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Oregon’s HIX: An Update

Barney SpeightPortland Actuarial Club

Feb. 22, 2011

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Today’s Topics

Overview of components in pending legislation that establishes Oregon’s Health Insurance Exchange (HIX) SB 99-1

Addressing children’s coverage in Oregon before 2014

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Type of Entity: Choices

State agency Public corporation Contract with private not-for-profit

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Type of Entity: Proposed

Public corporation

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Number of Entities: Choices

Individual HIX + Small Group HIX Combined HIX with 2 business

lines Statewide In-State Regions Multi-State

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Number of Entities: Proposed

Combined HIX with 2 business lines

Statewide

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Governance: Proposed 9 member Board

6 members appointed by Governor With Senate confirmation 4-year terms US citizens & residents of Oregon No more than 2 from “industry”

Insurance, Trade Assns., Providers At least 2 consumers (individual & small group)

3 ex-officio OHA, DCBS, OHPB Chair (or designee)

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Advisory Committees: Proposed

Consumer Advisory Committee Individual consumers, small group

purchasers, enrollment assisters Advisory & Technical Committees

Business sector, insurance carriers, producers, providers

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HIX Duties: Proposed - 1 Uniform information for consumers

Cost, benefits, networks, etc. Screen, certify & recertify health plans

as Qualified health plans Use federal & state guidelines Ensure QHPs provide meaningful coverage

choices Decertify QHPs that fail to meet federal

& state standards

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HIX Duties: Proposed - 2 Promote fair competition of carriers

participating & not participating in HIX Standardized health benefit plan options Web-based clearinghouse for comparison of

health plan coverage & cost Make QHPs available to individuals &

small employers, assist with enrollment, collect/remit premium where appropriate

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HIX Duties: Proposed - 3 Facilitate community-based enrollment

assistance (navigators) Grade health plans using federal criteria &

distribute grading information Certify exemptions from individual mandate Establish various open enrollment periods Provide information on eligibility for publicly

funded programs & assist with enrollment

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HIX Duties: Proposed - 4

Establish an electronic calculator to assist consumers in determining cost of coverage net of tax credits

Provide necessary information to federal government

Adopt necessary administrative rules

Etc.

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Exchange Operations - 1 January 1, 2014

Individuals Employers with <51 employees

January 1, 2016 Employers with 51 to 100 employees

“Groups meeting additional criteria established by the exchange for qualified purchasers”

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Exchange Operations - 2

A health plans shall be certified as a QHP if: It provides coverage that, at

minimum, include the “essential health benefits” &

“Making the health plan available is in the best interests of the individuals & employers in Oregon”

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Exchange Operations - 3

The HIX is authorized to limit the number of QHPs available in each level of coverage (bronze, silver, gold & platinum)

The HIX shall establish a streamlined & seamless application & enrollment process for both the HIX & state medical assistance (OHP)

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Exchange Operations - 4 The HIX shall coordinate the federal &

state risk mediation programs: Federal reinsurance Federal risk corridors State risk adjustment

The HIX shall define the role of insurance agents & brokers in accordance with federal guidelines & HIX policies

The HIX shall assure premium parity for plans sold inside & outside the exchange

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Assessments for HIX Expenses

HIX authorized to impose & collect assessments on all insurers Carrier Assessment = Total

Assessment x carrier market share % Market share calculation excludes:

Medicaid, disability income, hospital only, dental, vision, accident only, auto, specific disease, Medicare supplement, TRICARE, CHAMPUS, Rx only, LTC, FEHBP

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More Information on SB 99-1

http://www.leg.state.or.us/committees/ Senate Subcommittee on Health Care

February 17 Exhibits

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Early Innovator Grants Grantee: Oregon Health Authority

Award Amount: $48,096,307

Oregon is using commercially available, off-the-shelf software to create the Exchange. The Exchange Early Information Technology Innovation Grant will help Oregon create a modular, reusable IT solution that will provide the Exchange’s customers with seamless access to information, financial assistance and easy health insurance enrollment, with no gaps in coverage or assistance cliffs for anyone up to 400% of the federal poverty level. The OHA estimates that 516,000 Medicaid clients and 277,000 commercial insurance consumers will use the Health Insurance Exchange to shop for and enroll in health coverage.

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Children’s Reinsurance Program

Addresses guaranteed issue requirements for kids < age 19 prior to 2014

SB 514 will be vehicle for amendments

Financial risk ceded to OMIP Kids remain enrolled with carrier

Watch for hearing & amendments

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Contact Information

Barney SpeightVice President, Health Care Reform

speighb@odscompanies.com (503) 412-4008