While the Governor’s Mansion in Pennsylvania is currently under the control of the Republicans. I know the state’s Insurance Department is relatively apolitical. That’s why this September statement by Pennsylvania Commissioner Consedine before the U.S. House Ways and Means’ Subcommittee on Health is quite telling.
In it, Mr. Consedine describes how the Keystone state is encountering difficulties implementing an health insurance exchange. As readers will recall, exchanges are a key feature of the Affordable Care Act, because they’ll provide an online market that will enable individuals to obtain coverage.
According to Mr Consedine, CMS is failing to support a good law with the many regulatory details that turn a vague idea into a functioning reality. These failings include:
1. “Interim,” not “final” rules on eligibility, tax credit calculations, cost sharing and the role of brokers
2. Little formal guidance on the determination of the essential health benefit.
3. Delays in issuance of regulations on how states and Uncle Sam will split or mutually indemnify the myriad costs of the exchange and the Federal Data Hub.
4. Delays in the issuance of regulations on how states can exit a federally run exchange to set up one of their own.
5. Lack of clarification of CMS’ impact on insurance markets operating outside the exchanges.
6. Little understanding of who’s in charge of consumer protection statutes.
7. Confusion over reconciliation of multiple states’ insurance laws and regulations in multi-state exchanges.
8. No guidance on how to roll long-extablished and well functioning state-subsidized insurance programs into the exchanges.
9. Concern that funding of the information technology could be clawed back if Medicaid eligibility does not meet CMS’ criteria.
10. Little guidance on whether exchanges will need to provide consumers with a list of providers who are accepting new patients.
The concerns are also damning in the context of the the normal tug of war between the states and Washington DC. That’s because in his testimony, Mr. Consedine states he wrote to HHS weeks ago and has not received a reply. While its’ not unusual for the Feds to stiff politically inconvenient inquiries, I am fearful that the reason why HHS seems unwilling to provide a timely reply is because it doesn’t know the answers.
If Pennsylvania’s experience is typical, that means the roll out of the exchanges could be significantly delayed.
You read it here first.
Jaan Sidorov, MD, is a primary care internist and former Medical Director at Geisinger Health Plan with over 20 years experience in primary care, disease management and population-based care coordination. He shares his knowledge and insights at Disease Management Care Blog, where this post first appeared.
“As readers will recall, exchanges are a key feature of the Affordable Care Act, because they’ll provide an online market that will enable individuals to obtain coverage.”
The risk is a fixed component, the only way to reduce the risk (and price) is to reduce coverage. Don’t look for exchanges to significantly reduce premiums with the same risk.