Development of a health insurance exchange in oregon
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Development of a Health Insurance Exchange in Oregon. → Oregon’s goals → Federal Guidance and Requirements → State Flexibility. Nora Leibowitz, MPP Office for Oregon Health Policy & Research October 8, 2010. What is a Health Insurance Exchange?.

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Development of a Health Insurance Exchange in Oregon

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Development of a Health Insurance Exchange in Oregon

→Oregon’s goals → Federal Guidance and Requirements → State Flexibility

Nora Leibowitz, MPP

Office for Oregon Health Policy & Research

October 8, 2010


What is a Health Insurance Exchange?

  • Exchanges are “shopping centers” where individuals and small businesses purchase health insurance coverage.

  • Beginning in 2014, each state will have an exchange to help consumers compare and choose between plans that meet benefits and coverage benchmarks.

  • Exchange users may receive the new federal health insurance tax credits that will make health insurance more affordable.  


What are the Benefits of an Exchange?

  • Access to tax credits and cost sharing assistance

  • Ability to compare insurance products quickly and easily

  • Minimum standard for insurance purchased through exchange

  • Information accessible in a variety of formats (phone, web site, with agent or navigator help)


Who will use Exchanges?

Starting 2014:

  • Individuals

  • Small employer groups

  • People must purchase insurance through the exchange to access tax credits and financial assistance with cost-sharing expenses (deductibles and co-payments)

    • Federal premium tax credits are available for people with income up to 400% of the federal poverty level ($88,200 for a family of 4)

    • Federal assistance will reduce out-of-pocket expenses for many


Goals for Oregon’s Exchange

The goals identified by the Health Policy Board:

  • Simplify (access, regulation, plan rules)

  • Increased access to coverage and care

  • Changing the way services are provided/paid for

  • Cost containment


Exchange Functions per Federal Law

  • Provide Consumer Information

  • Certify Health Plans to Participate

  • Grade Health Plans

  • Offer Meaningful Coverage Choices

  • Provide Customer Assistance

  • Facilitate Community-based Assistance

  • Administer Exemptions

  • Provide Information to the Federal Government


State Decisions for an Oregon Exchange A

  • Organizational Framework

    • Public entity (state agency, public corporation)

    • Private, not-for-profit

  • Who Runs It (Board Structure)

    • Number of board members, appointment & confirmation requirements, terms of appointment, skill sets, etc.


State Decisions for an Oregon Exchange B

  • Size & Scope of Exchange

    • Sub-state regions, multi-state

    • One organization with two product lines (individual, group) or two exchanges

  • Benefit Design & Qualified Health Plan Choices

    • Role of Board in certifying Qualified Health Plans


State Decisions for an Oregon Exchange C

  • Market(s) Configuration

    • Parallel markets, single market; definition of small employer

  • Consumer Assistance

    • Role of agents and navigators

  • Funding Exchange Operations

    • Self-sustaining in 2015 and after


Exchange Development: Progress To Date

  • Assessment of state flexibility and available options

  • Technical advisory work group discussed options and implications

  • Other stakeholder meetings

  • Initial policy proposals presented to OHPB

  • Input at public meetings across the state


Next Steps

  • Policy Board discusses policy options and recommends course of action (October 12, 2010)

  • Policy Board report to Legislature (December 2010)

  • Exchange authorizing legislation (2011 Session)

  • Detailed operations planning work completed (September 2011)

  • Exchange implementation begins (fall 2011)


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