individual and small business markets and requiring individual and small business plans sold in D.C. to be sold within the exchange. In 2016, businesses with up to 100 employees would also have to buy group insurance through the exchange.
The D.C. Chamber of Commerce criticized the plan as a limit on choice and noted that the Washington D.C. City Council still has to approve the executive board's decision. Before the board's vote, about 150 D.C.-area businesses and organizations signed a petition opposing the idea.
Some ACA critics are pointing to the board's plan as a contradiction of promises to let people keep their current health plans, since the plan could force thousands of D.C. residents to change insurance.
"This decision pushes far beyond any other implementation of the law," Wisconsin's Republican Senator Ron Johnson wrote in a letter to D.C. Democratic Mayor Vincent Gray.
The exchange is proposed to cover about 100,000 people, one-sixth of the city's population, and the D.C. city government has received about $82 million in federal HIX grants.
The exchange's 11-member executive board started work in June and include a Brookings Institution fellow, a Georgetown professor, the director of D.C.'s healthcare finance department, a former D.C. Department of Health director and a representative from the Service Employees International Union.
As the board explained in a press release, having the HIX as the primary marketplace for the sale of small group and individual insurance "will help sustain the exchange in this unusually small market." If the plan goes through, Washington D.C. will join Vermont in limiting the insurance markets for small businesses and individuals to a state-based exchange.