When the controversial federal healthcare law was signed a year ago, it set out to create health exchanges for people to get coverage if they don't get it from their employer. Now it's up for each state to decide whether it will create a state exchange or leave it to the federal government. Nebraska's Department of Insurance has been studying how that could be done and what it would cost, and is taking input at public meetings - with one more tonight in Omaha. NET News' Grant Gerlock talks with Bruce Ramge, the State Insurance Director.
GERLOCK: Explain to me how a health exchange would work. What would actually happen? Would it be a state agency? What would be going on?
RAMGE: Well, if the state were to operate the exchange there are different, what we would call, governance models. One would be an entirely separate state agency. Another option would be within a state agency. It could be a quasi governmental entity with a board that would be appointed by the governor. There would be the option of a non-profit organization established by the state. In terms of a regional exchange, that would just be an agreement among various states. And then the federal fallback of course would be probably through Health and Human Services.
GERLOCK: U.S. Health and Human Services.
GERLOCK: In the end would it be private health plans coordinated by the state or whatever group is assigned that task?
RAMGE: This is two-fold. There would be private health plans that would offer their qualified health plans through the exchange. It would also be an entry point or portal if you wish for individuals to determine if they are qualified for Medicaid. Then it's anticipated they would go ahead and apply for whatever they're qualified for, either Medicaid or the health insurance plans. It's the only avenue for individuals also to obtain the proposed federal subsidies to purchase health insurance for the various income levels.
GERLOCK: What are the basics that the state would have to do, if the state chose to do an exchange itself? What are the basics that it would have to do to meet the federal requirements for a health exchange?
RAMGE: Well, it would have to allow individuals to compare health plans in a standardizes format so they could say that company A's plan looks like this and know what the prices are. Look at company B's plan
GERLOCK: So you can shop. Here are the benefits. Here are the costs and compare all of that in one place.
RAMGE: Yes. It would also require the exchange to have what is termed a calculator so that individuals could see what this would cost them, or what a plan would cost them after potential federal premium subsidies.
GERLOCK: Is this something that mostly people without insurance should be paying attention to or if you're someone who already has coverage is this something you need to be thinking about?
RAMGE: I think it's of interest to everyone really, because it's anticipated that these exchanges would have open enrollments each year so if individuals wanted to change their health insurance plans they could shop at that time. It's also going to be open up to small employer groups and after a certain number of years the exchanges may have the option of opening up to larger employers as well.
GERLOCK: These meetings have been going on, you've been doing your research at the same time that the state has been part of legal action in court aimed at overturning the healthcare law. The Governor has been very vocal about the Medicare costs associated with the healthcare law. There have even been bills introduced in the legislature this year aimed at blocking it. One would make it illegal to enforce the healthcare law. Is it a challenge to carry out this research while being objective toward those agendas?
RAMGE: There's no doubt that the administration thinks that this healthcare law was a bad law. It's bound to raise taxes. It's going to impose unfunded mandates on the states and has potential for lowering Medicare benefits. But at the same time the administration realizes this is the law of the land and if we're not being proactive and looking forward to how we would administer this it would put us in a bad situation. So, no, our job is to enforce the insurance laws and that's what we're doing.
GERLOCK: What's the deadline? Who makes the decision on what they state will do and when does that decision have to be made?
RAMGE: Our goal is to have a very thorough position paper, including the feedback we're getting at these meetings, and have that completed by mid-to-late summer. After that time it will be a joint decision of the Governor in conjunction with the legislature. He would work with the legislature with his recommendations.
GERLOCK: And the deadline?
RAMGE: That would be January 1, 2013.
GERLOCK: So at that point either the state will have one in place or the federal government will be making that move?
RAMGE: It'll have its plans in place and be able to have that up and running by January 1, 2014 or the federal government will operate the exchange.
GERLOCK: Well, we'll wait to see what kind of options come forward. Thanks for coming in.
RAMGE: Thank you. I appreciate this, Grant.