My Brain is Full! (An Update on the Health Insurance Exchange Board)
Research is the first step in the development of the health insurance exchange in Connecticut. The Arizona-based consultant outlined its 11 research “tasks” during Thursday’s meeting of the Health Insurance Exchange Board. It promised a draft report in early December (sounds like the 15 people dedicated to Connecticut’s contract will be burning the midnight oil over the holidays). The tasks are:
- Assessment of the uninsured and underinsured population in Connecticut
- Survey health insurance carriers to better understand the type of plan designs being sold, the corresponding premium levels and the number of enrollees in each market (group and non-group)
- Survey small employer market (under 50 and 50-100 employees) to identify current and anticipated future benefit design needs and other issues
- Conduct economic and actuarial modeling and analyses to project trends such as the number of newly insured, the impact of certain market changes on premium levels and the implications of different policy questions.
- Integrate high risk pools in the non-group market or maintain high risk pools separately
- Expand definition of small group from 50 to 100 prior to 2016
- Impact of the Exchange on employer provided insurance and specifically the impact of employer penalties and tax credits
- Merging the small group and individual markets
- Impact of the individual mandate to purchase health insurance and its influence on the market and the assumptions made with respect to the models
- Impact to markets and the Exchange in the Basic Health Plan option is considered
- Cost of Connecticut benefit mandates that are above the federal essential benefits in the context of a revised insurance market
- Impact of Exchange on insurer profitability and potential market exit
- Impact of the Exchange on household budgets
- Large employer market in Exchanges post 2017
- Impact of Exchange in regards to interaction with other health coverage initiatives (i.e., Medicaid) in Connecticut
- Develop a financial model for the Exchange to understand the administrative charges necessary to be financially self-sustaining by January 2015 and offer recommendations regarding the options to receive such charges
- Assess technical requirements and development of specifications for accounting and financial system functions for the Exchange
- Assess existing Medicaid eligibility system and identify interface issue and necessary requirements for integration with the Exchange information technology (IT) infrastructure
- Medicaid/CHIP (Children’s Health Insurance Program) impact analysis
- Analysis of the benefits of a multi-state Exchange or other opportunities to collaborate on Exchange development and operations
Whew! That is a lot of information! Mercer will be presenting more detailed results of each of these tasks in three board meetings. The Connecticut Mirror’s Arielle Levin-Becker wrote a great story on the cost of Connecticut’s benefit mandates (see 4.7 above) http://www.ctmirror.org/story/14541/state-benefit-mandates-could-cost-state-under-health-reform.
Other tasks that were more carefully reviewed included an assessment of the Medicaid eligibility system. In a nutshell, the 22-year-old system is OK for determining Medicaid eligibility at the Department of Social Services (DSS) but is too old to integrate functions the Exchange must perform. DSS Commissioner Roderick Bremby, who serves as a non-voting member of the board, reported that the DSS is planning to purchase a new eligibility system that will be able to interface with the Exchange.
Although the state’s Core-CT (PeopleSoft) information system could perform some of the financial and accounting systems functions for the Exchange, consultants raised several questions about the use of a state information system by a quasi-governmental body (which the Exchange Board will become once a legal consultant has been hired to perform this work).
Finally, after about 3 hours and 30 minutes, consultant with experience in Massachusetts indicated that a multi-state Exchange would be nearly impossible with the difference in insurance laws throughout the New England states.
I know this is a very modest overview of highly detailed and technical information. So, if you’re dying for more details, please visit the Office of Health Reform and Innovation’s website at www.healthreform.ct.gov and click under Insurance Exchange for all 129 pages of Mercer’s presentation.
In the two board meetings in December, I will be particularly interested in the tasks around Medicaid, the Basic Health Plan and the impact of the Exchange on household budgets. Stay tuned!