Government, Health Care, and Human Resources

Health exchange expert speaking here

March 15, 2013
| By Pete Daly |
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Joel Ario, former director of the Office of Health Insurance Exchanges at the U.S. Department of Health & Human Services, will speak in Grand Rapids Thursday at a day-long meeting of the West Michigan Association of Health Underwriters at the Crowne Plaza Hotel on 28th Street SE.

Ario, one of the country’s major public policy analysts and strategists, has worked to shape insurance reform efforts at the state and federal levels. As director of the Exchange Office at HHS, he advised President Barack Obama and led efforts to design and implement provisions of the nation’s health care reform law, the Patient Protection and Affordable Care Act. He previously served as state insurance commissioner in both Oregon and Pennsylvania, and is now the managing director of Washington, D.C.-based Manatt Health Solutions, a practice of Manatt, Phelps and Phillips LLC. In that capacity, he advises government entities, health plans and foundations on how to prepare for health care reform. He has more than 30 years of experience helping shape and implement public policy in the health care industry.

The symposium includes a panel discussion featuring CEOs from three Michigan health plans: Blue Cross/Blue Shield of Michigan, Grand Valley Health Plan and Priority Health.

“It’s really hard to see what’s correct and what’s not,” in regard to all the news about the Affordable Insurance Exchanges required by PPACA, so the WMAHU decided to invite Ario to explain it, said Dominic Siciliano, president of Benefit Profiles Inc. in Cascade Township and an officer in the WMAHU.

Ario said 16 states and the District of Columbia are building state-run exchanges, which are now in the approval stage at HHS. Michigan and about six other states are planning a partnership with the federal government in setting up and operating their exchanges. In the partnerships, the states will play a dominant role in agent/broker functions, said Ario.

A little more than half the states, which to some degree are opposed to PPACA, are going to let the federal government set up and run their exchanges, but Ario said that even in those cases, many states are intending to continue to perform certain functions, particularly the traditional regulatory role in insurance, including regulation of agents and brokers involved in the new health insurance system.

Ario told the Business Journal that one of the major issues facing the states with the exchanges is a “very challenging” requirement to build an electronic online enrollment system for its health insurance exchange, so that an individual can determine his or her own eligibility for an insurance tax credit or Medicaid coverage. Then the IT system has to connect the individual to enrollment options and complete the actual enrollment. The proposed system is often compared to the successful online travel booking services.

“That all is a pretty tall IT order,” said Ario, so a popular line of thought is to have the federal government handle the IT end of it in the partnership exchanges, because the feds would be doing so for many other states anyway.

In the partnership model, the state role will be largely in continuing to regulate its health insurance market, including licensing and review of the prices charged. Every one of those partnership states would also maintain its own consumer complaint function, as well as education of consumers regarding their health insurance and direct assistance to those consumers.

Ario said a consumer should not be able to tell the difference, whether the electronic online enrollment system is run by the state or the federal government.

There will be two sides to each state’s insurance exchange, according to Ario. One is the service to the individual consumers, also known as the individual or non-group market. The other side is the SHOP Program.

SHOP stands for Small Business Health Options Program, which takes effect at the start of 2014. It will offer small businesses (from one to 50 employees) and their employees new choices for health insurance. According to healthcare.gov, SHOP will give small businesses comparisons of qualified plans and details. SHOP is predicted to save money because it will give small businesses economies of scale in insurance purchases, now available only to large businesses.

In Michigan, meanwhile, the Legislature is still fighting over whether or not the state should partner with the federal government on a health insurance exchange market, which is Gov. Rick Snyder’s recommendation. The House has decided to accept $31 million in federal grant money to set up the exchange, but some Senate Republicans are now balking, apparently, as an election looms next year.

“I won’t drink their Kool-Aid,” said one Senate Republican, Mike Green of Nashville, in early March. He was referring to the federal grant. Green was among the Senate Republicans who, in fact, voted in late 2011 in favor of setting up a state insurance exchange in compliance with PPACA.

“There’s an irony here,” said Ario, noting that in 2011 the Michigan Senate was close to unanimous in its approval of a state-run exchange, but that was stopped by reluctance among House members. Now the House is in favor of a federal partnership exchange and the Senate is not sure it will go along with it, noted Ario.

Siciliano said, “It could be that if we don’t get that ($31 million in federal grant money) appropriated, that the oversight of agents in the exchange would defer back to HHS. That’s a real possibility, a pretty hot topic.”

The issue of Michigan’s insurance exchange “has flipped” in the House — “and it’s all politics,” said Siciliano, adding that senators facing primaries next year are feeling pressure from Tea Party supporters who are opposed to anything regarding PPACA.

The day-long WMAHU Symposium on March 21 at the Crowne Plaza Hotel, 5700 28th St. SE, will start at 8:30 a.m. Tickets are $35 and include exhibits, lunch, presentations and a happy hour event. Association members, their employer group and individual clients they serve are invited.

WMAHU is the local chapter of the National Association of Health Underwriters, representing more than 100,000 licensed health insurance agents, brokers, general agents, consultants and benefit professionals across the U.S.

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