Policy Roundtable Abstracts - AcademyHealth

PROPOSED PANEL The panel will feature four
leaders from four very different states: Kimberly Belshe
(CA), Jane Cline (WV), Bruce Greenstein (LA), and Joan
Henneberry (CO). It will be moderated by Anne Gauthier
(NASHP), who will present a short overview of the
critical policy choices states are facing in creating
exchanges. She will then conduct an interactive
discussion among these state policymakers, covering
their diverse approaches in addressing the following key
policy issues in exchange design and implementation:
1)Development of an overall vision for the exchange: To
best take advantage of the tools and flexibility states
have been given through ACA in creating their
exchange, they must first decide what policy goals they
may wish to accomplish with their exchange. An
effective exchange could give meaning to the
affordability standards in the federal law, and could be a
force for efficiency and an orientation toward quality in
the insurance and health delivery sectors. However,
such outcomes do not arise naturally or automatically
from the creation of an exchange. States must be active
and at times aggressive in administering the exchange.
2) Exchange governance structure: The exchange
governance structure – whether a state agency, a quasipublic
agency, or an independent not-for-profit – will
have an important impact on which voices are heard
most clearly when key decisions are made. Furthermore,
the location of a state’s governance structure could have
important implications for how nimble an exchange might
be, the power it will have in leveraging contracts with
both health plans and IT vendors, and how effectively it
can monitor the exchange appeals process. 3) Eligibility
and enrollment: An exchange must be capable of
determining whether a given individual is eligible a
subsidy or is eligible for other programs such Medicaid
and CHIP. States will need to think about how their
populations might transition between programs as their
eligibility for various programs changes over time in
order to ensure the receipt of continuous care. Many
states need to consider the role of county workers and
the interface with social service programs. And the vision
of a first-class customer experience, with as much
reliance on electronic interface as possible, presents
numerous challenges and design options for states. How
the exchange handles transitions of eligibility between
employer-sponsored coverage, exchange coverage and
Medicaid will determine whether consumers received
continuous care from their providers as their income
varies. 4 )Tools to promote affordability: How the state
selects participating health plans will affect how
effectively market forces will be brought to bear to
improve quality and reduce costs. States may span the
spectrum on how involved they may be in regulating plan
participation within the exchange. Some may choose to
have their exchange structured as an open marketplace
where all federally qualified health plans may compete
for their market share. On the other side of the spectrum,
states may leverage their capacity as active purchasers
of health to encourage or reward high value plans.
States will also need to consider implementing riskadjustment
mechanisms and controls for adverse
selection, so that insurance markets will not only be
affordable for even those high health needs, but also
sustainable into the future. 5) Stakeholder engagement:
The decisions that states make about exchanges are
important to a myriad of stakeholders including
consumers, health plans, employers, and health care
providers. Each is likely to have differing views regarding
exchange operations and goals, as well as differing
understanding of how various design choices will affect
them and the health care delivery system. It is important
for states to identify their key stakeholders as well as the
best ways to engage them in order to gain support and
perspective on exchange development.
PANELISTS The panelists bring rich
perspectives and experience to these issues. Anne
Gauthier currently directs several projects at the
forefront of supporting states developing exchanges and
is one of NASHP’s lead staff on interactions with federal
officials on reform implementation. Through her work
under HRSA’s State Health Access Program (SHAP),
she is working with 13 states to expand coverage and
implement reform and led a national webinar with over
500 attendees in a format similar to that proposed here.
She has also been an active participant in the Center for
Consumer Information and Insurance Oversight’s
(formerly OCIIO) early efforts to increase awareness of
critical exchange issues, including, a presentation on
exchange governance structures on OCIIO’s Technical
Assistance Webinar Series in November 2010. She is
also the project director of the recently launched State
Health Exchange Leadership Network, a peer-to-peer
learning community for state officials working on
exchange implementation. In December 2010, Kimberly
Belshé was appointed to the board of California’s newly
established Health Benefits Exchange. Previously, Ms.
Belshé served as Secretary of California’s Health and
Human Service Agency, playing a critical role in the
state’s recent passage of exchange enacting legislation.
Additionally, she serves as chair of the Governor’s Task
Force on Health Care Reform Implementation. Jane L.
Cline is West Virginia’s Insurance Commissioner. In
addition, Ms. Cline serves as President of the National
Association of Insurance Commissioners (NAIC), as well
as Chair of the Management Committee of the Interstate
Insurance Product Regulation Commission. In her role at
the NAIC, she has led the development of model
legislation to implement the Affordable Care Act. Bruce
Greenstein is Secretary of Louisiana’s largest agency,
the Department of Health and Hospitals. Secretary
Greenstein manages a budget of over $8 billion and will
provide oversight and services in mental health, public
health, emergency preparedness, Medicaid, health
information technology, addictive disorders and aging
services. Joan Henneberry was appointed in late 2010 to
lead Colorado’s exchange efforts under the new
governor. She recently left her position under the
previous governor as Executive Director for Colorado’s
Department of Health Care Policy and Financing and as
senior health policy advisor to the Governor, developing
and implementing health reform policies and initiatives.
She also spent seven years at the National Governors
Association providing consultation to states on health