Washington State
Washington State

Washington State - PowerPoint Presentation

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Health Insurance Exchange Phil Dyer Board Member Disclaimer The views and information expressed are my personal opinions and perspectives and do not represent the official position of the State of Washington or the Washington State Health Insurance Exchange Board or Staff ID: 441007 Download Presentation

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Washington StateHealth Insurance Exchange

Phil DyerBoard MemberSlide2


The views and information expressed are my personal opinions and perspectives and do not represent the official position of the State of Washington or the Washington State Health Insurance Exchange Board or Staff.Slide3

The WA Health Insurance Exchange

As laid out in Substitute Senate Bill 5445, twenty nominations for the Exchange Board were submitted by the house and senate caucuses and included individuals with expertise in individual health care coverage, small employer health care coverage, health benefits plan administration, health care finance and economics, actuarial science, and/or administering a public or private health care delivery system. Initial

members of the board will serve staggered terms not to exceed four years.

On March 15th, 2012, the Board assumed governing authority over the Exchange.Slide4

The WA Exchange Board

Chair: Margaret Stanley,

retired Executive Director of the Puget Sound Health Alliance, and former Senior Vice-President at Regence BlueShield and head of public employee benefits programs in both Washington and California

(Non Voting with exception of Tie Votes)




Director at the Odessa Brown Children's Clinic

Bill Baldwin

, Partner, The Partners Group

Don Conant

, General Manager at Valley Nut and Bolt in Olympia and Assistant Professor in the School of Business at St. Martin's University

Doug Conrad

, Professor of Health Services at the University of Washington School of Public Health

Melanie Curtice

, partner in the employee benefits section at the law firm of


Rives LLP

Phil Dyer

, Senior Vice President at Kibble & Prentice/USI and former state legislator

Steve Appel

, wheat and barley farmer and immediate past-President of the Washington Farm Bureau

Teresa Mosqueda

, Legislative and Policy Director for the Washington State Labor Council and Chair of the Healthy Washington Coalition



MaryAnne Lindeblad


Director of the Health Care Authority





, Washington State Insurance Commissioner Slide5

WA Exchange Board Goals

Increase access to affordable health plans.Organize a transparent and accountable insurance market -- to facilitate consumer choice.Provide an efficient, accurate and customer-friendly eligibility determination process.Enhance health plan competition on value -- price, access, quality, service, and innovation.Slide6

WA Exchange Major Committees

Operations Chair, Melanie CurticeSteve Appel

Bill Baldwin

Don Conant

Margaret Stanley


Chair, Teresa Mosqueda

Doug Conrad

Ben Danielson

Phil Dyer

Margaret StanleySlide7

Exchange Board Advisory Committee

May 16, the Exchange Board selected 17 committee members to provide expertise and experience on an array of issues related to developing the Health Benefit Exchange in Washington State. Those members include


American Indian Health Commission (AIHC) Representative


Beaudoin, WithinReach


Blotsky, Employee Benefit Services-Associated Employers Trust


Bogner, Molina Healthcare


Cramer, Premera

Mike Fournier, Washington Farm Bureau

Patty Hayes, Public Health – Seattle & King County

Dhyan Lal, Providence Health & Services

Mary McWilliams, Puget Sound Health Alliance


Merrikin, GroupHealth Cooperative

Hiroshi Nakano, South Sound Neurosurgery


Oliver, Community Member


Pinkerton, Regence


Steward, Association of Washington Business


Thompson, Whatcom Alliance for Healthcare Access


Association of Health Underwriters (WAHU) Representative


Welter, Mainstreet AllianceSlide8

Exchange Board Technical Advisory Committees

Dental Technical Advisory Committee

· Dr. Christopher Delecki – Odessa Brown Children’s Clinic

· David Digiuseppe – Community Health Plan of Washington

· Bracken Killpack - Washington State Dental Association

· Dr. Alejandro Navarez – Sea Mar CHC

· Dr. Brian Schur – Tri-Cities Community Health Center

· Chris Smith – Regence BlueShield

· Delta Dental Washington Dental Service Foundation Representative

Navigator Program Technical Advisory Committee

· Sofia Aragon – Washington State Nurses Association

· Pam Cowley – Tacoma-Pierce County Health Department

· Rhonda Hauff – Yakima Neighborhood Health Services

· Devon Love – Equal State Community Coalition for Multicultural Health

· Vicki Lowe – Jamestown S’Klallam Tribe

· Michelle Sarju – Open Arms Perinatal Services

· Lara Welker – Whatcom Alliance for Healthcare Access

Role of Agents/Brokers Technical Advisory Committee

· Lonnie Goodell – Group Health Cooperative

· Dave Guyll – Conover Insurance

· Bryan Marsh – Regence BlueShield

· Nita Petry – Gallagher Benefit Services, Inc.

· Harald Schot – LifePlan Financial Inc.Slide9

Health Care National Spending(Deloitte)

This year, the federal government will take in about $2.4 trillion and spend about $3.6 trillion—the fourth year in a row of the deficit exceeding $1 trillion.


for health care programs





Children’s Health Insurance Program


), military health


federal employee coverage

—will be almost

one-fourth of the government’s outlays and a third of all government revenues from taxes paid by individuals and companiesSlide10

State Action Toward Creating Health Insurance Exchanges

As of August 24, 2012Slide11


Washington is a Leading State in the Process of Securing $178 Million for Exchange Establishment & Medicaid Eligibility SystemsSlide12

Exchange Functions

Certifying health plans as “Qualified Health Plans” to be offered in the exchange.The final rule allows Exchanges to work with health insurers on structuring qualified health plan choices that are in the best interest of their customers. This could mean that the Exchange allows any health plan meeting the standards to participate or that the Exchange creates a competitive process for health plans to gain access to customers on the Exchange

Standards for Health


Exchanges, working with state insurance departments, to set specific standards to ensure that each qualified health plan gives consumers access to a variety of providers within a reasonable amount of time. Exchanges will also establish marketing standards to make sure that qualified health plans do not market plans in a way that discriminates against people with illnesses. Slide13


a website to facilitate comparisons among qualified health plans for



a toll-free hotline for consumer support, providing grant funding to entities called “Navigators” for consumer assistance, and conducting outreach and education to consumers regarding Exchanges

Exchange Functions

Consumer InteractionsSlide14

Exchange Functions

Determining eligibility of consumers for enrollment in qualified health plans and for insurance affordability programs (premium tax credits, Medicaid, CHIP and the Basic Health Plan)

Eligibility Determinations

Exchanges to consider whether consumers are eligible for all available programs using a single, streamlined application

Simple Verification of Data

Exchanges to rely on existing electronic sources of data to the maximum extent possible to verify relevant information, with high levels of privacy and security protection for consumers.

Coordinating across Programs:

The final rule ensures that Exchanges will coordinate with Medicaid, CHIP, and the Basic Health Program Slide15


Exchange Value – Specific Functions

I. Issuers of QHPs

II. Health Care Market

III. Public and State

Marketing & Outreach

Eligibility Determination for tax credits


Premium Aggregation

Easy plan comparison and purchase of health insurance

Reporting of cost/quality metrics

Awareness of need for health insurance

Appeals of eligibility determinations and individual responsibility

Information on health insurance carriers

Customer Service

Enrollment reconciliation with HHS

New Membership opportunity – previously uninsured

Supporting use of innovative product designs and payment methodologies

Expanded access to health insurance coverage

Reduced charity care

Trustworthy source of health care reform information

Broad-based Public Information

Other impacts of ACASlide16

Exchange Functions

Exchanges to build partnerships with and award grants to entities known as “Navigators”

who will reach out to employers and employees, consumers, and self-employed individuals to


Conduct public education activities to raise awareness about qualified health plans

Distribute fair and impartial information about enrollment in qualified health plans, premium tax credits, and cost-sharing reductions

Assist consumers in selecting qualified health plans

Provide referrals to an applicable consumer assistance program or ombudsman in the case of grievances, complaints, or questions regarding health plans or coverage

Provide information in a manner that is culturally and linguistically appropriate Slide17

Exchange Functions


Exchanges will operate a

Small Business Health Options Program



). SHOP will allow employers to choose the level of coverage they will offer and offer the employees choices of all qualified health plans within that level of coverage. This allows employees a choice among plans and can select the one that best fits their needs and their budget. Employers can offer coverage from multiple insurers, just like larger companies and government employee plans, but get a single bill and write a single check. SHOP Exchanges can also allow employers to select a single plan to offer its employee

Starting in


, small employers purchasing coverage through SHOP may be eligible for a tax credit of up to 50% of their premium payments if they have 25 or fewer employees, pay employees an average annual wage of less than $50,000, offer all full time employees coverage, and pay at least 50% of the premium. Slide18


Coverage Continuum in 2014



* Federal Basic Health Plan Option for individuals with incomes between 138% and 200% of the FPL will not be available in 2014.



SSI Presumptive

Medical Care Services Program

Basic Health Plan


Involuntary Treatment Act

Psych. Indigent Inpatient Program

Take Charge Family Planning

Family Planning Extension


Medicaid Standard

Medicaid Benchmark


Medicaid Standard

QHP with Subsidy

To-Be Landscape: Continuous Coverage

Note: Transition options to be addressed by State Legislature.

QHP without SubsidySlide20


Post Implementation of the Affordable Care Act (ACA):

Subsidized Coverage Landscape in Washington


Individuals (in thousands)

Note: Analysis forecast assumes full take up rate and the ACA was in effect in 2011. **Includes individuals who have access to other coverage (e.g., employer sponsored insurance). Sources: The ACA Medicaid Expansion in Washington, Health Policy Center, Urban Institute (May 2012); The ACA Basic Health Program in Washington State, Health Policy Center, Urban Institute (May 2012) ; Milliman Market Analysis; ‘and Washington Health Care Authority for Medicaid/CHIP enrollment.


1.16 million

current enrollees



currently eligible but not enrolled**


newly eligible


eligible for subsidiesSlide21


Post Implementation of the ACA: Remaining Uninsured

Undocumented immigrants

Individuals exempt from the mandate who choose to not be insured (e.g., because coverage not affordable)

Individuals subject to the mandate who do not enroll (and are therefore subject to the penalty)

Individuals who are eligible for Medicaid but do not enrollSlide22


Four Levels of Benefits





Exchange Functions

Apply the Essential Health Benefit Plan Levels established by Essential Health Benefits QHP’s must include items and services within at least the following 10 categories:

Ambulatory patient services

Emergency services


Maternity and newborn care

Mental health and substance use disorder services, including behavioral health treatment

Prescription drugs

Rehabilitative and habilitative services and devices

Laboratory services

Preventive and wellness services and chronic disease management, and

Pediatric services, including oral and vision careSlide24


Timeline of Key Tasks: Much Work To Be Done




Oct 1 2013:

Open enrollment begins.

Jan 1 2014:

Exchange goes live.

July 1 2013:

Finalize QHP contracts.

October 2012:

Complete business rules and workflow for all eligibility & enrollment operations.

Jan 1 2013:

Receive conditional or full exchange certification from Secretary.

QHP solicitation bids due.

Initiate marketing & outreach campaign.

Launch assisters training program.

Nov 2014:

Last Exchange Establishment application deadline.

Nov 16, 2012: Request federal certification for Exchange operations.

Dec 31 2014:

Exchanges must be self-sustaining.

Sept 30 2012:

Deadline to select benchmark Essential Health Benefits plan.

Aug 15, 2012:

First of ten new opportunities to apply for Exchange grantsSlide25


To Learn More About the Exchange



Includes information about:

Exchange Board

Legislation and grants

Policy discussion

TAC and stakeholder involvement

IT systems development

HHS guidance

Listserv registrationSlide26