Health exchange on track for implementation

DENVER – When Gov. John Hickenlooper signed Senate Bill 200 into law on June 1, he not only made Colorado the eighth state to comply with federal law requiring creation of health insurance exchanges. He also ensured that a year of work on health-care reform implementation in the state continues to the next level.

“SB 200 was a milestone,´ said Joan Henneberry, director of the Colorado Health Insurance Exchange, where small businesses and individuals can shop for health insurance. “It was the enabling legislation that allows us to go ahead.”

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SB 200, sponsored in the Senate by Sen. Betty Boyd, D-Lakewood, and in the House by Rep. Amy Stephens, R-Colorado Springs, was passed in the final weeks of the 2011 legislative session without a single Senate Republican vote. That made Colorado the only state so far to pass exchange legislation through a divided legislature, Hickenlooper said at the bill-signing ceremony.

The next step, as required by the law, is to seat a nine-member board of directors to direct and oversee implementation of the exchanges. The governor will appoint five members – not state employees – while the leadership of the state House and Senate will each select two, to serve four-year terms; three ex-officio nonvoting members will include the state insurance commissioner and representatives from the offices of Health Care Policy and Financing and Economic Development. The board must be seated by July 1, but they can’t be simply political appointments.

“It was important to get a skill-based board,” Henneberry said. “The legislation outlines the skill set requirements for directors.”

SB 200 says that a majority of the voting members must be business representatives or individuals not directly affiliated with the insurance industry, with demonstrated expertise in one, preferably two or more, areas such as health care finance or economics; individual or small employer health insurance coverage; health benefits administration; administration of a public or private health-care delivery system; the provision of health-care services; information technology; or starting a small business with 50 or fewer employees.

Henneberry said the board’s first meeting is tentatively scheduled for July 11. When it begins meeting, it will be responsible for, among other things, appointing an executive director to administer the exchange, creating operational and financial plans, and considering the structure of the exchange, including the appropriate size of the small employer market.

Volunteer working groups

The board will be able to hit the ground running, according to Henneberry, because of the efforts of 65 volunteers representing various stakeholders such as the business community, insurance industry, health care providers and economists and analysts.

“They’ve been meeting on an ongoing basis since last year, divided into four working groups, to help tee up the issues for the board,” she said.

One group focused on data analysis, running various simulations based on income and demographic assumptions to determine which insurance products would be most likely to be in demand.

Another focused on small employers, what factors would be most important for them in using the exchange, and how to make it easy for them to use.

Verification and enrollment occupied the efforts of a third group, which focused on IT and other solutions to effectively and efficiently determine eligibility to participate in the exchange and then work with it.

And the last group has been exploring marketing, education and outreach issues, what specific messages need to be delivered to educate the public and employers on how to access the program.

Henneberry said all this advance work will help, but the board will still be looking at pretty tight deadlines for implementation of the exchanges.

“We have to be ready to open the doors by late 2013, since the Affordable Care Act requires people to start getting benefits by Jan. 1, 2014,” she said. “That means we have to start testing in July 2013 before an open enrollment in the fourth quarter, at the latest. We have just about two years to get all the work done.”

National leader

While Colorado faces a massive effort to implement its health exchange by the Affordable Care Act deadline, it is far and away ahead of other states, even the few that have passed enabling legislation.

“Lots of states are still at the information-gathering stage,” Henneberry said. They have until the end of the year to decide if they want to pass enabling legislation in 2012. A couple have their legislatures just starting to draft a bill (like SB200), and a couple haven’t done anything. Some will decide they just won’t do it.”

If they don’t, or can’t, state residents will by default be included in the federal exchange program. This makes Colorado a national leader in how to keep state control of the process.

“We are absolutely in the top quartile in terms of progress,” Henneberry said. “The last year has helped us a lot.”

And all this planning has been done without spending one dime of state money, according to Henneberry. It has all come from a $1 million federal planning grant awarded at the beginning of the year.

“We’ve spent about half of it so far, so we’re on track,” she said. “We’ve been totally focused on keeping things lean and efficient.”

The exchange is supposed to be self-supporting by 2015, and Henneberry said that efforts so far have been focused on creating partnerships with private businesses in the state, which could result in job creation among local companies.

While implementation of the exchange moves along, Colorado is also one of 26 states suing the federal government over the constitutionality of mandating health coverage. That suit, most recently heard by a federal appellate judge in Atlanta on June 8, could reach the Supreme Court as early as its next session, which begins in October.