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State-federal partnership balances cost, control

May 20, 2013

By Carla Anderson
healthinsurance.org™ contributor

After first developing plans to operate a state-run health insurance exchange, West Virginia submitted a blueprint for a partnership exchange to the U.S. Department of Health and Human Services (HHS). That blueprint was approved in March 2013.

Gov. Earl Ray Tomblin’s administration cited cost, particularly the expense associated with information technology systems, as a key factor in deciding against a state-run exchange. Administration officials also said the partnership gives the state some control over the exchange.

Under the partnership, West Virginia will be responsible for regulating the companies that sell health insurance policies on the exchange. The state will also oversee the In-Person Assister (IPA) program. Assisters will be under contract with the state and provide individuals impartial help with the enrollment process.

The West Virginia Offices of the Insurance Commissioner (OIC) estimates that between 40,000 and 60,000 West Virginians will purchase insurance through the exchange. In May 2013, West Virginia announced it will expand Medicaid, which it estimates will extend health insurance coverage to another 91,500 people. According to Kaiser’s State Health Facts, 14 percent of West Virginians — about 260,000 people — are currently uninsured.

Updated May 20, 2013

Vermont Health Connect for 2014, single-payer system in 2017

May 16, 2013

By Carla Anderson
healthinsurance.org^TMcontributor

Vermont is creating a health benefit exchange to comply with the Affordable Care Act, but the state has plans to go well beyond that. A 2011 state law envisions Vermont with a single-payer health care system as soon as 2017.

For now, Vermont is implementing a state-based exchange: Vermont Health Connect. The state-based exchange was authorized by the state legislature and signed into law in 2012. The U.S. Department of Health and Human Services approved the state’s plan in January 2013. The state is using a 2012 federal grant of $104.2 million to design a technology system that will support the state-based health insurance exchange in the short-term and the single-payer system in the longer term. Individuals and businesses with 50 employees or fewer who want to purchase health insurance will have to do so through the exchange beginning in 2014 – policies will not be sold outside the exchange.

In 2017 Vermont plans to seek a waiver from the federal government to transition to Green Mountain Care, a single-payer system that will provide universal coverage.

According to Kaiser’s State Health Facts, 9 percent of Vermonters are uninsured; that’s about 56,340 people. Vermont estimates that 110,000 state residents will use the exchange to buy insurance.

Updated May 16, 2013

Virginia ultimately chooses federal health insurance exchange

May 14, 2013

By Carla Anderson
healthinsurance.org^TM contributor

Virginia Gov. Bob McDonnell, a Republican, opposed the Affordable Care Act. But along with the Republican-controlled General Assembly, he was conflicted as how best to resist the law’s implementation in the state. In a 2011 letter to state legislative leaders, McDonnell wrote of extreme difficulty in determining whether “ceding control of an exchange to the federal government or creating our own is in the Commonwealth’s best interest.” The governor’s and General Assembly’s actions over the next several years reflected their shared reluctance to implement either option.

In August 2010, McDonnell appointed the Health Reform Initiative Advisory Council. The council issued a report in December 2010 and recommended that Virginia implement a state-based exchange.

The Virginia General Assembly passed legislation in 2010 to invalidate the individual mandate of the Affordable Care Act, and the state attorney general filed a lawsuit against Kathleen Sebelius, the secretary of the U.S. Department of Health and Human Services, based on the new law. After a series of legal actions, the state law ultimately ruled invalid.

In 2011, the General Assembly passed legislation that was supportive of a state-based exchange, and McDonnell signed the bill into law. However, throughout the 2012 session the General Assembly failed to pass additional legislation necessary to move ahead with exchange implementation.

Finally, after President Obama’s re-election, McDonnell notified HHS that Virginia would not proceed with a state-based exchange nor Medicaid expansion. While the norm for the federally operated exchange leaves no role for the state, McDonnell did lobby for oversight of the health plans that will operate on the exchange within the state. HHS approved McDonnell’s request in March 2013.

According to Kaiser’s State Health Facts, 14 percent of Virginians do not have health insurance.

Updated May 14, 2013

Utah wins approval for dual-model exchange

May 14, 2013

By Carla Anderson
healthinsurance.org^TM contributor

Along with Massachusetts, Utah has a health insurance exchange that predates the Affordable Care Act. However, unlike the exchanges called for by the Affordable Care Act, Utah’s exchange is not open to individual consumers to purchase health insurance. That fact has led to a series of discussions and negotiations between the state and the U.S. Department of Health and Humans Services (HHS) — and ultimately, a unique approach that is attracting interest from other states.

The Utah Health Exchange was established in 2009 and rebranded as Avenue H in October 2012. Avenue H offers a “fixed contribution” approach for small employers. An employer contributes a fixed amount toward each employee’s health insurance. An employee then uses the exchange website to pick an insurer and policy to fit his or her individual or family needs. By late 2012 about 320 small businesses provided health insurance to about 7,600 people through the exchange.

Gov. Gary Herbert asked President Obama to direct the U.S. Department of Health and Human Services (HHS) to approve Utah’s exchange and to consider it a “minimum standard” for an ACA-compliant state-based exchange. In January 2013, HHS granted conditional approval for Utah’s exchange while maintaining that it must be expanded to serve individual consumers. Herbert continued to lobby for HHS to accept the Avenue H “as is” and proposed in February that the state continue running its small business exchange and that the federal government operate the individual exchange. In May, HHS and Utah reached an agreement for this dual-model approach. Once HHS officially changes its rules governing exchanges, other states could also pursue the dual-model approach.

According to Kaiser’s State Health Facts, about 14 percent of Utah’s population is uninsured.

Updated May 14, 2013

Utah strikes unique deal on health insurance exchange

May 13, 2013

Politico — HHS and Utah reached an agreement that allows Utah to continue to operate its Avenue H exchange for small businesses, while the federal government will implement an exchange for individuals. Utah Gov. Gary Herbert viewed the agreement as a victory, but consumer advocates are concerned that people using Avenue H won’t learn about potential tax credits or Medicaid eligibility.

Tags: aca, Utah, utah state health insurance exchange

Rhode Island counting on exchange to reach goal of near universal health insurance

May 7, 2013

By Carla Anderson
healthinsurance.org^TM contributor

Gov. Lincoln Chafee established the Rhode Island Health Benefits Exchange through an executive order in 2011. The state submitted a blueprint for a state-run exchange to the U.S. Department of Health and Human Services (HHS) and received conditional approval in December 2012.

Chafee’s executive order established the exchange with the executive branch of state government and set up a 13-member board of directors. The board receives input from the Expert Advisory Committee (which includes representatives of insurance brokers, insurers and medical providers) and the Rhode Island Healthcare Reform Commission (which includes more than 200 stakeholders). The Commission was established by Chafee in early 2011 and charged with implementing health care reform in the state. The Commission includes multiple workgroups that study and provide recommendations on various aspects of exchange operations.

The federal government has announced that states will not be required to launch the small business exchange, or SHOP, until 2015. However, Rhode Island will be ready with its SHOP exchange and its individual exchange when enrollment begins in October 2013, according to exchange director Christie Ferguson.

According to the state about 126,000 people in Rhode Island are uninsured — approximately 12 percent of the population. Between policies available on the exchange and through increased Medicaid enrollment, the state hopes to achieve near universal coverage. However, the state has not set a target date for reaching that goal.

Updated May 7, 2013

Cigna plans to sell policies on five health insurance exchanges

May 6, 2013

Chicago Business Tribune — Cigna’s chief executive officer announced the company will participate in the health insurance exchanges in Arizona, Colorado, Florida, Tennessee and Texas. Colorado will operate its own exchange, while the other four states have opted for the federal exchange.

Tags: arizona state health insurance exchange, colorado state health insurance exchange, florida state health insurance exchange, tennessee state health insurance exchange, texas state health insurance exchange

Arkansas planning partnership exchange

May 6, 2013

By Carla Anderson
healthinsurance.org contributor

Arkansas Gov. Mike Beebe formally notified the federal Department of Health and Human Services (HHS) on Dec. 12, 2012, that the state wishes to partner on the implementation of a health insurance exchange – or health insurance marketplace.

As in most states, Republicans and Democrats squabbled over exchange authorization. Legislation to establish a state-run exchange was considered during the 2011 legislative session but did not pass. The state Department of Insurance then shifted gears and received grant money in February 2012 to develop a partnership exchange.

HSS conditionally approved the state’s blueprint for the partnership exchange on Jan. 3. Beebe designated Arkansas Insurance Commissioner Jay Bradford as the state’s primary point of contact for HHS in establishing the partnership exchange and authorized Bradford to bind the state contractually on issues related to the exchange.

The state will retain control of plan management and consumer assistance functions.

The Plan Management Advisory Committee includes nearly 40 members who represent hospitals and other health care providers, insurance companies, benefit consultants, and businesses. The committee evaluated and recommended essential health benefits (EHB) and developed recommendations for health plan qualifications and network access standards.

The Consumer Assistance Advisory Committee includes about 30 members who represent hospitals and other health care providers, insurance companies, benefit consultants, unions and consumer advocacy groups.

Four positions have been defined to help Arkansans shop for insurance on the state’s exchange. While each position will perform mostly the same tasks, they will be overseen and funded differently.

Navigators will help people enroll and assist consumers once they are enrolled. For example, they may help someone who purchased insurance through the exchange with a complaint or coverage appeal. Navigator positions will be overseen by federal authorities and funded with federal grants.
Guides will perform similar functions to navigators. However, they will be employed by organizations that contract with the state department of insurance. The state will fund the contracts with federal money, but the vendors will set salaries and pay the guides.
Certified application counselors will be employees of and paid by hospitals, clinics, or consumer assistance organizations.
Agents and brokers will continue to assist consumers in selecting policies as they did before the exchange. Unlike the other positions, agents and brokers can advise consumers on specific policies. Agents and brokers are paid by commission from insurance companies.

The uninsured rate in Arkansas is 21% according to Kaiser’s statehealthfacts.org.

Updated May 6, 2013

Oregon is a frontrunner in establishing health insurance exchange

May 5, 2013

By Carla Anderson
healthinsurance.org^TM contributor

The Oregon legislature authorized a state health insurance exchange in 2011, and the state has moved steadily to get the exchange up and running. The exchange developed a formal business plan in late 2011 and early 2012, which the Legislature approved in February 2012 as a final go-ahead for the exchange. The U.S. Department of Health and Human Services (HHS) gave conditional approval to the state’s exchange — named Cover Oregon — in December 2012. The exchange has a 2014 budget of $105.7 million, which will be covered with federal grant money, and $62.4 million budget in 2015 according to a Cover Oregon spokesperson.

Cover Oregon is overseen by a nine-member board of directors, two of which are non-voting members. The board receives input from the Individual and Employer Consumer Advisory Committee. The 19-member committee holds monthly meetings, which are open to the public. The Consumer Advisory Committee was mandated by the legislation that established the state’s exchange. Committee members are selected by the board and must include individuals or employers who will use the exchange, individuals who will enroll in state medical assistance through the exchange, minority groups, and representatives of organizations that will people purchase insurance through the exchange. All geographic areas of the state must be represented.

Cover Oregon is acting as “active purchaser,” meaning that it will limit the number of health insurers that can participate in the exchange. Participating insurers are required to offer a bronze, silver and gold plan and have the option to offer additional plans. According to The Lund Report, 12 companies are interested in participating on the individual exchange and eight are interested in participating on the small business exchange.

In mid-May Cover Oregon plans to announce the rates proposed by insurers who wish to participate on the exchange. A rate review process, which will include public hearings, will be conducted through late spring and into summer. The premium for policies purchased on the exchange will include an administrative fee that insurers must pay toward the exchange’s operational costs. The fee is expected to be around $10 per person, per month.

According to Kaiser’s State Health Facts, about 17 percent of Oregon’s under-65 population is uninsured. Cover Oregon officials expect about 237,000 people to purchase health insurance through the exchange in 2014.

Updated May 5, 2013

Major insurer won’t participate in Oregon’s health insurance exchange

May 3, 2013

The Lund Report — Regence BlueCross BlueShield of Oregon covers more people in Oregon than any other health insurer. However, it will not participate in the small-business exchange. Regence’s parent company is creating a new company called BridgeSpan to offer individual policies on the exchange.

Tags: aca, Oregon, oregon state health insurance exchange

Arkansas outlines four roles to help consumers use health insurance exchange

April 28, 2013

Arkansas News Bureau — Officials with the state’s health insurance exchange expect to more than 450,000 people to use the exchange in its first year of operation. To help them, hundreds of people are expected to be hired in four types of consumer assistance jobs.

Tags: aca, arkansas, arkansas state health insurance exchange

Arkansas legislators approve alternate to Medicaid expansion

April 16, 2013

Reuters — The Arkansas House approved a plan to use federal Medicaid money to purchase private health insurance for some state residents through the state’s health insurance exchange. The bill is expected to pass the state Senate, and it is viewed as a model for other states that are reluctant to accept the ACA’s Medicaid expansion.

Tags: aca, arkansas, arkansas state health insurance exchange

Gov. Walker says federal exchange reduces Wisconsin’s financial risk

April 5, 2013

By Carla Anderson
healthinsurance.org^TM contributor

Gov. Scott Walker joined many other Republican governors in rejecting a state-run health insurance exchange.

Walker had previously expressed a preference for a state-run exchange rather than a “one size fits all” federally operated exchange. In 2011, Walker used an executive order to create the Office of Free Market Health Care to plan for a Wisconsin exchange. Walker’s plan for a “free-market, consumer driven approach” leaned heavily on an insurance marketplace implemented by former Gov. Jim Doyle. According to one state insurance expert, the only notable change proposed by Walker was to put the exchange online.

However, Walker showed a changed mindset in 2012, returning a $38 million federal grant and closing the Office of Free Market Health Care. In announcing his November 2012 decision to accept a federally operated exchange, Walker said the state would have no real control and much higher financial risk with a state-run exchange.

According to Kaiser’s statehealthfacts.org, about 10 percent of Wisconsin’s population lacks health insurance — about 560,000 people. An Associated Press story included estimates that about 60 percent of them will gain coverage through the exchange and that 63,000 small employers in the state will use the exchange.

Updated April 5, 2013

More Wisconsin health insurance exchange links

Wisconsin Office of the Commissioner of Insurance
Assists consumers who have purchased insurance on the individual market or who have insurance through an employer who only does business in Wisconsin.
(800) 236-8517 / ocicomplaints@wisconsin.gov

State Exchange Profile: Wisconsin
The Henry J. Kaiser Family Foundation overview of Wisconsin’s progress toward creating a state health insurance exchange.

Affordable Care Act in Your State: Wisconsin

Requirement to use D.C. health insurance exchange angers small businesses

April 5, 2013

By Carla Anderson
healthinsurance.org^TM contributor

The District of Columbia was an early adopter in moving to implement a health insurance exchange. Mayor Vincent Gray appointed the Health Reform Implementation Committee (HRIC) to begin work on a D.C. exchange in May 2011. The committee issued its final recommendations in October 2011. The D.C. City Council adopted many of the committee’s recommendations and passed a bill to create the District of Columbia Health Benefit Exchange Authority, which Gray signed it into law in January 2012. The District of Columbia received federal approval to operate a state-based exchange in December 2012.

The D.C. exchange is overseen by an 11-member board. Mila Kofman is the executive director. The board receives input from six HRIC sub-committees: Communications, Exchange Operation, Health Delivery System, Insurance, IT, and Medicaid Expansion and Eligibility.

While planning and implementation of the D.C. exchange has been less contentious than in many of the states, one decision by the D.C. Exchange Authority is drawing strong criticism and pushback. In October 2012, the Authority announced that small employers must use the exchange for health insurance purchases. Exchange officials say the mandate is necessary given the small population in the District. Without requiring small employers to participate, officials say, enrollment simply won’t be high enough to sustain exchange operations. Small business protested the decision. While the board seems intent on maintaining the requirement, it did vote to allow some businesses until 2016 to comply. The D.C. City Council is now considering the issue.

There are 42,000 uninsured people in D.C, which is about 7 percent of the population.

Updated April 5, 2013

More District of Columbia health insurance exchange links

DC Health Benefit Exchange Authority

Health Reform Implementation Committee

Implementing Health Insurance Exchanges: District of Columbia
The Henry J. Kaiser Family Foundation overview of the District of Columbia’s progress toward creating a state health insurance exchange.

Affordable Care Act in Your State: District of Columbia

Federal extension will not delay Rhode Island SHOP exchange

April 3, 2013

Rhode Island Public Radio — While the federal government has pushed out the required
effective date for the Small Business Health Options (SHOP) Program, Rhode Island will be ready to
proceed. The director of the Rhode Island said the state’s SHOP exchange will be
ready to accept enrollment in October 2013.

Tags: aca, rhode island, rhode island state health insurance exchange

Tennessee governor proposes alternative to Medicaid expansion

April 3, 2013

Metro Pulse — Tennessee Gov. Bill Haslam announced plans to approach the federal government with a request to use federal funds to purchase private insurance rather than expand TennCare. Several states are pursuing this option with the Centers for Medicare & Medicaid Services.

State-run exchange not OK’d for Oklahoma

April 2, 2013

By Carla Anderson
healthinsurance.org^TM contributor

Gov. Mary Fallin announced in November 2012 that Oklahoma will not implement a state-run health insurance exchange. In the same press release, Fallin expressed her support for lawsuit brought by Oklahoma Attorney General Scott Pruitt. The suit contends the federal government cannot implement a federally operated health insurance exchange in a state that has not authorized an exchange.

The Fallin administration state officials initially showed some openness to a state-run exchange — if only as a slightly less distasteful option than a federally operated exchange. The Oklahoma Joint Committee on Federal Health Care Law studied exchange options and issued its final recommendations in February 2012. The committee supported a state-run exchange open to small businesses, but not individuals. A bill for this type of exchange, which is similar to Utah’s exchange, was introduced but not passed in 2012.

According to Kaiser’s statehealthfacts.org, about 17 percent of people in Oklahoma do not have health insurance.

Updated April 2, 2013

North Dakota says no to state-run exchange

April 2, 2013

North Dakota is among the 26 states that have opted for a federally operated health insurance exchange. The North Dakota House of Representative voted against a state-run health insurance exchange in 2011, and Gov. Jack Dalrymple’s administration reiterated that position in November 2012.

As in other states, exchange opponents believe that state-run exchanges will have little flexibility and that administrative costs will be excessive. The Associated Press reported estimated that it would cost the state $10 million every two years to operate an exchange.

North Dakota is leaning toward expanding its Medicaid program under a provision of the Affordable Care Act. Dalrymple favors the expansion, and the state House approved the measure in February 2012. About 20,000 additional people would gain coverage through Medicaid, bringing total Medicaid enrollment in the state to about 85,000.

About 11 percent of North Dakotans are uninsured, according to Kaiser’s statehealthfacts.org.

Updated April 2, 2013

Vermont announces proposed premiums for health insurance exchange policies

April 1, 2013

vtdigger.org — The proposed average premiums for health insurance policies to be sold on Vermont Health Connect range from $375 to $609 per person. The rates are subject to review by the Green Mountain Care Board and the Vermont Department of Financial Regulation.

Tags: aca, Vermont, vermont state health insurance exchange

Gov. Martinez pushes state toward state-run exchange

March 23, 2013

By Carla Anderson
healthinsurance.org™ contributor

New Mexico is headed toward a state-run health insurance exchange, but the path has been unusual. New Mexico Gov. Susana Martinez, a Republican who opposes the federal health reform law, has been the driving force in establishing a state-run exchange. Despite vetoing exchange legislation in 2011, Martinez notified the federal government in November 2012 that New Mexico would operate its own exchange. New Mexico’s exchange blueprint received conditional approval from the U.S. Department of Health and Human Services in January.

Martinez designated that the Health Insurance Alliance develop the exchange. The Health Insurance Alliance is a nonprofit association of health plans created by the state Legislature in 1994 to offer health insurance coverage to small employers. However, state legislators questioned whether the Martinez administration has authority to proceed with the exchange without legislative approval, and state Attorney General Gary King cautioned the administration that the Health Insurance Alliance might lack the legal authority to establish New Mexico’s health exchange.

Throughout the first quarter of 2013, legislators debated various bills to authorize the exchange. In mid-March, the Senate and House both approved compromise legislation. Martinez is expected to sign the bill.

The state expects 200,000 people to purchase insurance through the exchange. According to Kaiser’s statehealthfacts.org, 417,000 New Mexicans — 21 percent of the population — are uninsured.

Updated March 23, 2013

Silver State Health Insurance Exchange wins federal approval

March 22, 2013

By Carla Anderson
healthinsurance.org™ contributor

Nevada’s blueprint for its state-run health insurance exchange received federal approval on Dec. 3, 2012. Gov. Brian Sandoval and the state legislature created the Silver State Health Insurance Exchange in 2011, and the state has since made steady progress to get the exchange up and running.

Nevada’s exchange is overseen by a 10-member board, seven of which are voting members. Five of the voting members were appointed by the governor, and the other two were appointed by the state Senate majority leader. The three nonvoting members lead the state’s departments of Administration, Health & Human Services, and Insurance.

The Silver State exchange will operate as a “free market facilitator,” meaning it will allow all qualified health insurance companies to sell policies on the exchange. Insurers can participate in both the individual and small-business exchanges.

Nevada has received about $75 million in federal grants to establish its exchange.

Going forward, the exchange will be funded by a monthly fee charged to health insurance companies that operate on the exchange. Plans that include dental coverage will pay $5.31 per issued policy, while those without will pay $4.95 in 2014. The monthly fees will increase annually and are estimated to be about $8 per month for medical-only policies in 2017.

Silver State Health Insurance Exchange officials hope to reduce the state’s uninsured rate from the current 22 percent to 8 percent, according to a Kaiser Health News article.

Updated March 22, 2013

Minnesota’s health insurance exchange is finally a sure thing

March 22, 2013

By Carla Anderson
healthinsurance.org™ contributor

Gov. Mark Dayton’s administration won conditional approval from the U.S. Department of Health and Human Services for a state-run exchange in December 2012. With a March 31 deadline looming, the state legislature finally authorized the exchange. Dayton signed the bill, which dubs the exchange as MNsure, into law on March 20.

Legislation failed to gain traction in 2011 or 2012 when Republicans controlled both legislative houses. Democrats gained majorities in the state House and Senate in the most recent elections, and they passed the final legislation to create MNsure without any Republican votes.

While legislation was stalled, the executive branch moved ahead with planning. Originally, the Commerce Department led the planning effort. Dayton reassigned responsibility to the Management and Budget in September 2012 to avoid a potential conflict of interest in having the Commerce Department create the online marketplace that it will later regulate. A 15-member Insurance Exchange Advisory Task Force and 11 technical work groups are guiding the development of Minnesota’s exchange.

Going forward, MNsure will be overseen by a seven-member board. Six members will be appointed by Dayton, and the commissioner of Human Services or her designee. Beginning in 2015, the board will have the authority to limit the health plans that can participate in the exchange.

Minnesota has received about $113 million in federal grants to plan and establish its exchange. Annual operating costs are estimated at $50 to $60 million. Operating costs will be funded by withholding a portion of premiums: 1.5 percent in 2014 and up to 3.5 percent in 2015.

The state estimates 1.3 million Minnesotans will use the insurance exchange. Minnesota’s underinsured rate is 9 percent according to Kaiser’s statehealthfacts.org.

Updated March 22, 2013

More Minnesota health insurance exchange links

Minnesota Health Insurance Exchange

State Exchange Profile: Minnesota
The Henry J. Kaiser Family Foundation overview of Minnesota’s progress toward creating a state health insurance exchange.

Affordable Care Act in Your State: Minnesota

State Republicans continue efforts to thwart health insurance exchange in Tennessee

March 21, 2013

Legal Newsline — Republicans in the House and Senate have proposed bills to alter state insurance law to prevent insurance companies from participating in health insurance exchanges. In a legal opinion, the state attorney general said the bills were constitutionally questionable.

Tags: aca, tennessee, tennessee state health insurance exchange

Minnesota authorizes state-run health insurance exchange

March 21, 2013

Minneapolis Star Tribune — Gov. Mark Dayton signed MNsure, a state-run health insurance exchange, into law today. While some modifications sought by state Republicans were included in the final bill, the legislation passed without any GOP votes.

Tags: aca, minnesota, minnesota state health insurance exchange

Nebraska governor cites high cost in rejecting state-run exchange

March 19, 2013

By Carla Anderson
healthinsurance.org^TM contributor

Despite work completed by the Nebraska Department of Insurance (DOI), Gov. Dave Heineman announced in November 2012 that the state will not operate a health insurance exchange. In rejecting a state-run exchange, Heineman said it would be much more expensive for the state to run its own exchange. He also expressed doubt that even a state-run exchange would give Nebraska much authority over exchange operations.

Before Heineman’s final decision, he had expressed some support for a state-run exchange, and the DOI had studied that option. The DOI gathered input from stakeholders, developed a set of working assumptions around policy and operations, and issued a number of requests for information and requests for proposals to engage subcontractors in developing an exchange.

In November 2012 prepared remarks about his decision for a federally operated exchange, Heineman cited an estimate from the state Departments of Insurance and Health and Human Services that said the state would pay $646 million for a state exchange versus $176 million for a federal exchange over eight years (2013 to 2020).

According to Kaiser’s statehealthfacts.org, Nebraska’s uninsured rate is about 13 percent.

Updated March 19, 2013

Federally operated exchange coming to state

March 19, 2013

By Carla Anderson
healthinsurance.org^TM contributor

Montana’s legislature not only failed to authorize a state-run exchange, it also passed a bill in 2011 to prohibit the creation of an insurance exchange in Montana. While Democratic Gov. Brian Schweitzer vetoed that bill, neither he nor Monica Lindeen, the state auditor and insurance commissioner, were able to generate legislative or public support for an exchange. Consequently, the federal government will operate an exchange in Montana.

Under the federal model, most aspects of the exchange will be managed by the federal government. However, the state can retain control of “plan management” functions, and Montana plans to do so. Lindeen’s office will regulate plans that operate on the exchange, as it does for plans sold outside the exchange.

According to Kaiser’s statehealthfacts.org, about 180,000 people — 18 percent of the population — in Montana do not have health insurance.

Updated March 19, 2013

HHS rejects Mississippi’s plan for state-based exchange

March 18, 2013

By Carla Anderson
healthinsurance.org^TM contributor

State Commissioner of Insurance Mike Chaney clashed with two governors as to what form a health insurance exchange should take in Mississippi. Chaney, current Gov. Phil Bryant, and former Gov. Haley Barbour are all Republicans and on record as opposing the Affordable Care Act. However, Chaney consistently maintained that the state would be better off running its own exchange.

Chaney pushed hard for a state-run exchange. In 2011, he announced that the Mississippi Comprehensive Health Insurance Risk Pool Association would operate an exchange. The Risk Pool Association developed a plan in which the exchange would be developed in four phases, with work outsourced. Once developed, exchange operations would be handled jointly by Risk Pool Association and the state Department of Insurance. In July 2012, the exchange website and call center began operating.

Exchange planning was carried out by the board of directors of the Risk Pool Association and an advisory board appointed by Chaney. The Risk Pool Association, the advisory board, and the insurance department continued working throughout 2012, and in November, Chaney notified the U.S. Department of Health and Human Services that Mississippi intended to implement a state-run exchange. However, Bryant told HHS in December 2012 that Chaney had overstepped his authority. In February, HHS rejected Mississippi’s exchange blueprint.

The federal government will operate Mississippi’s exchange, which is expected to serve the approximately one in five Mississippians who do not have health insurance.

Updated: March 18, 2013

Affordable Care Act declared ‘invalid’ in Oklahoma

March 15, 2013

Associated Press — The Oklahoma House voted 72-20 to nullify the Affordable Care Act within the state. The state constitution was amended in 2010 to prohibit requiring a person or health care provider to participate in a health care system. Legal experts say neither act has much practical impact.

Tags: aca, oklahoma, oklahoma state health insurance exchange

Minnesota House passes health insurance exchange bill

March 15, 2013

StarTribune — Legislators debated a compromise bill on creating a health insurance exchange late Thursday, then passed it early Friday 72-61. Previously, House and Senate negotiators had worked out a final compromise on the exchange, which will change the way one out of every five Minnesotans shops for health insurance next year. The Senate will take up its version of the bill next week.

Tags: aca, minnesota, minnesota state health insurance exchange

Covered California getting the word out

March 14, 2013

California Health Report — The state health insurance exchange is offering $46 million in grant money to let people know they can buy subsidized health insurance on the state’s exchange beginning in October.

Tags: aca, california, california state health insurance exchange

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