Health care exchange watch dog growls about the role of the feds

The Colorado Statesman

Republican State Rep. Bob Gardner, vice-chairman of a committee charged with keeping watch over Colorado’s health care insurance exchange board, raised concerns to the board last Monday about federal regulations for the virtual health insurance marketplace in Colorado.

Gardner, R-Colorado Springs, criticized more than 240 pages of what he calls “restrictions” or “mandates” by the U.S. Department of Health and Human Services (HHS) concerning the implementation of a health care insurance exchange. Gardner voted against Senate Bill 200 earlier this year to create such an exchange — a component of President Barack Obama’s federal health care reform requirements for states. The mandate has bipartisan support in Colorado, as the hope is that it will lower costs for both consumers and small business owners.

All funding for the exchange must come from gifts, grants and donations. An independent third party will operate and manage the program, which would work similar to how airlines sell tickets through Expedia and Travelocity. Consumers should have no longer than a 20-minute “world-class” experience operating the exchange, according to federal guidelines. Short wait times, the use of multiple languages and Americans With Disabilities Act-friendly options are promised under the federal guidelines.

While some of Gardner’s fellow Republicans — including House Majority Leader Amy Stephens, R-Monument — believe Colorado would benefit from an exchange despite Obama’s health reform law, Gardner advised the board on Monday that it should express concerns to HHS officials about requirements. He believes Colorado should be allowed to operate autonomously of the federal government if an exchange is created in the state. “Colorado needs the maximum amount of flexibility to design this health benefit exchange for the good of the people of Colorado,” said Gardner.

He pointed out that elected officials who have a full understanding of Colorado-specific issues have appointed the members of the nine-member Colorado Health Benefit Exchange Board and the 10-member Health Benefit Exchange Implementation Review Committee.

“We are closest to the people; we are closest to the problems of Colorado, I think we probably, while not perfect, do have some chance of knowing better what works for Colorado,” Gardner said.

Steve ErkenBrack, a member of the Health Benefit Exchange Board and president of Rocky Mountain Health Plans, asked Gardner and the review committee to work with the board in order to implement an exchange with a unified voice. He believes it is important for Colorado to be aggressive in dealing with the federal government.

“One of the things that was discussed right off the bat here is that there is consensus that the regulations should be structured to allow maximum flexibility for Colorado to build its own exchange,” said ErkenBrack. “I wouldn’t want us to be silent on that if we have an opportunity when HHS comes in to speak to that.”
The board on Monday created a subcommittee to review HHS rules and guidelines in implementing the exchange, with the goal of reporting to federal officials with questions, comments and concerns. Gardner believes the subcommittee is a step in the right direction, but he still has reservations.

“I don’t know that the committee itself alleviates my concerns, the committee will be doing important work, as will the legislative oversight committee, to hopefully bring together a unified document, even perhaps with the governor’s office, that will address our concerns to the federal department of health and human services,” Gardner told The Colorado Statesman following the board meeting. “We won’t know until they publish their final regulations whether we have been affected. But, I’m pleased that the board is being very proactive.”

Integrating human service programs

The board on Monday also grappled with how to integrate the exchange with human service programs. Federal law requires that individuals be screened and enrolled in Medicaid, the Children’s Health Insurance Program, or new federal health insurance subsidy programs when visiting the virtual exchange. The exchange must be interoperable, but it does not have to be integrated with human service programs. That leaves states with a good deal of flexibility in determining how to integrate human service programs.

Jim Jones, a health insurance consultant from Wisconsin hired to advise on eligibility enrollment, explained that the board essentially has four choices of integration: a fully integrated model; an interoperable model; keeping systems separate; or using multiple doors to integrate human services. He said a fully integrated system would cost the most and may take the longest to implement, while separate systems would cost the least to develop, but cost the most to maintain. An interoperable system may be the exchange’s best option, as it uses existing functionality and could be implemented on schedule. The exchange must be completely self-sufficient by 2015.

State Rep. Cheri Gerou, R-Evergreen, raised concerns over integrating the systems all at once. She pointed out that in 1995, the legislature required that the state coordinate human services eligibility as a “one-stop-shop.” The system took nine years to implement and cost more than $320 million for a system that is only 63 percent accurate, she said.

“What you’re trying to do is solve a problem in one shot, and what I’ve learned serving the state is that the state doesn’t do very good with that,” said Gerou, the chair of the House Appropriations committee and member of the Joint Budget Committee.

Jennifer Corrigan Politi, a policy analyst with the Colorado Human Services Directors Association, spoke in favor of an integrated services delivery model that she says creates the best outcomes for low-income families.“Colorado has the opportunity to break down silos that exist between departments and programs and to develop an efficient, streamlined health and human services system,” said Politi. “Together, we can develop a vision for how to best serve all families in Colorado.”