States Turn in their Exchange Homework

It’s that time of year again: studying, cramming, sleepless nights, and turning in final reports and papers just in time for the holidays. College? No, we’re talking about states working on health insurance exchanges! Many states were assigned homework during legislative sessions earlier in the year, and due dates are quickly approaching.  Other states are hard at work making policy and implementation decisions related to the creation of a state exchange before state legislative sessions begin early next year.
Reports and Study Commissions
Virginia, Alabama, South Carolina, and Georgia established study committees earlier this year to report on and make recommendations about creating a state-based exchange.

• The Virginia Health Reform Initiative (VHRI) Advisory Council was created as a result of legislation passed in the 2011 session. The Council’s  report addresses five key issues: where the exchange should be housed, the makeup of the governing board, a needs and sustainability analysis, specific functions of the exchange, and potential interactions between the exchange and other programs, including Medicaid. Key recommendations include: establishing the exchange as a quasi-governmental entity or within an existing state agency, maintaining the same market rules and mandates both inside and outside the exchange, and creating the exchange as a “passive purchaser.”
• Alabama’s Health Insurance Exchange Study Commission was set up through anexecutive order issued by Governor Robert Bentley in June 2011. The commission was charged with making recommendations on 5 major issues: where the exchange should be housed, the makeup of the governing board, a sustainability and needs analysis, specific functions of the exchange, and potential interactions between the exchange and other programs, including Medicaid and Public Health. The resulting report makes recommendations including establishing the exchange as a quasi-governmental entity, keeping the individual and small group risk pools separate, setting up the exchange as a “free market facilitator,” and funding the exchange through an assessment on products sold both inside and outside the exchange.
• The South Carolina Health Planning Committee, established by Governor Nikki Haley through an executive order in March 2011 to study the feasibility of a state based exchange and review alternative options, released its report in November. The committee recommends against the state developing its own exchange; suggesting instead that the state should facilitate the establishment of private exchanges. The report also recommends the state retain control over insurance marketplace functions and recruit new carriers to the market.
• Georgia Governor Nathan Deal issued an executive order in June, establishing the Georgia Health Insurance Exchange Advisory Committee to make recommendations on whether to create a state-based exchange. The committee is charged with making the exchange sustainable and providing better options to individuals and employers to purchase affordable insurance. The committee’s interim report issued in September outlines research and actions of the committee to date. Final recommendations are due December 15, 2011.

Policy Decisions
States are also moving forward on making key policy decisions for the exchange, including:

•  Maryland’s Health Benefit Exchange board has been holding a series of meetings to create a final report for the legislature. Six consultant reports and four advisory committee reports were delivered to the board at its November 15, 2011 meeting. The six reports were required by the state’s exchange enabling legislation and tackle financing and sustainability, operating models, insurance rules, SHOP options, navigators, and public relations.
• Minnesota Governor Mark Dayton issued an executive order on October 31, 2011, creating a Health Care Reform Task Force. Among other duties, the task force, under the direction of the Commerce Commissioner, will aid in the development of the state’s exchange. The Commissioner created an exchange advisory task force in September. Earlier this month, Minnesota released three potential prototypes for an exchange and is seeking public comment on them. The prototypes are in response to an Exchange IT RFPthe state released in June.
• Pennsylvania’s Governor Tom Corbett decided to move forward with a state-based exchange and the state has set up a website to share information with the public.

As your state completes its exchange homework you may find these resources helpful:

• The State Refor(u)m exchange legislation and executive orders chart
• Our ever-growing collection of exchange establishment grants. Don’t see your state’s application listed? Post it here.
• Not sure where to start? Check out our collection of over 300 exchange related documents.   You can sort and filter them to meet your needs.

What kind of exchange-related activities is your state working on?   Do you have questions about any of the information in this blog post?  Share those with us in the comments below!