Deeds Not Words: Senate Finance Committee Explores Health Insurance Exchange Progress

By Allison Johnson and Sarah Dash

With a scarce eight months to go until open enrollment begins for the new health insurance marketplaces known as exchanges, the Senate Finance Committee held a hearing yesterday to examine the progress of building health insurance marketplaces, better known as exchanges. The committee heard from four witnesses: Gary Cohen, Deputy Administrator and Director of CCIIO, Don Hughes, Advisor to Governor Jan Brewer of Arizona, Christine Ferguson, Director of the Rhode Island Health Benefit Exchange and Bettina Tweardy- Riveros, Chair of the Delaware Health Care Commission and Advisor to Governor Jack Markell. Over the course of two panels, witnesses provided updates and answered questions regarding the current status of the exchanges and the challenges they anticipate going forward towards the critical October 1st, 2013 open enrollment date and the start of coverage next January 1.

Committee members focused their questions on key aspects of exchange readiness, including development of the technology that will connect individuals and small businesses with issuers in the exchanges. Members on both sides expressed concern over the readiness of the federal Data Services Hub, which will coordinate data from federal agencies (including the Social Security Administration, Department of Homeland Security and Internal Revenue Service) to determine eligibility for public coverage and premium subsidies. The Data Services Hub has undergone extensive technical evaluation across agencies “and will soon begin to test the hub with States that are the furthest along with implementing their marketplaces.”

Committee members also posed questions regarding enrollment, including Senator Orrin Hatch (R-UT) who expressed concerns about the tight timeline between the establishment of open enrollment October 1, 2013 and the provision of benefits next January. He cited the example of the Medicare Part D benefit that had a two-year lag between application and coverage. Mr. Cohen testified “regardless of who operates the Marketplace, CMS is working to ensure streamlined and secure access to a variety of information sources that are essential for operation.” He continued that the exchanges will be on track to fulfill the one of the key aims of the law: to provide a one-stop shop for public or private coverage. Mr. Cohen further noted that a broad public education campaign is planned for later this year to alert the public about the open enrollment process. Mr. Cohen testified that the federal portal for health reform, www.healthcare.gov has undergone consumer testing to assess its ease of use and accessibility.

The process of actually enrolling individuals via the exchanges was also discussed including the funding structure and role of Navigators and in-person Assisters and the role of licensed brokers for enrolling individuals and employers through the Marketplace.

Despite the sometimes tough questioning about progress on exchanges, several committee members recognized the broader potential role of the exchanges in achieving the ACA’s goal of better health and healthcare for Americans. The witnesses from Delaware and Rhode Island provided enlightening testimony on this front, demonstrating that they are thinking beyond basic operational readiness to figuring out the best way to leverage the exchange to achieve better outcomes. For example, Ms. Tweardy-Riveros emphasized the role of Delaware’s plan certification process to push issuers to participate in the state’s health information technology network. Ms. Ferguson emphasized Rhode Island’s past efforts with health reform including the establishment of the Rhode Island’s Chronic Care Sustainability Initiative in 2008 that promotes patient-centered medical homes, and how these experiences have helped guide the “vision, mission and principles” of the Rhode Island Exchange.

Members also pushed the witnesses on other provisions of the law, including the Basic Health Plan that HHS has acknowledged appears unlikely to be established before 2015, future funding of CO-OP’s that was shelved as part of the fiscal cliff deal in December 2012, and whether or not the federal high risk pools (PCIP) will have enough funds to reach December 31, 2013.

The hearing yesterday highlighted the significant work that has already been accomplished by states. However, the questions raised by committee members are a reminder of the lengthy to-do list that still confronts states and the federal agencies tasked with implementation. With today‘s deadline for states to notify HHS whether or not they intend to operate a state-based exchange and less than eight months before enrollment begins, the issues highlighted by members of the Senate Finance Committee illustrate the many essential decisions left to be made at both the state and federal level. As key deadlines near, Senator Baucus requested that Mr. Cohen provide a comprehensive list of the remaining benchmarks and their estimated dates of completion to the Committee by next Tuesday, February 19. The Chairman suggested that the success of the Exchanges, indeed the entire health reform law, rests on the actual deeds, rather than the words of state and federal administrators.

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