State-run ex­changes grap­ple with GOP plan

Fu­ture of pro­grams un­cer­tain amid ‘re­peal, re­place’ bill

The Washington Times Daily - - POLITICS - BY TOM HOW­ELL JR.

As Congress plans the re­peal of Oba­macare, gov­ern­ment web­sites set up to sell in­sur­ance un­der the pro­gram are be­gin­ning to grap­ple with an un­cer­tain fu­ture and whether they can adapt to a GOP model down the road.

State-run ex­changes in more than a dozen states cost bil­lions to set up, and they serve as the pub­lic de­liv­ery sys­tem for Oba­macare-com­pli­ant plans and fed­eral sub­si­dies that make cov­er­age more af­ford­able for low- and mod­er­ate-in­come Amer­i­cans.

Yet, they’re also the “front-door” for de­ter­min­ing whether cus­tomers qual­ify for the fed­eral-state Med­i­caid pro­gram or tax cred­its on the in­di­vid­ual mar­ket — a form of as­sis­tance that’s in­cluded in the Repub­li­can over­haul that squeaked through the House and is be­ing re­worked in the Se­nate.

Ex­changes of­fi­cials say they’re also po­si­tioned to mar­ket health sav­ings ac­counts or other prod­ucts.

“I think there’s still a pos­si­bil­ity for us to look at new lines of busi­ness,” Con­nect for Health Colorado CEO Kevin Pat­ter­son said.

Al­ready, Colorado is talk­ing about trans­form­ing the ex­change into a por­tal for county and state gov­ern­ment em­ploy­ees who seek cov­er­age through their pub­lic jobs.

The Health and Hu­man Ser­vices Depart­ment awarded about $4.6 bil­lion in grant fund­ing to 16 states to set up their web-based ex­changes, ac­cord­ing to the House En­ergy and Com­merce Com­mit­tee.

Some of the por­tals fared bet­ter than oth­ers, how­ever, and three states were forced to give up and shift on­line en­roll­ment onto the fed­eral web­site, Health­Care.gov.

Though the ex­changes are in­trin­si­cally linked to Pres­i­dent Obama’s over­haul, the House-passed plan to re­peal and re­place that law doesn’t touch them, giv­ing ex­changes of­fi­cials hope they can still fill a niche.

“There’s noth­ing in [the bill] that re­peals mar­ket­places,” said Mila Kof­man, ex­ec­u­tive direc­tor of the D.C. ex­change. “In fact, there’s lan­guage that talks about the new tax cred­its be­ing ad­vance­able. Gen­er­ally, peo­ple who sup­port this freemar­ket phi­los­o­phy also sup­port full trans­parency and con­sumer de­ci­sions and con­sumer em­pow­er­ment, and that’s what mar­ket­places are.”

How­ever, the Trump ad­min­is­tra­tion is al­ready try­ing to un­tether the in­sur­ance mar­ket from gov­ern­ment por­tals.

The Trump ad­min­is­tra­tion said small busi­nesses will no longer use Health­Care.gov to en­roll em­ploy­ees who qual­ify for cov­er­age through the SHOP pro­gram, and it’s paving the way for cus­tomers in dozens of states to seek out cov­er­age on third-party sites with­out hav­ing to tog­gle back and forth be­tween web­sites.

Robert Laszewski, a health pol­icy con­sul­tant in Alexan­dria, Vir­ginia, said while the ex­changes could sur­vive, they will play a di­min­ished role as they com­pete for screen time with pri­vate play­ers in the mar­ket.

“The Oba­macare ar­chi­tects fore­saw in­sur­ance ex­changes do­ing away with agents and bro­kers thinking the ex­changes would be a more ef­fi­cient way to dis­trib­ute health in­sur­ance,” he said. “Un­der the House bill that vi­sion will be se­verely changed with ex­changes be­com­ing only one dis­tri­bu­tion ve­hi­cle and in di­rect com­pe­ti­tion with agents and bro­kers.”

Se­nate Repub­li­cans are try­ing to fast­track their re­place­ment bill to a floor vote this sum­mer, though they must clear stick­ing points in the pol­icy and get a “score” from the Con­gres­sional Bud­get Of­fice.

Sen­a­tors draft­ing the plan are ex­pected to make tax cred­its more gen­er­ous for older and poorer cus­tomers who could be forced to pay more for their in­sur­ance un­der the House-passed tem­plate.

Michael Marc­hand, spokesman for the Wash­ing­ton state ex­change, said it’s “kind of tough to hy­poth­e­size” how the GOP’s tax cred­its will be struc­tured with­out a fi­nal bill, or if his state’s leg­is­la­ture will at­tempt to back­fill any Oba­macare-re­lated ben­e­fits that are stripped out by Capitol Hill Repub­li­cans.

“If there’s a con­tin­u­a­tion of a tax credit at a fed­eral level that needs to be im­ple­mented, we’re ideally suited to do that,” he said. “It’s just a mat­ter of re­defin­ing how it works.”

The Ne­vada Health Link also said it needs to see a fin­ished prod­uct be­fore it plots its next moves, though “the ex­change re­mains nim­ble and flex­i­ble and will con­tinue to con­nect and ed­u­cate Ne­vadans on how to ac­cess af­ford­able care op­tions.”

“If I were shot and killed to­mor­row, half of Twit­ter would ex­plode in ap­plause and ex­cite­ment.”

— Trump coun­selor Kellyanne Con­way

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