The Arkansas Insurance Department used part of what remains from the million dollar grant money received for Level 1 planning of implementing state health insurance exchanges to host a forum that was a mix of continued advocacy for early implementation of state exchanges and a report to the stakeholders on what has been done up to this point. Other than a bit of back-and-forth between some Republican state lawmakers and the speakers brought in to advocate for the state insurance exchange, there was not a whole lot of new territory discussed.
I did speak briefly with one of the keynote speakers – Dr. Joel Ario, immediate past director of the Federal Office of Health Insurance Exchanges. My main question that I have not really heard answered is: How will the federal government outsourcing the health insurance exchange to the state be any different in the end product that the taxpayer uses?
"It depends on how the state chooses," explained Ario. "The most important issues are how do you work with insurers, do you have low bars and essentially have a lot of insurance come into the marketplace so that there is a lot of choice and sort of let the marketplace sort it out, or do you try to do a competitive bidding process and whittle it down to the insurers? That’s a big decision that states have to make."
"What kind of options should be available to small businesses on the exchange? That’s a big decision. Should it be a model where the employer puts the money in and employees choose the plan or should it be a model where the employer picks the plan for the employees? Both of those are possible, you can choose one or the other in the exchange," he added.
"The state would run the exchange in the state exchange model and there would be some federal regulation but a minimum set of standards, a floor regulation if you will, and then states have a lot of flexibility about the floor," responded Ario to my question as to how much flexibility the state would have in setting up the exchange. "If you see the federal government running the exchange, then the federal government is making those decisions. The federal government is still going to reach out to the states and want input, but it is a much different thing for the federal government running the exchange asking for input that it can take or not take versus the state running it and having to meet minimal standards and being accountable only for those standards and making its own choices above that floor."