Colorado Health Benefit ExchangeUpdate – 9/2011

Jim SugdenCSAHU Exchange Coordinator

Senate Bill 11-200

Authorized Colorado Health Benefit Exchange

– “a nonprofit unincorporated public entity”

– Governed by a 12 member board

9 appointed voting members

3 ex-officio nonvoting members – DOI, HCPF, Dir. OED

– “A majority of voting members must be business

representatives or individuals who are mot directly affiliated

with the insurance industry”

Powers of the COHBE Board

Appoint an Executive Director Create an initial Operational and Financial Plan Apply for planning and establishment grants Create Technical Advisory Groups Provide a written report to Governor and Legislature by

1/15/2012 Review internet portal options Consider structure of the Exchange (individual/group) Request appropriate Waivers Enter into information sharing agreements

Legislative Health Benefit Exchange Implementation Review Committee

10 appointed members form both Houses Duties

– Report up to 5 bills per year– Review grants applications– Review the Financial and Operational Plan

– ? – Is COHBE legislation limited to the 5 bills that may be reported by the Leg. Review Committee?

Working Groups

Formed before the legislation was passed Organized by the Colorado Health Institute

– EVE - Eligibility Verification and Enrollment– DAWG - Data Advisory Work Group– MEOW - Marketing Education and Outreach

Workgroup– SEWG - Small Employer Work Group

Others groups to be formed as required

Timeline

CHI establishes WGs and commissions a demographic study 7/1/2011 – COHBE Board Formed 8/1/2011 – Legislative Review Committee formed 1/15/2012 - Report due to General Assembly

Enabling legislation Federal operational grant of $30 - $50 million

1/1/2013 – have made substantial progress to avoid federal intervention

10/2013 – Initial Enrollment – Test Run 1/1/2014 – Open for business 1/1/2015 – Financially self sufficient

CSAHU Involvement

CSAHU members on Working Groups– Joel Rosenblum on MEOW– Jim Sugden on SEWG

CSAHU focus group results provided to SEWG at their 8/17 meeting

Ongoing meetings with… Key legislators, Committee and Board members Stakeholder allies – CAHP, CACI, NFIB Division of Insurance – Producer Advisory Council

Opportunities

Supported for SB 11-200 as a “pre-emptive” measure

CSAHU has a voice in shaping COHBE Public comment opportunities at meetings Monitor the activities of other stakeholders Continued dialog with key legislators Ability to “tell our story” to civic groups

Concerns

The pace of development is slow and full of

bureaucratic maneuvering/wrangling

The Legislative Review Committee has potential for

grid-lock

Groups with competing interests are working behind

the scenes to control or sabotage the process

Bureaucratic overreach – Horizontal Integration

Key Concerns to CSAHU

PPACA and HHS Regulations allow states to “permit” producers to participate– What will be the extent of producer involvement in

COHBE?

– Will the compensation program be acceptable?

– Will COHBE offer suitable support for producers?

Key Concerns to CSAHU

The market outside the Exchange– States seem to have retained broad latitude to

regulate the “outside” market. – Will the outside market be broad with lots of

coverage options or narrowed to reflect only the exchange options?

– How will HDHPs and CDHPs be affected?

Key Concerns to CSAHU

Navigators– Will the establishment of Navigator programs

seek to supplant producers as a primary delivery system?

– Will Navigators be required to be licensed, insured, certified, regulated?

This is a critical consumer protection issue

– Will Navigators stay “on mission” of serving underserved populations?

What can CSAHU members do?

Continue membership in NAHU and CSAHU Tell the story of the “Value of the Broker” Attend public forums and Board meetings Testify/Comment at those meetings

Producers are critical to the success of any Exchange. COHBE cannot reach the critical enrollment mass it needs without the services of experienced brokers.

Without producer involvement, the role of producers will be minimized.

Questions?