Health Insurance Exchanges under the PPACA

[rbmrtn]

Looks like we're pretty much ready to flip the switch.

Intent letter: http://www.mid.ms.gov/pdf/ExchDecLtr.pdf

Site: One, Mississippi - Your Health Insurance Marketplace

Looks like ehealthinsurance is going to be providing most of the supporting structure for these exchanges.

[JoeWras]

I don't fully understand this, but NC has chosen a hybrid of state and federal run exchange.

NC to build state-federal online insurance market :: WRAL.com

[rbmrtn]

Quote:

Originally Posted by JoeWras I don't fully understand this, but NC has chosen a hybrid of state and federal run exchange. NC to build state-federal online insurance market :: WRAL.com

I had not of the partnership exchange either; kaiser has some updated info on it

Health Insurance Exchanges - Kaiser State Health Facts

"As of July 30, 2012, three states, Arkansas, Delaware, and Illinois, are planning to pursue a state-federal
partnership exchange. A state opting for a partnership exchange can choose to operate plan management
functions, consumer assistance functions, or both, leaving the federal government to assume responsibility for
all other exchange components in the state. While only a few states have committed to a partnership exchange
to date, this option may become an increasingly viable strategy for states that have delayed establishing an
exchange. Additionally, states with small populations, such as Montana and Wyoming, are considering the
partnership model because it would allow the state to benefit from the economies of scale that arise from sharing
costs and resources with the federal government. States that are not ready to run a fully state-based exchange
beginning in 2014 may transition from a partnership exchange to a state-based exchange at a later date."

http://www.kff.org/healthreform/upload/8213-2.pdf

[JoeWras]

Thanks rbmtn. That explains it better. Also explains why our governor says this gives flexibility for the next governor and legislature.

[samclem]

Update: According to an announcement yesterday by Governor LePage, Maine will not be setting up a state-run exchange and will leave it to the feds.

From a piece in the Bangor Daily News:

Quote:

AUGUSTA, Maine — Maine will let the federal government take the reins on setting up a mandated online health insurance market, according to comments Gov. Paul LePage made Thursday to a national news outlet. States must decide whether to set up the markets, called exchanges, or let the federal government step in to do it for them.

For Mainers wondering why, it looks like LePage's reasons paralleled those of Gov Walker in Wisconsin:

Quote:

LePage sent a letter to U.S. Department of Health and Human Services Commissioner Kathleen Sebelius, saying Maine would not set up an exchange. “The [federal health reform law] is full of federal mandates; as such, even a state-based health insurance exchange is actually controlled by the federal government,” LePage wrote. “In the end, a state exchange puts the burden onto the states and the expense onto our taxpayers, without giving the state the authority and flexibility we must have to best meet the needs of the people of Maine.”

For those looking for a recap, the link at the MichaelB's original post is still good. KFF is keeping the map up to date--it looks like 15 states have announced they won't do state-run exchanges, 17 states will do them, and 5 states will do partnerships. The rest remain undecided.

[Olbidness]

Will a State running its own plan or federal run affect where a person chooses to declare residency? It seems likley since retirees choose states based upon income tax this would be another variable.

[samclem]

Quote:

Originally Posted by Olbidness Will a State running its own plan or federal run affect where a person chooses to declare residency? It seems likley since retirees choose states based upon income tax this would be another variable.

Based on what I'm seeing, there probably wont be much difference between states on the level and cost of care provided within the exchanges. A major theme among many governors is the rigidity of the federal mandates and rules, that indicates there may not be much difference between the state plans. The availability of medical providers in a particular location (city vs rural, etc) may be a bigger factor than the state lines.

But--for those folks that will depend on Medicaid, the choice of state of residence is likely to be much more important. Some states are going along with an expansion of Medicaid, some likely will not.

And the state taxes will likely be an issue for many of us. To the degree states are refusing to expand Medicaid or set up their own PPACA exchanges, they are attempting to limit the size of the bill to residents of their state. Those tax bills will need to be paid by someone. Folks shopping around for a place to retire will look carefully at these issues.

[ziggy29]

What I'm still trying to figure out is: What is the benefit of a state-run exchange instead of using the federal exchange? I've not figured that out, and I assume there must be some benefit or else all the states would be using the federal exchange instead of investing the time and money into creating their own.

Does creating your own exchange require that you accept the expansion of Medicaid? That would seem like the only reason to do it as far as I can see -- if a state wants that expansion (and for a while, federal funds to pay for it), they might have to use their own exchange? Just a guess, I'm still not sure...

[imoldernu]

What I find fascinating, is that most of this medicare "stuff" applies to those who are 65+....
Most of the folks posting on this forum are under 65... and the complexities involved in choosing are daunting. In my senior communities the average age is probably closer to 70 to 75 with many who are well into their 80's and 90's.

Think of your mom or dad receiving (as we just did from our provider) books and pamphlets totalling more than 300 large, closely spaced pages of information... and another 200 pages with Plan D information... One set for DW and one set for me. And that only included info from one provider. To compare between two or three other providers, and it turns into more than a 15 minute decision process.

...and then making an educated decision.

We've given in, and at our advancing age, will stick with what we have... thus avoiding angst and depression.

[marko]

So many unknowns in key/critical areas.


With only 13 months before launch, I just don't see how something this enormous will be ironed out well enough for a practical implementation.

I do know that I was told that if I wanted to "...go learn to play the guitar or 'do art', I could now do that without worrying about having to get a job with HI...". So I've got that going for me.

[ziggy29]

Quote:

Originally Posted by marko With only 13 months before launch, I just don't see how something this enormous will be ironed out well enough for a practical implementation

This is, for me, a reason why if I were running a state, I think I'd want to use the federal exchange first and see how the state exchanges work for people in their states. If they are more cost-effective, more responsive to the needs of the state's residents, then I'd think it would be worth rolling out a state exchange. But because states can always implement their own exchanges in the future (this isn't a binding one-time decision), there seems no need to rush. Let other states be the guinea pigs...

[youbet]

Quote:

Originally Posted by imoldernu What I find fascinating, is that most of this medicare "stuff" applies to those who are 65+.... Most of the folks posting on this forum are under 65... and the complexities involved in choosing are daunting. In my senior communities the average age is probably closer to 70 to 75 with many who are well into their 80's and 90's. .

I haven't seen comments on this thread that relate to Medicare....... Medicaid (expanded) and so-called Obama-care, and the subsequent development of insurance exchanges, are being discussed, but not Medicare.

I do agree with you, as a fellow post-65 geezer, that making Medicare choices is not trivial. I don't think that will be impacted by the implementation of state/federal/joint exchanges however.

[samclem]

Quote:

Originally Posted by ziggy29 But because states can always implement their own exchanges in the future (this isn't a binding one-time decision), there seems no need to rush. Let other states be the guinea pigs...

There is one complicating factor: States were offered "federal" money (one-time, or limited time, I think) to be used in setting up their state exchanges. Waiting might mean that a state will have to fund startup costs out of pocket.
I think some of the states saw the dough and reflexively grabbed it and started running. IMO, it's more prudent to wait, let some other states make their mistakes and maybe get some more flexibility from DC, then press ahead when the situation is more clear and they can use the "best practices" discovered elsewhere.

[Olbidness]

Quote:

Originally Posted by samclem Based on what I'm seeing, there probably wont be much difference between states on the level and cost of care provided within the exchanges.

Under our current Health Care System there is variablity state to state in costs and premiums. I have not seen how this would change under this new system. Insurers still have to compete based on costs.

A single payer system with price controls, preimiums nation wide would be equal but with low cost States subsidizing high cost States.

I'm not sure about any of this.

[youbet]

Quote:

Originally Posted by Olbidness I'm not sure about any of this.

Life's like that.........

[MichaelB]

Just speculating, but a few reasons a State might choose to run the exchange:

- they can ensure compliance with their existing insurance regulations

- they can include other public health care programs, such as Medicaid and children's health insurance programs

- State's rights

- they want to influence which insurance companies and products are offered in the exchange

The cost to set up and operate the exchange

[MichaelB]

The deadline has passed for State Governors to inform HHS of their intention to set up and run the health exchange. Here is the latest status, updating the first post to highlight the changes.

Quote:

16 19 To Establish State Exchange: California, Colorado, Connecticut, DC, Hawaii, Kentucky, Maryland, Massachusetts, Nevada, New York, Oregon, Rhode Island, Utah, Vermont, Washington, West Virginia Idaho, New Mexico, Minnesota, Mississippi, 3 7 Planning for Partnership Exchange: Arkansas, Delaware, Illinois. Iowa, Michigan, North Carolina, West Virginia, 16 Studying Options: Alabama, Arizona, Idaho, Indiana, Iowa, Michigan, Minnesota, Mississippi, Montana, Nebraska, New Jersey, New Mexico, North Carolina, Pennsylvania, Tennessee, Virginia 8 No Significant Activity: Georgia, Kansas, Missouri, North Dakota, Ohio, Oklahoma, Wisconsin, Wyoming 8 25 Decision Not to Create State Exchange: Alabama, Alaska, Arizona, Florida, Georgia, Indiana, Kansas, Louisiana, Maine, Missouri, Montana, Nebraska, New Hampshire, New Jersey, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Virginia, Wisconsin, Wyoming

Utah has a special request which may be denied, so it is not final.

From this point, what can change? A state may want to set up its own exchange but be unable to do so and find itself moving into the partnership or federal exchange group. HHS can also reject a state application. If either of these happen we should know relatively soon.

A state may allow HHS to set up the exchange and then ask to take it over and run it. This is a real possibility, but the logistics of a new operation make this unlikely for the first year or so, which means this becomes more likely in 2016 and beyond.

Another possibility is a state changing it's mind and choosing to set up its own exchange. The effort, investment and lead time needed for this is such that the real likelihood is small and declining at a very fast pace.

[audreyh1]

Thanks, Michael, for keeping us updated on this.

[rbmrtn]

I came across this web page that is a easy to read point by point explanation of PPACA changes and links to supporting information in the actual document. Thought it was very well laid out and easier to digest.

Political Irony › ObamaCare Explained So Everyone Can Understand It

[marko]

Quote:

Originally Posted by rbmrtn I came across this web page that is a easy to read point by point explanation of PPACA changes and links to supporting information in the actual document. Thought it was very well laid out and easier to digest. Political Irony › ObamaCare Explained So Everyone Can Understand It

Excellent synopsis! Thanks!

Although, with all the other good detail in this article, I find the short reference to "Cut some Medicare" a little unnerving.