Planning for Health Insurance Exchange Comes Under Fire

Critics say that the committee that this week issued its recommendations on the exchange to the Legislature and Governor Paul LePage is putting the interests of insurance industry's ahead of consumers'.

"I don't think it's surprising that a group that explicitly excluded individual consumers comes up with a plan that probably won't work well for those consumers," said State Rep. Sharon Treat.

Treat, a Hallowell Democrat on the Legislature's Insurance and Financial Services Committee, pointed to the fact that the nine-member advisory committee is wholly comprised of insurance and health care insiders except for one representative of small business and another representing Maine's Indian tribes.

Treat said she's troubled that the committee does not think the exchange should use its buying clout to negotiate with insurers over the pricing of plans.

Potentially, tens of thousands of Mainers could buy coverage through the exchange. The US census indicates that roughly 133,000 people, or about 10 percent of Maine?s population, do not have coverage.

"The exchange provides the opportunity to really go out there and do group purchasing or negotiate the best possible policies or to limit those policies," Treat said. "Also, this is public money and that public money should be spent to purchase really good effective insurance."

Joe Bruno, who chairs the advisory committee, said that "most of us felt the free-market approach is the best way to have competition and to keep prices lower."

Bruno, a former Republican state legislator and owner of a pharmacy company, said committee members were drawing on the experiences of Maine's insurance market for individuals.

"It's a failed market because we don't have competition," Bruno said. "We have an insurance market controlled by one or two insurers. That has not worked."

Bruno downplayed concerns that industry members appointed to the new board overseeing the exchange --- say an insurance broker -- would be allowed to weigh in on policy decisions that stand to benefit them directly.

"Maine is a small state and will there be a conflict?" Bruno said. "There may be, but it's pretty clear in the law, what you need to recuse yourself from a lot of the times."

But the advocacy group Consumers for Affordable Health Care still worries that consumers are getting short shrift. Policy director Mitchell Stein said he's concerned that the committee didn't focus more attention on so-called navigators -- the people who would be hired to help exchange shoppers choose plans and determine whether they qualify for federal tax credits. Not everybody, Stein said, will know how to use the web site that will be set up for the exchange.

"As friendly as the web site might be," Stein said, "there are many who are not skilled at negotiating web sites and may not even have access so they would need more one on one assistance with the process."

Stein says that some of those so-called "navigators" could very well be staffers at Consumers for Affordable Health Care, which already runs a state-wide helpline for people with questions about coverage.

State Representative Jonathan McKane, a Republican from Newcastle who is also on the Insurance and Financial Services Committee, has not had a chance to review all of the committee's recommendations. But he opposed the idea of Consumers for Affordable Health Care playing a larger role in the exchange.

He says the businesses that buy health care are better representatives of consumers, and should be on the exchange's board. At the same time, he thinks the state should plan for the scenario in which the states trying to get the federal Affordable Care Act thrown out in the courts are victorious, and an exchange is no longer mandated.

"I think there needs to be perhaps a kick-out clause that if the federal mandate goes aweay so does our exchange," McKane said.

McKane and Treat both offered separate pieces of legislation on the health insurance exchanges last session. Lawmakers will take up their bills when the Legislature reconvenes in January.

The two legislators disagree on what kind of role the existing Dirigo Health agency should play in the new insurance exchange. Treat wants to take advantage of the organizational structure and expertise within the agency; McKane says he want to keep any new exchange as small as possible.

Regardless of who staffs the exchange, it appears it will be housed within the state Department of Professional and Financial Regulation, as the advisory committee has recommended.

Legislation is also expected to come out of the advisory committee's recommendations, which the Insurance and Financial Services Committee will take up for the first time at a meeting on Monday.

Source: http://www.mpbn.net/Home/tabid/36/ctl/ViewItem/mid/3478/ItemId/18156/Default.aspx

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