The Connecticut Health Insurance Exchange is moving forward despite delays at the federal level in distributing key guidance to states and carriers on how to structure exchanges and plans and which health benefits should be deemed “essential.”
The U.S. Department of Health and Human Services (HHS) as of last week had yet to issue key regulations and informal instructions to guide states in carrying out the provision of the Affordable Care Act requiring them to institute their own insurance exchanges or to partner with a federally backed exchange.
Connecticut Health Insurance Exchange (HIX) CEO Kevin Counihan said the state is ahead of the curve, having agreed to a set of minimum standards for plans participating in the exchange during the summer and having submitted a blueprint of its exchange to HHS in October.
With the election out of the way, Counihan said he expects to see “a torrent of guidance come out between now and Thanksgiving.”
“We’re highly dependent on a lot of federal agencies and a lot of state agencies to make this work,” he said. However, he added, “If the guidance and direction doesn’t come, it’s not going to slow us down.”
Under the Affordable Care Act, states are required to have a health insurance exchange in place by Jan. 1, 2014. Marketing for plans participating in each state’s exchange is set to begin in October 2013.
Counihan said Connecticut HIX representatives have met with most of the state’s existing health insurance carriers “to make this process easy and simple for state residents, for small businesses, for brokers, for navigators and for the health plans.”
Some business officials have questioned whether Connecticut HIX, which is a quasi-governmental agency with a 14-member advisory board, set the bar too high in determining the minimum standards, or essential health benefits, for plans that will be marketed through the state exchange.
“One of the concerns is that the state is going to be offering very expensive plans through that exchange to the public,” said Jennifer Herz, who as assistant counsel for the Connecticut Business & Industry Association (CBIA) focuses on health care legislation and public policy.
“That’s the issue – that we’re trying through the exchange to offer an alternative and the essential health benefits package is just a very rich baseline to work from,” Herz said. “It doesn’t really provide a lot of room to maneuver.”
Counihan defended the exchange’s essential benefits package, which is modeled after ConnecticCare’s health maintenance organization (HMO) plan.
“Our board of directors picked a plan which is one of the most popular small group plans in the state,” he said. “It wasn’t made up from scratch – it was an existing plan marketed by one of the premier carriers in the state.”
Counihan predicted that federal subsidies enacted by the Affordable Care Act designed to help individuals and families to pay for health care coverage “are going to prove to be very popular and attractive” in Connecticut, where he said about 10 percent of the population is currently uninsured.
The subsidies are available to individuals and families with incomes up to 400 percent of the federal poverty level, which for a family of four equates to about $92,000.
Furthermore, Counihan said that by providing an orderly marketplace for comparing coverage plans, Connecticut HIX and other states’ exchanges will act as catalysts to drive discussion around projected long-term increases in the cost of delivering health care.
“Because frankly, that’s the 800-pound gorilla that we’re all facing nationally,” he said. “This first step of getting people insured, getting the exchange up and running, it’s really a first step for a broader mission.”
With regard to the subsidies currently dictated by the Affordable Care Act, Counihan acknowledged speculation that Congress could re-tool parts of the bill as part of efforts to trim spending that promise to occupy much of the current lame-duck session.
“There’s all kinds of speculation that negotiations around the fiscal cliff could involve the ACA to some degree, Medicaid, and other policy issues … I just have no idea,” he said. “I think almost anybody would say that this law is going to keep evolving, that the policies are going to keep changing. It’s so big and comprehensive that it’s going to need fine-tuning.”