2011 alec annual meeting august 4, 2011 new orleans, la health insurance exchanges: states in...
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2011 ALEC Annual MeetingAugust 4, 2011
New Orleans, LA
Health Insurance Exchanges:States In Charge!
Agenda
• What States Face in the Wake of PPACA
• Exchanges: A Look at State Actions
• HHS’ Proposed Rule on Exchanges
• Looking Ahead: Critical Decisions and Strategic
Imperatives
2
3
2010 2014201320122011 201720162015 2018
HHS must determine if states have made sufficient progress in developing exchange
Jan 1, 2014 Premium tax credits available for enrollees under 400% FPL
March 23, 2011 Deadline for HHS Secretary to award Exchange grants
Jan 1, 2015 Exchange must be financially self-sustaining
Jan - May Non bi-cameral State legislatures convene
Jan 1, 2017Large group Exchange to go live
Jan 1, 2014 State Exchanges required to go live
July 1, 2010 Healthcare.gov goes live, simulating first Exchange
Preliminary insurance regulations take affect
Jan 1, 2015 Employer & Individual mandates in effect
Jan 1, 2016 States must choose to engage in healthcare Choice Compacts
PPACA Timeline
4
Functioning Statewide Health Insurance Exchange
Functioning State Exchanges
DC
Hawaii
Alaska
Last updated Jul 11, 2011
PPACA Compliance
States with PPACA Compliant Exchanges
Hawaii
Alaska
DC
Last updated Jul 11, 2011
Federal Funding for Exchanges
Planning & Establishment Grant Applied for and Awarded
Hawaii
Alaska
DC
Last updated Jul 11, 2011
Early Innovator Grant Recipient
Alaska
Federal Funding for Exchanges
DC
Hawaii
Last updated Jul 11, 2011
Alaska
Federal Funding for Exchanges
DC
Hawaii
Rejected, Returned, Intend to Return, or Intend to Reject PPACA Federal Funds for Exchange Establishment
Last updated Jul 11, 2011
Alaska
Federal Funding for Exchanges
DC
Hawaii
Level I Round One Grant Recipient
Last updated Jul 11, 2011
Hawaii
Alaska
DC Study Committee
Legislation Failed
Legislation Pending
Alternative Authority
No Bill
Establishment Legislation
State Exchange Implementation Authority
Last updated Jul 11, 2011
11
State Actions: A Closer Look (I)
• California• Early out of the gate with legislation• Slowing momentum
• Georgia• 2011 legislation dies in the face of opposition• Gov. Deal issues Executive Order creating Exchange Study Panel
• Idaho• Gov. Otter issues Executive Order prohibiting state agencies from
implementing PPACA provisions• Vetoes similar legislative measure, concerned it may prohibit
establishment of a state exchange
12
State Actions: A Closer Look (II)
• Mississippi• Legislation fails fourth year in a row• DOI uses existing language• MS exchange board is now the longest-established board in the
country
• Oklahoma• 2011 exchange legislation fails• State returns $54.6 million Innovator Grant• Not willing to default to the federal model, many state lawmakers
remain committed to state established exchange• Special Joint Legislative Committee established to study exchange
implementation
13
HHS’ Proposed Rule on Exchanges
• No big surprises
• HHS is preparing to implement the federal fallback
• Early mover advantage
• Emphasis on state flexibility
14
Potential State Positions on Exchanges
• Fully operational • State designs, builds, and operates an exchange complete with all the
features specified in PPACA
• Hybrid model• State oversees some functions of the exchange while contacting with
HHS for other features
• Minimalist approach• State implements exchange with just enough functionality to get
“conditional approval” from HHS
• Do nothing• State defaults into federal exchange; cedes control of all features and
functions
Mandated Exchange Functions
15
Portal / Web site
Enrollment and
Eligibility Interface
Carrier1
Carrier2
Carrier3
HealthPlan#1
Plan Comparison InterfaceHealth
Plan#2
HealthPlan#3
Administration Interface
Communication Interface
TREASURY
HOME LANDSECURITY
IRS
HHS
SOCIALSECURITY Verify Citizenship
Verify Income
Tax Credits
Verify Residency
STATEMedicaid
Eligibility
Reporting
Subsidies
Cost Reduction
CUSTOMERSERVICE
Notifications
Pay Premiums
Employeeor
Consumer
Billing or Invoices
Employeeor
ConsumerAdmin, Life Events, etc.
Customer Service
ONLINECALCULATORDisplay Total
Costs
HealthPlan#4
Carrier4
StateInsurance
Agency
Certify, RecertifyDecertify
Health Plans
NavigatorGuidance
DataService
Hub
FISCALAGENT
RISK ADJUSTMENT
Core Functions
16
Portal / Web site
Enrollment Interface
HealthPlan#1
Plan Comparison Interface
HealthPlan#2
HealthPlan#3
HealthPlan#4
Employeeor
Consumer
Carrier1
Carrier2
Carrier3
Administration Interface
Carrier4
Communication Interface
Admin, Life Events, etc.
Billing or Invoices
Employer
17
Early Decisions for States
Exchange
Federally Established
State Established
Selective Contractor
Market Facilitator
Non-Profit
Government Agency
Quasi Governmental
Government Agency
Quasi Governmental
Non-Profit
18
Operational Priorities for States
• Establish guiding principles
• Develop a general timeline
• Develop baseline information
• Engage stakeholders and create feedback mechanism
• Establish authority and governance
19
Strategic Imperatives for States
• Retain maximum control at the state level• Regulatory• Budgetary
• Lead, rather than follow• BY you or TO you• Influence federal regulations
Leavitt Partners, LLC
Salt Lake City Office299 South Main StreetSuite #2300Salt Lake City, UT 84111
Washington DC Office1776 I Street, NW9th FloorWashington, DC 20006
Phone: (801) 656-9716www.leavittpartners.com
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