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

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

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

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

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

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

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

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

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

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

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

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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