The public health insurance exchange experience, for the executives, policy makers, IT workers and regulators managing them, has largely been of the designing and building a ship at the same time -- and months before it's set to cross an ocean.
The main venue for the individual mandate premium support credits, one of the Affordable Care Act's most crucial policies, HIXs are in some ways meant to be a vessel for health insurance markets, envisioned as a way to enable a future market with as few people uninsured as possible -- starting from a baseline of some 45 million Americans lacking coverage.
State insurance exchanges have been designing and building the new online exchange with a wide range of ambition -- some states reluctant early on but now creating their own, some defaulting to the federal HIX, and some that were early adopters.
At the 2013 AHIP Institute session "The Nine Month Sprint," on Wednesday, June 12, the executive director of Nevada's Silver State Exchange, Jon Hager, will offer a birds eye view of HIX development so far -- from an exchange, created under a Republican governor, that's starting to serve as a policy model for Idaho and New Mexico.
Led by Hager, the former director of the state employee benefits plan, Nevada started work in 2011 on the exchange and recently has taken the approach of being relatively laissez faire, with a wide range of health plan choices allowed and a funding structure using a per-member per-month fee.
Another early adopted has been the Colorado Health Benefit Exchange, now branded as Connect for Health Colorado. With a background at Horizon Blue Cross Blue Shield in New Jersey, AHIP and the federal government, Lindy Hinman, the COO of the Colorado Health Benefit Exchange, will share her experience in setting up operations for the exchange, which like many others is a nonprofit created by the state..
And from a government agency developing one of the most interesting ACA exchange policies in the nation, session attendees will hear from Cynthia Crone, the director of the Arkansas Insurance Department's Health Benefit Exchange Partnership Division.
Arkansas is pioneering what's come to be known as the Medicaid private option -- a policy under a federal waiver that will allow the state to offer subsidies for Medicaid expansion-eligible individuals to buy insurance purchased in the exchange.
At the start of this year, the idea for helping Medicaid-eligible consumers buy private health plans through an exchange hadn't been widely proposed, if it all. Halfway through the year, the idea is being turned into policy in part by Crone, a nurse practitioner and former director of family treatment consultation at the University of Arkansas for Medical Services. Other states like New Hampshire are looking to it as a possible model -- which CMS has signalled may be permissible in the next few years.