Development of a Health Insurance Exchange in Oregon

1
Development of a Health Insurance Exchange in
Oregon
? Oregons goals ? Federal Guidance and
Requirements ? State Flexibility

• Nora Leibowitz, MPP
• Office for Oregon Health Policy Research
• October 8, 2010

2
What is a Health Insurance Exchange?

• Exchanges are shopping centers where
  individuals and small businesses purchase health
  insurance coverage.
• Beginning in 2014, each state will have an
  exchange to help consumers compare and choose
  between plans that meet benefits and coverage
  benchmarks.
• Exchange users may receive the new federal health
  insurance tax credits that will make health
  insurance more affordable.  

3
What are the Benefits of an Exchange?

• Access to tax credits and cost sharing assistance
  
• Ability to compare insurance products quickly and
  easily
• Minimum standard for insurance purchased through
  exchange
• Information accessible in a variety of formats
  (phone, web site, with agent or navigator help)

4
Who will use Exchanges?

• Starting 2014
• Individuals
• Small employer groups
• People must purchase insurance through the
  exchange to access tax credits and financial
  assistance with cost-sharing expenses
  (deductibles and co-payments)
• Federal premium tax credits are available for
  people with income up to 400 of the federal
  poverty level (88,200 for a family of 4)
• Federal assistance will reduce out-of-pocket
  expenses for many

5
Goals for Oregons Exchange

• The goals identified by the Health Policy Board
• Simplify (access, regulation, plan rules)
• Increased access to coverage and care
• Changing the way services are provided/paid for
• Cost containment

6
Exchange Functions per Federal Law

• Provide Consumer Information
• Certify Health Plans to Participate
• Grade Health Plans
• Offer Meaningful Coverage Choices
• Provide Customer Assistance
• Facilitate Community-based Assistance
• Administer Exemptions
• Provide Information to the Federal Government

7
State Decisions for an Oregon Exchange A

• Organizational Framework
• Public entity (state agency, public corporation)
• Private, not-for-profit
• Who Runs It (Board Structure)
• Number of board members, appointment
  confirmation requirements, terms of appointment,
  skill sets, etc.

8
State Decisions for an Oregon Exchange B

• Size Scope of Exchange
• Sub-state regions, multi-state
• One organization with two product lines
  (individual, group) or two exchanges
• Benefit Design Qualified Health Plan Choices
• Role of Board in certifying Qualified Health
  Plans

9
State Decisions for an Oregon Exchange C

• Market(s) Configuration
• Parallel markets, single market definition of
  small employer
• Consumer Assistance
• Role of agents and navigators
• Funding Exchange Operations
• Self-sustaining in 2015 and after

10
Exchange Development Progress To Date

• Assessment of state flexibility and available
  options
• Technical advisory work group discussed options
  and implications
• Other stakeholder meetings
• Initial policy proposals presented to OHPB
• Input at public meetings across the state

11
Next Steps

• Policy Board discusses policy options and
  recommends course of action (October 12, 2010)
• Policy Board report to Legislature (December
  2010)
• Exchange authorizing legislation (2011 Session)
• Detailed operations planning work completed
  (September 2011)
• Exchange implementation begins (fall 2011)