Development of a Health Insurance Exchange in Oregon

1. 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

2. 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.  

3. 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)

4. 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

5. 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

6. 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

7. 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.

8. 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

9. 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

10. 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

11. 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)