Development of a Health Insurance Exchange in Oregon

Nora Leibowitz, MPPOffice for Oregon Health Policy & Research

October 8, 2010

→ Oregon’s goals → Federal Guidance and Requirements → State Flexibility

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What is a Health Insurance Exchange?

• Exchanges are “shopping centers” where individuals and small businesses purchase health insurance coverage.

• Beginning in 2014, each state will have an exchange to help consumers compare and choose between plans that meet benefits and coverage benchmarks.

• Exchange users may receive the new federal health insurance tax credits that will make health insurance more affordable.  

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What are the Benefits of an Exchange?

• Access to tax credits and cost sharing assistance

• Ability to compare insurance products quickly and easily

• Minimum standard for insurance purchased through exchange

• Information accessible in a variety of formats (phone, web site, with agent or navigator help)

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Who will use Exchanges?

Starting 2014: • Individuals • Small employer groups• People must purchase insurance through the exchange to

access tax credits and financial assistance with cost-sharing expenses (deductibles and co-payments) – Federal premium tax credits are available for people with income up to

400% of the federal poverty level ($88,200 for a family of 4)

– Federal assistance will reduce out-of-pocket expenses for many

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Goals for Oregon’s Exchange

The goals identified by the Health Policy Board:

• Simplify (access, regulation, plan rules)

• Increased access to coverage and care

• Changing the way services are provided/paid for

• Cost containment

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Exchange Functions per Federal Law

• Provide Consumer Information• Certify Health Plans to Participate• Grade Health Plans• Offer Meaningful Coverage Choices• Provide Customer Assistance• Facilitate Community-based Assistance• Administer Exemptions• Provide Information to the Federal Government

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State Decisions for an Oregon Exchange A

• Organizational Framework– Public entity (state agency, public corporation)– Private, not-for-profit

• Who Runs It (Board Structure)– Number of board members, appointment &

confirmation requirements, terms of appointment, skill sets, etc.

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State Decisions for an Oregon Exchange B

• Size & Scope of Exchange– Sub-state regions, multi-state– One organization with two product lines (individual,

group) or two exchanges

• Benefit Design & Qualified Health Plan Choices– Role of Board in certifying Qualified Health Plans

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State Decisions for an Oregon Exchange C

• Market(s) Configuration – Parallel markets, single market; definition of small

employer

• Consumer Assistance– Role of agents and navigators

• Funding Exchange Operations– Self-sustaining in 2015 and after

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Exchange Development: Progress To Date

• Assessment of state flexibility and available options

• Technical advisory work group discussed options and implications

• Other stakeholder meetings

• Initial policy proposals presented to OHPB

• Input at public meetings across the state

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Next Steps

• Policy Board discusses policy options and recommends course of action (October 12, 2010)

• Policy Board report to Legislature (December 2010)

• Exchange authorizing legislation (2011 Session)

• Detailed operations planning work completed (September 2011)

• Exchange implementation begins (fall 2011)