New Jersey lawmakers considering conflict-of-interests modeled on casino regs
In New Jersey, lawmakers and industry stakeholders negotiating HIX legislation are trying to reconcile differences on proposed conflict of interest rules for the governing board, WHYY's Newsworks reported.
A bill crafted by New Jersey Democrats, and said to be nearly identical to the HIX legislation vetoed in May by Republican Governor Chris Christie, would bar members of the legislature-appointed board from working for or sitting on the boards of healthcare companies, brokers, trade associations or medical centers.
The conflict of interest provisions in the bill, the New Jersey Health Benefits Exchange Act, are modeled on those for New Jersey casino regulators.
"It is important to take the personal interest out of it," Democratic state representative Herb Conaway said at a recent public panel, as Newsworks reported. "We have to have a plan for it and mitigate against it. We have to end the revolving door between industry and government. We're talking about tens of millions of government dollars that will be going to insurers under the exchanges."
The proposed rules have pleased some advocacy groups, and at the same time made some stakeholders wary. Thomas Considine, former head of New Jersey's Department of Banking and Insurance and current COO for self-insured health benefits network MagnaCare, told Newsworks that a lack of industry representation on the board would deprive it of expertise. "The absence of total conflict of interest leads to an absence of interest," he said.
There's been no word yet from Christie on the legislation, whose sponsors admit they're not likely to pass anything until after the November elections. Meanwhile, 200 New Jersey small business owners sent a letter to Christie urging him to implement the HIX, the New Jersey Business Journal wrote.
Chasing deadlines in New York, and whether to merge small biz and individual markets
State health officials in New York are racing to meet the Department of Health and Human Services' October 1 deadline to list essential health benefits for health plans sold in the HIX, established by Democratic Governor Andrew Cuomo's executive order in April. New York government health leaders have spent September touring the state and meeting with regional stakeholder groups, and last week they start sharing findings with an advisory board in Albany, the Albany Times Union reported.
"The overwhelming takeaway for us is we heard a desire for comprehensive benefits and affordability," said Danielle Holahan, project director of the New York Health Benefits Exchange.
As the Times Union noted, desires for comprehensive benefits and affordability can be in conflict. And there are several key questions about the exchange's functions and regulatory scope that state officials are still sorting out: whether the small business and individual markets should be merged, what role brokers should have and if the state's mandated minimum benefits should exceed federal requirements.
A merged small business and individual market in the exchange could mean some plan costs rise, while others fall. As the Times Union wrote, the average annual cost for an individual private health plan for a family of four in New York is currently $15,000. Buying an individual plan on the HIX is supposed to be about a third of that, the Times Union wrote,making some wonder whether small business plan costs would rise.
Colorado benchmark: $4,200 for 40-year-old, nonsmoker
Colorado has reached something of a consensus on essential health benefits benchmark, Colorado Public Radio and Kaiser Health News reported.
Colorado lawmakers formed a working group with the state's Governor, Democrat John Hickenlooper, members of the state's exchange board and the state insurance commissioner.
The working group compared the 10 plans the Affordable Care Acts lists as minimum benefits, including the three biggest federal health plans offered in the state, the biggest HMO and others. They picked a Kaiser Permanente plan meeting most of the ACA's 10 essential health benefits and Colorado mandates, and selling for about $4,200 for a 40-year-old, non-smoking male living in greater Denver.
Though the plan meets all the minimum benefits, its price is likely to vary greatly, Colorado Public Radio and Kasier Health News noted. The plan will still need to incorporate the ACA's "habilitative services" and pediatric dental and eye care, and insurance companies haven't yet drafted prices for this new market.
The Colorado Association of Health Plans' Neil Waldron told Colorado Public Radio and Kaiser Health News: "I don't see it as bringing plans into the market, but I don't see it driving plans out, either. The market's very competitive right now, most players will stay in."