Members of an interim legislative committee heard testimony Wednesday updating them on the implementation of the federal health care law.
Insurance Commissioner Adam Hamm discussed enactment of the Patient Protection and Affordable Care Act with the Health Care Review Reform Committee. It was the first time the committee had met since the U.S. Supreme Court’s decision last month to uphold the law.
Hamm outlined the issue of creating a state-based health insurance exchange. The Affordable Care Act requires states to either set up a health insurance exchange or have the federal government put one in place. The exchanges are a set of state-regulated and standardized health care plans through which people can purchase health insurance.
“Because of all the fiscal, regulatory and political uncertainty that surrounded the exchange issue last fall, specifically November, I agreed with the North Dakota Legislature’s decision during the special session not to build and run a PPACA-compliant exchange,” Hamm said.
States have until Nov. 16 to inform the federal government if they will create a state-run exchange. During last November’s special session, the Legislature voted by a 64-30 margin not to do it.
“There is so much fiscal uncertainty regarding the exchanges that the best course of action, among a bunch of horrible options made available to the states, would be to make the federal government prove that they can make the exchanges work,” Hamm said.
The Kaiser Family Foundation, an organization that analyzes health care policy, has been tracking the progress of states in enacting the health care law. As of July 17, a total of 17 states are studying their options in implementing an exchange. Another 10 states, including North Dakota, have made no significant progress. A total of seven states have said they won’t be creating one.
State Sen. Tim Mathern, D-Fargo, asked Hamm about the possibility of a state-federal exchange. This model is basically the federal exchange, but the state is in charge of operating several elements of the program.
“What if we took that as a traditional partnership?” Mathern said.
Mathern asked Hamm if his opinion on the law would be affected if the fiscal responsibility were distributed between the state and federal government in a mutually beneficial way.
Hamm replied that he’s seen nothing to this point that would lead him to believe the federal government would do so.
Hamm also discussed the Affordable Care Act requirement for states to form essential health packages. Those packages must contain a number of benefits covering people in and outside of state health care exchanges, Medicaid and other programs. The original deadline the federal Department of Health and Human Services set for states to select their essential health package was Sept. 30.
“We received information from HHS late last week that Sept. 30 is now being termed a, quote, ‘soft date,’ because the final regulations have not been issued,” Hamm said.
Hamm said Health and Human Services now recommends, but isn’t requiring, states to submit their choices by that time.
“If a state fails to choose one of the benchmark plans, HHS will use, as a default, the largest plan by enrollment in the largest product in the state’s small group market,” Hamm said. He identified the largest plan that would be the default as the Medica Choice Passport plan, which has an approximate enrollment of 5,800.