Some Southern States Push Ahead on Exchanges, While Others Don’t

Featured Health Business Daily Story, Dec. 16, 2011

Some Southern States Push Ahead on Exchanges, While Others Don’t

Reprinted from AIS’s HEALTH REFORM WEEK, the nation’s leading publication on the business implications of the massive changes for the health industry mandated by reform.

By Judy Packer Tursman, Contributing Editor – December 5, 2011 – Volume 2 Issue 37

Despite their general opposition to the health reform law, some GOP-led southern states are proceeding with plans to form health insurance exchanges. A governor-appointed advisory panel in Georgia, which is part of the multistate legal challenge to reform awaiting U.S. Supreme Court review, recently recommended setting up a quasi-governmental state-based exchange. A gubernatorial panel also recently issued recommendations for an exchange in Alabama — which is among 13 states to obtain a total of nearly $220 million in a new round of HHS grants awarded Nov. 29 to develop exchanges (HRW E-News Alert, 11/30/11).

“Whether or not legislation will pass in Alabama is hard to predict, but they’re moving forward,” says Joy Johnson Wilson, health policy director for the National Conference of State Legislatures (NCSL). “I believe the committee is recommending to the governor he should move forward and get the [federal exchange] establishment grant. I don’t think they’ve drafted anything [i.e., legislation] yet.”

“It’s kind of a mixed bag in the south,” Wilson tells HRW. “Florida is basically looking at private exchanges, and not really moving forward on the [Obama] administration’s approach. In Texas Gov. [Rick] Perry has indicated to the legislature that he’s waiting to see what the Supreme Court does. And if they uphold the law, he believes he can do what needs to get done through an executive order.” Louisiana is opting for a “federally facilitated” exchange, Wilson says, “and South Carolina just announced last week they’re not going to move forward on an exchange.”

North Carolina, which has a Democratic governor, is expected to apply for a federal exchange establishment grant before the deadline, she adds. And a panel in Virginia “has made recommendations to the governor to move forward, and he [i.e., Gov. Bob McDonnell (R)] has not responded yet,” she says.

At the end of October, the Georgia Health Insurance Exchange Advisory Committee agreed to recommend that the state set up a quasi-governmental, nonprofit entity with a seven-member board of directors. Its exchanges would cover individuals and small businesses (initially defined as having one to 50 employees). Gov. Nathan Deal (R) set up the panel, which includes health plan representatives, through an executive order in June. That occurred after Deal had to pull exchange legislation when “tea party” conservatives began a protest as the state’s General Assembly prepared to vote on the measure.

NCSL’s Wilson notes that Deal will get a formal report from the panel later in December. “We don’t know what the governor intends to do,” she adds. Blake Fulenwider, a health policy adviser to Deal, has said that the governor will get the report by Dec. 15. Fulenwider was noncommittal about whether Deal would move forward on the exchange or whether he and the legislature were likely to draft an exchange bill.

Wilson says it is difficult to make generalizations about southern states’ approaches. “It may be different folks have different interests,” she says. “Some may be doing it to be practical. Some may want [exchanges] to happen.”

In Mississippi, the state legislature adjourned in April without passing legislation to set up a state-based exchange. Lawmakers won’t return until January 2012, so the state insurance commissioner asked Mississippi’s high-risk pool to establish and operate the exchange, and it agreed to do so in May (HRW 5/30/11, p. 1).

Since then, the focus on how to set up Mississippi’s exchange has narrowed over the short term, says Lanny Craft, executive director of the Mississippi Comprehensive Health Insurance Risk Pool Association. “What we concluded would be the best approach for us if we wanted to get results in a short timeline was to pick a particular piece and get it implemented immediately,” he tells HRW. This “piece” is what Craft calls a “shop and compare” feature, similar to that of the HHS website www.medicare.gov. His board issued a request for proposals Nov. 16 for an electronic platform capable of supporting “shop and compare”; proposals are due “back to us” by Dec. 16, he says.

The next step for Mississippi? “Our goal is extremely ambitious: to put out an operational platform by the end of first-quarter 2012,” Craft says, “and as soon as HHS puts out information on qualified health plans, we’ll put them in.” Similarly, the platform will be able to plug other mandated functions, such as Medicaid eligibility determinations, into the exchange as soon as information on how to do so becomes available. Doing it in this way “gives us the opportunity to be ahead of the curve,” he says.

Kevin Wrege, Esq.

Founder & President

Pulse Issues & Advocacy LLC

Office: 202-625-1787

Mobile: 202-253-4929

4410 Massachusetts Ave., NW, #150

Washington, DC 20016

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