What role should brokers play in state health benefit Exchanges? This was one of several intriguing questions raised by the executive directors of state health benefit Exchanges for California, Colorado and Alabama during a recent webinar. Under the Patient Protection and Affordable Care Act (PPACA), states are required to establish their own public health Exchanges to offer consumers cost-effective insurance options.
More than 1,100 registrants from Governor’s offices, state insurance departments, Medicaid agencies, and other stakeholders participated in the session offered by StateRefor(u)m, part of the National Academy for State Health Policy (NASHP).
The webinar, moderated by Health Affairs Editor Susan Dentzler, featured:
· Peter Lee, executive director, California Health Benefit Exchange;
· Patty Fontneau, executive director and CEO, Colorado Health Benefit Exchange; and
· Richard Fiore, executive director, Alabama Health Insurance Exchange.
NASHP staff Sonya Schwartz and Rachel Dolan provided background and briefly discussed the progress made by states to prepare or establish exchanges. You can listen to the webinar by clicking here.
Schwartz and Dolan highlighted that Exchange directors have a number of major structural decisions to make, including:
· Should Exchanges follow the active purchaser or open marketplace model?
· How much interaction should Exchanges have with other state programs?
· Should individual and SHOP Exchanges be separate or combined, including risk pools?
· Should Exchanges offer a basic health plan?
· What are navigator, broker and consumer assistor roles within Exchanges?
According to NASHP, one “hot topic” among states is the role of Brokers and navigators – what type of training will navigators or assistors need? How will they be compensated? For example, several states such as Minnesota and Maryland have studied and issued reports on how Brokers and navigators should interface in their respective state-based Exchanges.
In addition, the first question asked during the question and answer portion of the webinar concerned the role of Brokers in each state. Each Exchange executive director offered their perspective:
In California, Peter Lee said there were many small group and industry meetings from the start. Also, the Board recently held public hearings to receive input from Brokers, counties, legal aid and advocates. Lee offered the Board’s perspective that an “all hands on deck” approach, including Brokers, is needed to maximize enrollment. The state estimates more than five million people will be eligible for subsidies through the Exchange and Medicaid.
The state’s Exchange also has been publishing lists of questions on various issues to solicit views from a range of stakeholders. The responses are public. For example, they recently asked fifty questions related to outreach. Responders included the Small Business Majority and Consumers Union.
The California Exchange is in the process of determining how Brokers will be included in the individual and SHOP Exchanges. Decisions will be made through the public Board decision process in about two months.
Colorado’s Exchange is one of the few in the country required to take a free market approach with no active purchasing. “Brokers need to be at the table as we’re crafting solutions,” said Patty Fontneau, executive director.
This public nonprofit Exchange is in the process of creating platforms to allow individuals and small employers to purchase insurance coverage. To meet this goal, the Exchange will be establishing charters to ask for input and recommendations. Fontneau expects one of the first issues they tackle will concern how Brokers engage with individuals and small businesses. Once the charters have developed recommendations, they’ll go to the Exchange Board to make policy decisions.
Alabama Exchange Director Richard Fiore said Brokers have been part of their Exchange process from the start, beginning with the state’s planning grant request. Brokers have been included in the state’s focus groups, a study commission and recommendations in the commission’s final report. Fiore said Brokers would also be part of whatever advisory board the state establishes. Alabama has yet to create an Exchange Board.
StateRefor(u)m is an online resource that tracks state progress on implementation of PPACA. In addition to webinars, the site features public documents from individual states and ongoing discussion forums that include state policymakers. For more information on individual state activities regarding PPACA implementation and trend data, visit statereforum.org.
BenefitMall has published dozens of updates on the state-based Exchanges. Click here to review many of these documents. We will continue to keep you apprised of the latest developments as health care reform continues to evolve. For blog posts, legislative alerts, pools, surveys and other resources, visit www.HealthcareExchange.com or www.BenefitMall.com.
The views expressed in this post do not necessarily reflect the official policy, position, or opinions of BenefitMall. This update is provided for informational purposes. Please consult with a licensed accountant or attorney regarding any legal and tax matters discussed herein.