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How does a state create from scratch a place where individuals and small businesses can shop for health insurance?
And what of the thousand – million — and one details needed to start and run such a beast?
Tom Dehner, a former member of Massachusetts board that controlled that state’s first-in-the-nation health insurance exchange, previewed a few challenges – and opportunities – Friday for New Mexico officials who are looking to create the state’s own health care exchange, the concept at the heart of the new federal health care law.
Speaking before several cabinet secretaries, top aides and a roomful of advocates, lobbyists and interested residents, Dehner told how Massachusetts got the word out to the public about its exchange created in 2006 and what he’d do differently if he had it all to do over again.
He also left officials with various questions the state should ask as it works toward creating an exchange, including how much power to give the entity.
New Mexico must decide if the exchange will drive reform
Should it be a weak exchange — his words – that is merely a centralized area for insurance plans and consumers to come together? Or should it be a strong exchange — one that actively wields its potential bulk purchasing power to drive reform?
Dehner told officials they had to keep that question in the back of their minds as they worked toward their goal and told them that the state would have leverage working with insurers.
“As far as I can tell, most people think that health insurers very much to want to do what it takes to be a plan that is part of the market that is created by this exchange,” Dehner told the crowd. “The fact that carriers are going to want to have access to this new insurance market is a real advantage for everyone.”
Nandini Pillai Kuehn, a Corrales resident and consultant who has worked in health care around the world, left no ambiguity about her preference.
“I think it’s our job and yours to find something that drives health reform,” Kuehn said after rising from the crowd at the end of the meeting to indicate her support for a strong exchange.
The new federal health care reform law borrowed a lot of ideas from the Massachusetts health care exchange, known as the Commonwealth Connector, which is why Dehner was invited to give a presentation Friday.
Exchange will be for individuals and small businesses only
New Mexico has a lot of work ahead as it aims toward creating and running its own health exchange by January 2014, the deadline in the federal health care law.
Once it is operating the state then must get the word out to those who would be eligible to use it – individual New Mexicans and small businesses. It would not apply to large employers with existing plans for workers.
In Massachusetts the Commonwealth Connector partnered with the Boston Red Sox, putting up signs and booths at the team’s home baseball games to let people know about the exchange, Dehner said. In a state that holds the Red Sox in near religious reverence the partnership worked great, Dehner said.
The goal was to lower the state’s rate of uninsured individuals and 2 1/2 years after its creation, the exchange had more than 400,000 newly insured Massachusetts residents, Dehner said.
New Mexico doesn’t have the Boston Red Sox as a potential marketing partner. But state officials were nodding in recognition at the importance of getting the word out on New Mexico’s own health care exchange when it’s up and running.
Plan for gaps in coverage due to loss of Medicaid eligibility, expert says
Asked what would he do over if he had the chance, Dehner said he’d pay closer attention to when people no longer eligible for Medicaid, the government’s low-income health insurance program, could become eligible for purchasing insurance off the exchange.
“We designed it as a commercial insurance program,” Dehner said of the Massachusetts Commonwealth Connector. “Once you were eligible you’d get insurance at the beginning of the next month. That seemed rational.”
But he said that led to problems for people whose shift income, due to landing a job perhaps, made them ineligible for Medicaid. “In Medicaid when income changed, you had to do it quickly – like that day,” Dehner said of removing individuals from the state’s Medicaid rolls.
Because they weren’t eligible to purchase insurance off the exchange until the beginning of the next month, they experienced gaps in health insurance coverage, sometimes for weeks, he said.
