Federal agencies slow to create health insurance exchange
BY WAYNE GREENE World Senior Writer
Friday, January 04, 2013
1/04/13 at 7:22 AM
Read the Tulsa World continuing coverage of the health care law.
Oklahoma officials say they have seen little evidence that federal officials are working on building a health insurance exchange for Oklahoma.
So far, the state has received only a 25-question federal survey seeking to define the legal boundaries for exchange issues, said Julie Cox-Kain, chief operating officer of the Oklahoma Department of Health and designated contact person for most exchange issues.
"That's it so far," she said.
None of the major issues - such as working with officials to integrate the state's Medicaid system into an exchange computer system - has been started, she said.
"There's still just a wad of unanswered questions on the technological standpoint. There are still a lot of unanswered questions about many of these things," she said.
The U.S. Department of Health and Human Services announced conditional approval of health insurance exchange plans in eight states in a teleconference Thursday. With the latest additions, 19 states and the District of Columbia appear to be on track to operate - at least partially - exchanges, which are essential elements of the federal Affordable Care Act.
Five other states reportedly are working on exchange plans, and one state - Mississippi - is in limbo, meaning at least 25 states don't intend to have any part in an exchange, leaving the job to the federal government.
Gary Cohen, deputy administrator of the U.S. Centers for Medicare and Medicaid Services, said consumers in those states, including Oklahoma, can rest assured that a federally operated marketplace will be ready to go on Oct. 1, the deadline for client enrollment to begin.
"The commitment is: They'll either operate a state-based exchange, or we'll have a federally facilitated exchange in every state," Cohen said. "I think work on the ground is happening now and people will continue to see more work on the ground as we approach a call to action for open enrollment in October."
But state officials said they haven't seen evidence of that work.
"I would imagine that we will see them rapidly ramping up. They have a very short time to build an exchange in these 25 states," Cox-Kain said.
Kelly Collins, spokeswoman for the Oklahoma Insurance Department, said the department hasn't seen any concrete evidence of federal preparations to operate an exchange here.
Some conference calls have been organized, but they were subsequently canceled by federal officials, she said.
In the teleconference, U.S. Secretary of Health and Human Services Kathleen Sebelius announced conditional approval of state exchanges in California, Hawaii, Idaho, Nevada, New Mexico, Utah and Vermont, and conditional approval of an exchange that will be cooperatively operated by the federal government and the state of Arkansas.
"From the beginning, this process has been guided by our belief that states know their own needs better than anyone else," Sebelius said. "That's why we've worked so hard to give states the flexibility and resources to operate and participate in marketplaces that work best for their citizens, and it's encouraging to see so many states moving forward to do just that.
"No matter what state Americans live in, they'll soon have better health coverage options."
Federal officials previously approved state exchange plans from Colorado, Connecticut, the District of Columbia, Kentucky, Massachusetts, Maryland, Minnesota, New York, Oregon, Rhode Island and Washington, and a partnership plan from Delaware.
A plan for Mississippi has been submitted, but subsequently it became apparent that there was disagreement among state officials about the legal authority to operate an exchange, and federal officials have put off decisions on the submission.
The deadline for submitting independent state exchange plans has passed, but states have until Feb. 15 to offer plans to operate exchanges in partnership with the federal government, Sebelius said.
Illinois, Iowa, Michigan, North Carolina and West Virginia are planning partnership exchanges, according to the Henry J. Kaiser Family Foundation of California, which provides independent health-policy analysis. The other 25 states are not planning any participation in an exchange, leaving the job to the federal government.
In some of the conditionally approved states - particularly Utah - state officials have made it clear that they aren't interested in full compliance with federal mandates, raising the possibility that Health and Human Services officials will have to step in and impose a compliant exchange late in the process.
Cohen wouldn't give a deadline for state plans to meet federal standards or be pushed aside, except to say exchanges would be enrolling clients by Oct. 1 and offering coverage as of Jan. 1.
Gov. Mary Fallin has made it clear that Oklahoma will not be building an exchange, and Oklahoma Attorney General Scott Pruitt has argued in federal court that if the state doesn't establish an exchange, federal officials can't enforce the law's mandate here.
The Affordable Care Act provided for federal exchanges in states that didn't build their own, but planners clearly didn't foresee half of the states not taking part in the program, raising doubts about the ability of the federal government to start enrolling participants on Oct. 1 and fully operating the system by Jan. 1.
"At this point, the folks on the inside ... say they are going to be ready," said Edmund Haislmaier, senior research fellow for the Heritage Foundation, a conservative think tank. "All of us on the outside are highly skeptical."
There is little evidence that federal officials have made any substantial progress in setting up exchanges in states like Oklahoma, Haislmaier said.
"I haven't seen it," he said.
Protest rally to be held at state Capitol Feb. 5
A rally at the state Capitol to protest Gov. Mary Fallin's decision not to participate in a Medicaid expansion is scheduled for noon Feb. 5 - the first full day of the legislative session.
Several groups, including MoveOn.org, Change Oklahoma, Empower Oklahoma, the NAACP and the League of Women Voters, have worked on the project, said organizer Ginny Webster, Oklahoma regional organizer for MoveOn.org.
A dozen speakers - including several legislators and Anthony Douglas, state president of the Oklahoma NAACP - have agreed to speak at the rally, Webster said.
Simultaneous with the rally, organizers will deliver to Fallin's office a petition calling for her to accept Medicaid funding under the Affordable Care Act. Fallin has previously announced that she will not accept the funding, citing potential future costs to the state.
The petition is available at tulsaworld.com/medicaidpetition.
Original Print Headline: State officials: Feds slow to build exchange
Wayne Greene 918-581-8308
wayne.greene@tulsaworld.com
