Article by . Published on Wednesday, November 24, 2010 EST.
The governor’s office is seeking comments on draft legislation addressing the most important state component of federal health care reform — creation of a state health insurance exchange
Johnathan Seib, health care adviser to Gov. Christine Gregoire
By Washington State Wire
OLYMPIA, Nov. 25.—Jonathan Seib has a boyish face, but he is a 22-year veteran of Olympia and now is tasked with leading the governor’s effort to implement federal health care reform in Washington State.
Earlier this month he floated documents on ideas that might transform health care in Washington State. It’s a bold vision looking to consolidate state health care purchasing and joining with other large employers to improve outcomes with bundled payments, performance-based contracts, and evidence-based treatments at select providers or centers of excellence. Federal waivers will be required for much of the vision.
Now Seib is circulating the governor’s draft legislation to begin the development of state health exchanges. As Prof. Timothy Jost wrote this week in Health Affairs :
“The health insurance exchange is the centerpiece of the reformed health insurance system created by the Affordable Care Act. When the ACA is fully implemented in 2014, state exchanges will offer a market through which millions of Americans in the individual and small group (and eventually — potentially — large group) markets will compare and purchase high-value health insurance products. The exchanges will assist individuals and families who do not qualify for Medicare and who do not have employer-sponsored benefits apply for premium tax credits and cost-sharing reduction subsidies, or, if they have an income below 138 percent of the federal poverty level, for Medicaid.”
In Washington state there is a vigorous debate as to whether an exchange should (1) be a state entity or separate non-profit, (2) be an “open marketplace” model (Utah) or “active purchaser” model (California and Massachusetts), (3) combine or keep separate group and individual insurance plan pools, and (4) have to some degree or not, the ability to regulate and tax plans outside the exchange — to name a few issues.
For 2011 the governor’s office has attempted to avoid these debates by drafting a bill that empowers a new body, the Health Benefit Development Board, to manage grants and develop a business plan and implementation timetable for a state exchange by January 1, 2011.
A “boring piece of legislation” as Jonathan refers to it. Skeptics are certain to point to one sentence that does appear to give the Health Care Authority agency the authority to move ahead with the development of the state exchange information system.
Seib emphasizes some additional points. First, they do not need legislation to move ahead with everything in this bill. In fact, although the question is still under review, the governor’s office does not believe that any legislation is required to implement a state exchange in 2014. However, they are sensitive of the need to work with the Legislature in this ground breaking endeavor.
They understand that some legislators will want to go further than this bill and force a decision on some of the key policy decisions. However given the fact that the state just recently received its federal grant of almost $1 million to help plan for the exchange, and key studies will not be complete for this legislative session. He believes it makes sense to complete the planning first.
Seib did indicate that substantive provisions might be added to the bill where (1) the authority is needed now to be able to implement in 2014, or (2) there is general agreement on the authority.
Your support matters.
Public service journalism is important today as ever. If you get something from our coverage, please consider making a donation to support our work. Thanks for reading our stuff.
