Stakeholder Discussion April 21, 2011 Empire State Plaza Meeting - - PDF document

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Health Insurance Exchange Options

Stakeholder Discussion

April 21, 2011 Empire State Plaza Meeting Room 6

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IT Systems Architecture Federal Rulemaking State Legislation and Regulations Federal & State IT Buildouts Secretary Determines if State will Establish Enrollment Begins Federal Policymaking Coverage Effective Outreach & Education Plan Bidding/Contracting States Begin Qualifying Plans

2010 2011 2012 2013 2014 2010 2011 2012 2013 2014

Exchange Timeline

Planning & Establishment Grants

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New York’s Health Insurance Exchange

• I. Principles
• II. Functions
• III. Exchange Design Questions

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Principle: It must promote affordable, comprehensive health insurance options

• Access to federal subsidies
• Plans compete based on price and

quality, not risk selection

• Opportunity to pool purchasing power

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Principle: It must be consumer-oriented

• First class consumer experience
• Easy to navigate
• Assistance for questions and problems
• No wrong door
• Attracts small businesses

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Principle: It must be transparent and accountable

• Information publicly accessible
• Opportunity for stakeholder input
• Subject to reporting, audits and review
• Ethics considerations (e.g., conflicts,

gifts, post-employment)

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Principle: It must work

• Short timeframe: operating by 2014
• Needs to be flexible

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Commercial Insurance Market Public Programs: Medicaid Child Health Plus Family Health Plus

Exchange Will Operate Within a Larger Environment

Exchange

NYSID NYSDOH IRS HHS/CMS

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Exchange Functions

Function of the Exchange DOH SID Certification, recertification, and decertification of plans √ √ Assignment of price and quality rating to plans √ √ Operate toll free hotline √ √ Maintenance of website for providing plan information √ √ Presentation of enrollee satisfaction survey results √

• Eligibility determination and enrollment into a wide range
• f coverage options

√

• Provision for open enrollment period
• √

Consultation with stakeholders √ √

Some are the same or similar to those currently conducted by State regulatory agencies:

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Exchange Functions (cont)

Function of the Exchange DOH SID “Customer-centric” systems approach, including presentation of plan benefits in a simple, standardized, comparative format

• Provision of an electronic calculator
• Certification of individuals exempt from individual

responsibility

• Provision of information to the U.S. Treasury Department
• Navigator to assist consumers in shopping and enrollment
• Publication of data on Exchange’s administrative costs
• Some are new and are not currently

conducted by State regulatory agencies:

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Governance

Where should the Exchange be placed?

• State Agency
• Public Authority
• Not-for-Profit

Principles: Affordable High Quality Consumer- Oriented Transparent/ Accountable It Must Work

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Alabama Arizona Arkansas California Colorado Florida Georgia Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Connecticut Delaware Maryland New Jersey Rhode Island

Exchange Legislation

DC Quasi-governmental entity Two options: existing agency or non-profit Within existing agency or office Non-profit New state agency Not specified

• Formal draft prepared

Introduced Passed and signed into law Passed and not signed into law

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(Statuses shown are accurate as of 4/19/2011)

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Structure

• 1. Should there be one statewide

Exchange or multiple subsidiary Exchanges?

• 2. Should there be one combined

Exchange for individuals and small businesses (SHOP) or separate Exchanges for each group?

Principles: Affordable High Quality Consumer- Oriented Transparent/ Accountable It Must Work

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Purchasing Role

Principles: Affordable High Quality Consumer- Oriented Transparent/ Accountable It Must Work

Clearinghouse Model Selective Contractor Active Purchaser

Which plan participation model should be used?

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Benefits Design

How to balance plan innovation with ensuring ease of comparison shopping?

– Platinum: benefits actuarially equivalent to 90% of full actuarial value – Gold: benefits actuarially equivalent to 80% of full actuarial value – Silver: benefits actuarially equivalent to 70% of full actuarial value – Bronze : benefits actuarially equivalent to 60% of full actuarial value

Principles: Affordable High Quality Consumer- Oriented Transparent/ Accountable It Must Work

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Adverse Selection

• 1. Should the rules inside and
• utside the Exchange be the

same?

• 2. Should insurers outside the

Exchange be required to offer all benefit options (e.g., California)?

Principles: Affordable High Quality Consumer- Oriented Transparent/ Accountable It Must Work

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Organization of Market

Should New York:

• 1. Merge individual and small

group markets?

• 2. Expand small group size

(50 to 100)?

• 3. Include large groups in the

Exchange?

Principles: Affordable High Quality Consumer- Oriented Transparent/ Accountable It Must Work

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Additional Information

www.HealthCareReform.ny.gov Questions regarding implementation can be sent to: HealthCareReform@exec.ny.gov.

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