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Colorado Health Benefit Exchange Update – 9/2011

Colorado Health Benefit Exchange Update – 9/2011. Jim Sugden CSAHU 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

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Colorado Health Benefit Exchange Update – 9/2011

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  1. Colorado Health Benefit ExchangeUpdate – 9/2011 Jim Sugden CSAHU Exchange Coordinator

  2. 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”

  3. 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

  4. 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?

  5. 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

  6. 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

  7. 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

  8. 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

  9. 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

  10. 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?

  11. 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?

  12. 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?

  13. 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.

  14. Questions?

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