Coverage offered in the following cities and locations
Cascade Mountains CITIES: Brightwood, Camp Sherman,
Cascade Locks, Cascadia, Chemult, Chiloquin,
Crescent, Crescent Lake, Detroit, Diamond Lake, Drew, Estacada, Fort Klamath,
Gates, Gilchrist, Government Camp, Idanha, Klamath Agency, La Pine, Lakeview,
McKenzie Bridge, Mill City, North Umpqua, Oakridge, Prospect, Rhododendron,
Sandy,
Sisters,
Sunriver, Warm Springs,
Welches, Westfir, Zigzag AREAS: Crater Lake National Park, Deshutes National Forest,
Fremont National Forest, Mount Hood National Forest, Rogue River National
Forest, The Three Sisters, Umpqua National Forest, Willamette National
Forest, Winema National Forest
Central Oregon CITIES: Antelope,
Arlington,
Bend, Brothers, Condon, Culver, Dufur,
Fossil, Grass Valley, Hampton, Lonerock,
Madras, Maupin, Metolius, Mitchell, Moro,
Mosier, Paulina, Post, Prineville,
Redmond, Rowena,
Rufus, Shaniko, Spray,
The Dalles, Wasco
Northeast Oregon CITIES: Adams,
Arlington, Athena,
Baker City, Boardman, Canyon City, Condon,
Cove, Dayville, Echo, Elgin,
Enterprise, Fossil, Greenhorn, Haines,
Halfway, Heppner, Hermiston, Huntington, Imbler, Imnaha, Irrigon, Island
City, John Day,
Joseph,
La Grande, Lexington, Long Creek,
Lostine, Medical Springs, Milton-Freewater, Monument, Mt Vernon, North
Powder, Oxbow,
Pendleton, Pilot Rock, Prairie City,
Richland, Seneca, Summerville, Sumpter, Ukiah, Umatilla, Union, Unity,
Wallowa, Weston AREAS:
Hell's Canyon
Southeast Oregon
Adel, Adrian, Burns, Diamond, Drewsey,
Frenchglen, Hines, Jordan Valley, Juntura, Lakeview, Nyssa,
Ontario, Plush, Vale
Southern Oregon CITIES:
Ashland, Butte Falls, Cave Junction,
Canyonville, Central Point, Dillard, Drain, Eagle Point, Elkton, Glendale,
Glide, Gold Hill,
Grants Pass, Jacksonville, Klamath Falls,
Malin,
Medford,
Merlin, Myrtle Creek, Oakland, Phoenix,
Prospect, Riddle, Rouge River, Roseburg, Shady Cove, Sutherlin,
Talent, Umpqua, White City, Winchester, Winston, Wolf Creek, Yoncalla
AREAS: Applegate Valley, Illinois Valley
Willamette Valley Albany, Alsea, Amity, Aumsville,
Aurora, Brooks,
Brownsville, Canby, Canyonville, Carlton,
Corvallis, Coburg, Cottage Grove, Creswell,
Culp Creek, Dallas, Dayton, Detroit, Donald,
Dundee,
Eugene, Falls City, Gates, Gervais,
Halsey, Harrisburg, Independence, Jefferson, Junction City, Keizer, Lebanon,
Lowell, Lyons,
McMinnville, Mill City, Millersburg,
Mt.Angel, Molalla, Monmouth, Newberg, Oakridge, Oregon City, Philomath,
Salem, Scio, Scott Mills, Sheridan,
Silverton, Sodaville, Springfield, Stayton, St. Paul, Sublimity, Sweet
Home, Tangerit, Turner, Veneta, Walterville, Waterloo, Willamina, Woodburn,
Yamhill
Cover Oregon - Oregon health insurance exchange
The purpose of this webpage is to help
share the information on the Oregon Health Insurance Exchange, and the
Affordable Care Act signed by President Obama. All information on this
webpage is collected and shared from websites currently explaining progression
of the Oregon Health Insurance Exchange including but not limited to
http://www.CoverOregon.com
Please visit this official website for all and current information.
Press Releases - Sources listed with each news release.
March 26th, 2014
Governor Kitzhaber Announces Cover Oregon Extended Application
Period, New Tax Credit Options for Small Businesses
Oregonians have until April 30 to apply for private health
insurance
(Salem, OR) — Governor Kitzhaber announced today that Oregonians
now have until April 30, 2014, to apply for private health
insurance. The announcement came following conversations between
the Governor and Health & Human Services (HHS) Secretary Kathleen
Sebelius. Oregon’s extended application period is in response to
technology issues that lengthened the time it takes to apply for
and enroll in health insurance through Cover Oregon, the state's
health insurance exchange.
“I know that for too many Oregonians, the Cover Oregon website and
its ongoing technical problems have created delays, confusion, and
frustration,” said Governor Kitzhaber. “I worked with Secretary
Sebelius to give Oregonians more opportunity to secure health care
coverage and get the financial help they deserve.”
Under HHS guidelines, each state may have its own approach to
managing extended application periods. Oregon’s extended
application period is targeted to people purchasing private health
insurance coverage either through Cover Oregon or directly from an
insurance carrier. People who purchase through Cover Oregon can
access tax credits and other financial assistance. Oregonians who
are eligible for the Oregon Health Plan or Healthy Kids can apply
for coverage year round. Governor Kitzhaber said, “Cover Oregon
has successfully completed more than 175,000 enrollments for
Oregonians across our state. I want to make sure that people know
they can still apply. They have time to do so, for themselves and
their families, and they should take advantage right
away.” Oregonians have until April 30 to submit their application
for private coverage.
Oregonians can find an agent or community partner in their area
who can help them enroll in one sitting by visiting CoverOregon.com.
They can also go to CoverOregon.com to
find resources to apply, including an online PDF application they
can submit electronically. Those who apply for coverage from a
private plan through Cover Oregon before April 30 and then later
enroll will not be subject to a potential federal tax penalty.
People who apply and enroll in plans outside of Cover Oregon
between April 1 and April 30 may have to pay a partial federal
penalty. The Oregon Insurance Division will provide more
information about how penalties may apply to individuals who do
not apply for coverage through Cover Oregon. Answers to questions
about the extended application period can be found here.
Help With Tax Credits for Small Businesses
The Governor also announced an agreement between Cover Oregon and
participating insurance companies that will help small businesses
access federal tax credits. Qualified small businesses that
purchase a Cover Oregon-certified plan after April 1 directly from
an insurance company will be able to access tax credits for 2014.
“This is an important step forward to support small businesses and
get health insurance coverage for more people,” said Governor
Kitzhaber.
For the small business tax credit, Cover Oregon will provide an
eligibility notice to Oregon employers that qualify to
participate. Eligible businesses must have 50 or fewer full-time
equivalent employees; purchase a “qualified health plan” certified
by Cover Oregon; and contribute at least 50 percent of the premium
cost for employee coverage. With confirmed eligibility, employers
can apply for the Small Business Health Care Tax Credit when
filing their 2014 taxes. The Internal Revenue Service, not Cover
Oregon, determines eligibility for the tax credit. Cover Oregon
developed the new process for facilitating the employer tax credit
in cooperation with Atrio, Health Republic, Kaiser Permanente,
Moda, Oregon’s Health Co-op, PacificSource, Providence, Trillium,
Best Life, Dental Health Services, Guardian, and ODS. “Insurance
companies have provided us a great deal of flexibility to serve
Oregon small businesses,” said the Governor.
Oregonians with questions about how to apply can visit CoverOregon.com or
call 1-855-CoverOR. The Cover Oregon service center is open
Monday-Friday from 8am to 8pm, and Saturday-Sunday from
8am-6pm. Additional information on small business tax credit may
be found here.
Consumer Advisory: Protect Yourself Against Fraud
August 12th, 2013
Thousands of Oregon individuals,
families and small businesses are getting ready to
sign up for health insurance and may access
financial help through Cover Oregon this fall. For
many, the wait for health coverage has lasted
months, or even years. Our goal is to not only to
provide access to coverage, but also to make the
customer experience as easy, safe and seamless as
possible.
Starting Oct. 1, individuals and small
businesses will be able to apply for health
insurance through an insurance agent or community
partner, including Tribal organizations, who has
been certified with Cover Oregon. Later in October,
Oregonians will be able to apply online without the
assistance of community partners or agents, if
desired.
To help you keep your information safe
and avoid fraud, the Oregon Department of Justice,
the Oregon Insurance Division and Cover Oregon
recommend the following tips:
Do not pay for help. There
is no charge to use Cover Oregon services, either
online or with the help of a certified insurance
agent or community partner. If consumers receive
an offer to sign up on Cover Oregon for a fee,
they should hang up the phone or walk away.
Consumers should not give their credit card or
banking information to anyone they do not know or
did not contact.
Make sure you are working with
a certified Cover Oregon agent or community
partner. Referrals to trained, certified
representatives will be available at the end of
September. Consumers will be able to access this
service by calling 1-855-CoverOR (1-855-268-3767)
or visiting CoverOregon.com to
find help in their area. Information will be
available in multiple languages. Consumers are
advised to write down and keep the name, company,
phone number, mailing address, email address and
website of anyone who assists them.
Protect health care and
financial information. Cover Oregon will never
visit or call people unannounced to ask for their
Social Security number, credit card, or personal
health information. Consumers should not share
personal, financial or Medicare information with
anyone they do not know even if they only ask you
to confirm your information.
Cover Oregon does not offer
Medicare. Cover Oregon has no impact on
Medicare and consumers cannot enroll in Medicare
through Cover Oregon. Consumers should not share
their Medicare number or other personal
information with anyone who contacts them
uninvited. For questions, contact Medicare at
1-800-MEDICARE (1-800-633-4227).
Remember that you can ONLY get
tax credits through Cover Oregon. Oregonians
who purchase insurance through Cover Oregon may
qualify for tax credits to help cut the cost. No
one but Cover Oregon can offer these credits, and
there is no charge to
apply for the credits.
We are committed to helping Oregonians
distinguish between the real Cover Oregon and
scammers who may be looking to take advantage of
consumers. If you’re ever in doubt, stop and call us
toll free at at
1-855-CoverOR (1-855-268-3767) to be
sure you’re in good hands.
Durham, Ore. Aug. 26, 2013 – Cover Oregon rolled
out its second set of TV ads today, designed to educate Oregonians
about the online health care marketplace opening October 1st.
The three ads, titled “Compare,”
“Save”
and “Covered,”
explain various features of Cover Oregon, such as access to
financial help and the ability to make an apples-to-apples
comparison of plans. The ads use graphics, moving text and
voiceover, as well as the songs by local artists featured in the
initial ads that launched in July.
The television campaign is part of a comprehensive marketing
and outreach strategy to reach all Oregonians and let them know
how individuals, families and small businesses can use Cover
Oregon to compare and enroll in health insurance that fits their
needs and budget. Cover Oregon is the only place to access
financial help to pay for that coverage, which starts in January
2014.
“These ads begin to tell the story of how Cover Oregon will
help more Oregonians access health insurance,” said Howard “Rocky”
King, executive director for Cover Oregon. “With the ability to
choose from a wide range of plans and get financial help,
Oregonians will finally get the health coverage they need and
deserve.”
“Compare,” “Save” and “Covered” will join the TV, radio, print,
billboard and digital ads featuring local artists in circulation
across Oregon as part of the first phase of advertising. In total,
the first phase of the advertising campaign, including production
and the media buy, will cost approximately $3.2 million. The
second phase of the campaign, which begins in October, will focus
on enrolling Oregonians in health coverage by directing them to
CoverOregon.com.
“We’re telling a big story and purposefully doing that over
phases. The first ads featuring local artists were our way of
saying ‘hello’ and raising awareness about Cover Oregon,” said
Mark Ray, creative director for Cover Oregon’s advertising agency,
NORTH. “These new ads start the process of educating consumers
about the new opportunities that will be available to them through
Cover Oregon and what they can expect.”
In addition to paid advertising, Cover Oregon has a robust
on-the-ground effort under way in partnership with community
organizations, agents, Tribes, providers and business
associations, state agencies and other key partners. Cover Oregon
is providing grants to organizations to conduct outreach and
enrollment assistance and is training agents and community
partners to help Oregonians enroll in coverage this fall.
Oregonians can go to
CoverOregon.com/creative to view and share the TV, radio and
digital ads, and follow Cover Oregon’s
Facebook,
Twitter and
LinkedIn networks. Go to CoverOregon.com for more information
or call 1-855-CoverOR (1-855-268-3767).
Durham, Ore. – Cover Oregon announced
Thursday at its board of directors meeting that it will be ready
to launch its online marketplace Oct. 1.
“The clock has been ticking for the past year and a half, and
it’s exciting to announce a date when the doors will open,” said
Board Chair Liz Baxter. “More Oregonians than ever will have
access to health coverage through Cover Oregon this fall, and we
have a thoughtful plan to ensure their experience is positive.”
Cover Oregon will be rolling out the following plan in
October:
Starting Oct. 1, individuals and small businesses will be
able to apply for health insurance through an insurance agent or
community partner, including Tribal organizations, who has been
certified with Cover Oregon.
Community partners and agents will have access to the Cover
Oregon “portal” (the online application and enrollment system),
where they will help customers apply for financial help, compare
plans and enroll in health coverage.
Staff at the Cover Oregon Service Center will be available
to answer questions and report any issues identified by
community partners and agents to our technical staff. They also
will refer individuals and small businesses who want to start
enrolling to community partners and agents.
Later in October, Oregonians will be able to apply online
directly through Cover Oregon without the assistance of
community partners or agents, if desired.
“It’s not uncommon for technology projects of this importance
to launch in phases,” said Triz delaRosa, Chief Operating Officer
of Cover Oregon. “We’re opening on time with all of the planned
features for individuals and small businesses. And, by launching
through our network of trained agents and community partners, we
can correct bugs, fine-tune the process and ensure the shopping
experience is easy and seamless now and into the future.”
Enrollment opens Oct. 1 and continues for individuals through
March 31, 2014. Coverage does not begin until Jan. 1, so consumers
have plenty of time to go through the application and shopping
process.
Working with agents and community partners is free. To find
certified agents and partners, call our Service Center at
1-855-CoverOR (1-855-268-3767) or visit
CoverOregon.comin September.
Marisa O’Brien
of Cover Oregon says it’s already running mass media advertising
to let individuals know about the exchange. But the group wants to
give three to five businesses associations up to $150,000 each to
educate small businesses.
“We’re not exactly sure,” O’Brien says. “We want them to put
together the plan that they think is best going to reach their
target members. I would anticipate it would be more face-to-face —
one-on-one individual meetings, those kind of activities.”
Cover Oregon announced
today $750,000 in grant funding that will be made available to
business organizations and associations to help small
businesses learn about the health insurance options available
through Cover Oregon this fall.
Cover Oregon is a new online marketplace opening in October
where small businesses with 50 or fewer employees can compare,
select and enroll in health insurance plans all in one
convenient place.
“Small businesses have struggled for too long to find a health
insurance plan that meets the needs of all of their
employees,” said Howard “Rocky” King, executive director of
Cover Oregon. “These grants will help trusted business
organizations reach small business owners to inform them about
new options through Cover Oregon.”
Cover Oregon will provide clear information on a broad range
of insurance plans so small businesses can make side-by-side
comparisons and choose the right plan for them. The online
marketplace also will allow small businesses to offer more
choice to their employees. They will be able to set the amount
they can pay toward premiums and let employees choose from
many plans offered through Cover Oregon.
Cover Oregon will also be awarding a series of outreach and
enrollment grants to community organizations, Tribes and
health care providers over the coming months.
The Business Organization Request for Grant Proposals (RFGP)
is now open withresponses due on Friday, August 9 at
5:00 pm PT.
Cover Oregon anticipates final agreements will be signed in
September and outreach activities will begin in October 2103.
Grantees will be chosen through a formal Request For Grant
Proposal (RFGP) process. Cover Oregon will evaluate
submissions and award funds based on a proposed work plan and
budget.
The grant documents can be accessed here.
A website refresh will be completed soon at which time, the
grant documents will be found on the “Small Business” page.
All questions specific to the RFGP should be directed to the
contact listed in the solicitation. All questions specific to
the RFGP should be directed to the contact listed in the RFGP.
Durham, Ore. – Cover Oregon rolled
out its comprehensive marketing
campaign today that features TV, radio and online ads created
by Oregon artists, and an on-the-ground outreach effort in
partnership with agents, community organizations, Tribes,
providers, business associations, state agencies and other key
partners.
The goal is to let as many Oregonians as possible know about
the new online marketplace and how individuals, families and small
businesses can compare and enroll in health coverage that fits
their needs and budget.
Cover Oregon is the only place to access financial assistance
to help pay for that coverage and enrollment begins in October,
with coverage starting in January 2014.
“Health coverage will be more accessible than ever,” said
Howard “Rocky” King, executive director for Cover Oregon. “It’s
our job is to make sure Oregonians are aware of Cover Oregon and
the options they have to find the right coverage for them that
fits their needs and budget. That’s why we’re spreading the word
through both the media and our growing on-the-ground network of
local, grassroots partners and agents.”
The two TV spots feature
a the “Long Live Oregonians” anthem sung by Portland-based
musician Matt
Sheehy of Lost Lander, and an ode to Cover Oregon from folk
singer Laura
Gibson, a Coquille, Oregon-native who is currently touring
with the Portland Cello Project. The campaign also includes TV
and radio
spots from Lifesavas, Vikesh Kapoor, Edna Vazquez (coming soon
in Spanish language) and Dave Depper, as well as artwork from
artists across the state.
“It was really important to us that we kept this true to
Oregon. We were reminded by the song that Bonneville Power
Administration asked Woody Guthrie to write to help explain how
the Bonneville Dam would benefit Oregonians,” said Mark Ray,
creative director for Cover Oregon’s advertising agency, NORTH.
“We were inspired. We asked local artists to be a part of this
movement and, in that way, were able to put dollars back into the
Oregon artist community and into a population of people who are
traditionally uninsured.”
In total, the first phase of the advertising campaign,
including production and the media buy, will cost approximately
$3.2 million. The second phase of the campaign which begins in
October will focus on enrolling Oregonians in health coverage by
directing them to CoverOregon.com.
Cover Oregon will also be funding community-based organizations
throughout the state to conduct outreach and enrollment assistance
to hard-to-reach populations. Other grants are going to business
associations to assist with small business outreach, provider
organizations to conduct enrollment assistance in clinics and
Tribal partners. Cover Oregon has also spoken at more than 80
conferences, meetings and events, and will continue to do this
through the fall. In addition, Cover Oregon is training an
estimated 1,5000 insurance agents in more than 60 trainings across
the state.
Outreach materials such as brochures and fact sheets will be
available for order in the coming weeks through CoverOregon.com.
Oregonians can go to CoverOregon.com/ads to
view and share the TV, radio and digital ads, and follow Cover
Oregon’s Facebook, Twitter and LinkedIn networks.
They can also go to CoverOregon.com to
check their potential eligibility for financial help and sign up
for email updates , talk to an insurance agent, community partner
or call 1-855-CoverOR (1-855-268-3767) to talk to a trained
specialist on the phone, with assistance available in multiple
languages.
Durham,
Ore. – Following is a statement from Rocky King,
executive director of Cover
Oregon, Oregon’s new online marketplace for health coverage,
in response to the federal government’s decision Tuesday to delay
penalties for employers with more than 50 full-time equivalent
employees who do not offer health insurance to their employees
until 2015:
“Cover Oregon’s focus is, and has always been, to provide
access to health coverage for Oregon individuals, families and
small employers (initially, employers with 50 or fewer employees,
expanding to employers with up to 100 employees in 2016). The
federal government’s decision does not impact the work we are
doing at Cover Oregon or the choices available to small
businesses.
Penalties have not existed for businesses with fewer than 50
employees. We will continue to move forward with our robust
offerings for small businesses, as well as for individuals and
families, beginning in October.
Cover Oregon gives small businesses the opportunity to offer
their employees more choice in carriers and plans. They can set
how much they want to contribute and let their employees choose
from a variety of plans available through Cover Oregon.
Oregonians who are not offered coverage through their employer
can come toCoverOregon.com in
October to find a plan that fits their budget and needs, and
access financial help.
We are committed to making sure all Oregonians have access to
health coverage, and look forward to working with small employers
who want to offer health coverage to their employees.”
More than 1,200 Agents Signed Up for Trainings Across State
Durham, Ore. (June 13, 2013) – More than 1,200 insurance agents
have signed up for the Cover Oregon agent training program.
In-person training is set to start in July, with pilot sessions
starting this week in Lake Oswego. Agents can register here for
a prerequisite online training and then sign up for one of more
than 50 in-person trainings across the state.
The training program will certify thousands of agents over the
coming months to help Oregonians access health coverage through
Cover Oregon, a new online marketplace launching this October
where Oregonians will be able to compare and enroll in health and
dental coverage.
“Agents are one of Cover Oregon’s most important partners in
making sure Oregonians can access health coverage that fits their
needs and budget. We can’t do this without them,” said Howard
“Rocky” King, executive director for Cover Oregon. “It’s a
win-win. Agents will be able to grow their businesses by offering
customers more choice in plans and access to financial help.”
Insurance agents who certify with Cover Oregon will be able to
sell and receive commission for all plans that are offered through
Cover Oregon. It is anticipated that more in-person trainings will
be scheduled due to high demand.
Through Cover Oregon, more Oregonians will be able to access
health coverage, even if they already have a health condition, and
they can apply for financial help. Small businesses will have a
broad choice of plans to choose from and may qualify for a tax
credit.
The agent training will include a comprehensive, full-day
session covering the technical information agents need to assist
individuals and small businesses with the application for
eligibility and with sorting and filtering plan choices for
enrollment.
There is a $25 registration fee and agents will receive eight
hours of continuing education (CE) credits. They must be a
licensed producer to attend.
Posted on May 16th
2013Durham, Ore. – The U.S. Department of Health and Human
Services announced last week that 29 federally qualified Oregon
community health centers would be eligible for an additional $2.8
million in outreach and enrollment grants to connect residents to
Cover Oregon, the new online marketplace where Oregonians can
compare and enroll in health coverage, set to open later this
year.
“We are going to need all hands on deck to raise awareness
about and get Oregonians enrolled in health coverage through Cover
Oregon,” said Howard “Rocky” King, executive director for Cover
Oregon. “Community health centers are a critical part of our
outreach efforts and are trusted health care resources in their
communities.”
Community health centers that are eligible for the grant
(listed below) must submit applications to the Health Resources
and Services Administration (HRSA) by May 31, 2013 in order to be
considered for the grant. The funds will help heath centers hire
new staff, train existing staff and conduct community outreach
events and other educational activities. Community health centers
have extensive experience in helping uninsured consumers apply for
and enroll in health coverage. They can also connect consumers to
information about the health plans available through Cover Oregon.
“Community health centers have always offered health care
regardless of a customer’s ability to pay,” said Laurie Francis,
senior director of clinic operations and quality with the Oregon
Primary Care Association. “As a result, health centers are a
natural and ideal place for individuals and families to learn
about newly available health coverage options. Many of the
customers our clinics serve are uninsured and, as with insured
clients, they need help navigating the health care system. Our
health centers look forward to working with Cover Oregon to
connect more Oregonians to health coverage.”
The Oregon Primary Care Association represents all of the
federally qualified health centers in the state and works with
them to access and use grant funds. The grant supports the federal
government’s efforts to enroll individuals, families and small
businesses in new health insurance marketplaces created as part of
the Affordable Care Act. It is estimated that about 217,000 Oregon
residents will enroll in health coverage through Cover Oregon.
In addition to this federal grant administered by HRSA, Cover
Oregon, in partnership with the Oregon Health Authority (OHA),
will award separate grants to community organizations this summer
to conduct outreach and application assistance. The first request
for these grant proposals closes May 16, and two more
opportunities will open in the coming months (information
available through ORPIN).
Community health centers eligible for the federal HRSA grant
can also apply for the Cover Oregon/OHA grants. Health centers
that are awarded both a HRSA grant and a Cover Oregon/OHA grant
can either accept only one of the grants, or they will need to
certify and demonstrate that they will not replace or duplicate
funding for any activities within the scope of work of one grant
with funding from the other. Cover Oregon and OHA will coordinate
with all grantees for training and outreach support.
For more information or assistance on applying for the grant,
community health centers can go to: http://bphc.hrsa.gov/outreachandenrollment/.
The following health care centers are eligible for the grant and
must submit an application by Friday, May 31, 2013 at 2:00 p.m.
PT.
For immediate release: May 9, 2013
Plan Filings Show Cover Oregon will be
Competitive Online Marketplace
Durham, OR – Today, Cover Oregon
announced that 12 health insurance carriers have filed
plans to sell on its online marketplace opening this
fall. All 12 have indicated they will participate in
the individual market and eight carriers will offer
plans in the small group market.
“We believe the carriers that will be offering plans
through Cover Oregon are committed to transforming the
Oregon health delivery system for individuals and small
employers,” said Howard “Rocky” King, the executive
director for Cover Oregon. “We are pleased to partner
with these carriers to give Oregonians coverage options
with a focus on quality and value.”
The plans were filed last week with the
Oregon Department of Consumer and Business Services
Insurance Division. The division will now review the
rates – through a stringent public process – and make
sure the plans meet requirements that are new in 2014,
including expanded benefits and limits on out-of-pocket
costs. Cover Oregon also must certify the plans as
“Qualified Health Plans” before they are offered on the
marketplace. Plans purchased through Cover Oregon will
be effective January 1, 2014.
“Although there are still many steps in the process, we
believe Oregonians will have a broad choice of plans
through Cover Oregon – and an easy way to compare and
enroll in them starting this fall,” King said.
In addition to making it easier to shop for coverage,
Cover Oregon will offer financial help. More than
400,000 Oregonians could qualify for financial
assistance through Cover Oregon to help them pay their
premiums, according to a recent study by Families USA.
For example, an individual earning up to $45,900 and
families of four earning up to $92,400 would be eligible
for a tax credit to help pay for their coverage. The tax
credit is based on income and can be taken monthly or
when taxes are filed. Some individuals and families also
may be able to receive help paying out-of-pocket costs
such as co-pays and deductibles.
Click here for some tools to help you estimate what
insurance coverage may cost with financial assistance.
In addition to those already covered by the Oregon
Health Plan and Healthy Kids, approximately 200,000
residents may qualify for no-cost health coverage
through the public programs, which will also be
available through Cover Oregon.
For small employers, Cover Oregon will provide the
opportunity to offer more choice to their employees.
Employers can set a defined contribution toward premiums
and let their employees choose from virtually all the
small employer carriers and plans offered through Cover
Oregon – this is not available in the small group market
today and will not be available in states running
federal exchanges.
Starting in 2014, all health plans will be guaranteed
issue, even if a person has a pre-existing health
condition, and will be required to cover essential
benefits in 10 categories. These services include:
prevention and wellness; primary care, hospitalizations;
ambulatory services; rehabilitative and habilitative
services and devices; emergency services; prescription
drugs; laboratory services; maternity and newborn care;
pediatric oral and vision care; and mental and
behavioral health.
To participate in Cover Oregon, carriers must meet
several state and federal laws, such as being licensed
and in good standing with the state, offering a standard
bronze, silver and gold plan as well as cost-sharing
variations of silver plans, and ensuring network
adequacy. They also had to provide information to Cover
Oregon about transparency, quality, and the use of
medical homes.
ABOUT COVER OREGON Cover Oregon is a new
online marketplace where Oregonians can compare and
enroll in health insurance that fits their needs and
budget, and also access financial help. More
Oregonians can now get health insurance, even if they
already have a health condition, and also access
financial help. Cover Oregon will provide clear
information on a range of insurance plans so
individuals, families and small business owners can
make side-by-side comparisons and choose the right
plan for them. It will include plans from public
companies and state plans like Healthy Kids and Oregon
Health Plan. Enrollment begins in October. Learn more,
check eligibility for financial help and sign up for
updates at www.coveroregon.com,
or call 1-800-CoverOR (1-800-268-3767) to talk to a
trained specialist on the phone or in-person.
PRESS Release – April 2, 2013
Cover Oregon approves 22 carriers to offer
medical and dental plans
Cover Oregon has approved the health insurance carriers that will
participate in its online marketplace – a key step in preparing for
open enrollment in October.
Cover Oregon gave approval this week to 22 carriers that plan to
offer individual, small employer, and dental plans. The plans
themselves have not yet been reviewed or approved, and there are still
many steps the carriers must follow to make their plans available this
fall, but Cover Oregon expects it will provide a robust level of
coverage choices to Oregonians.
“Providing high quality, affordable options to Oregonians across
the state is part of Cover Oregon’s mission and a key expectation of
the Board of Directors,” said Liz Baxter, chair of the board. “One
measure of a successful launch will be that individuals, families and
small employers are able to select coverage that is right for them.”
Cover Oregon is a central online marketplace where individuals and
small employers can shop for and compare health coverage options and
access financial assistance.
To participate in Cover Oregon, carriers must meet several state
and federal laws, such as being licensed and in good standing with the
state, offering a standard bronze, silver and gold plan as well as
cost-sharing variations of silver plans, and ensuring network
adequacy. They also had to provide information to Cover Oregon about
transparency, quality, and the use of medical homes.
Next, carriers must submit the plans they seek to offer in Cover
Oregon to the Department of Consumer and Business Services Insurance
Division by April 30. The division will review the plans’ rates and
make sure the plans contain the “essential health benefits” required
by the Affordable Care Act. After the Insurance Division approves the
plans, Cover Oregon will review the carrier’s filings to check for
exchange-specific requirements and certify the plans as “Qualified
Health Plans.”
Individuals and small employers can begin shopping for the
Qualified Health Plans through Cover Oregon in October. Coverage will
take effect Jan. 1, 2014.
Approved Cover Oregon Carriers
Ameritas Life Insurance Corp – dental
ATRIO Health Plans, Inc. – medical
BEST Life and Health Insurance Company –
dental
BridgeSpan Health Company – medical
Dental Health Services – dental
Dentegra Insurance Company – dental
Family Care Health Plans, Inc. – medical
Freelancers CO-OP of Oregon – medical
Guardian Life Ins. Co – dental
Health Net Health Plans of Oregon –
medical
Kaiser Foundation Health Plan of the
Northwest – medical and dental
LifeWise Health Plan of Oregon, Inc. –
medical and dental
Mid Rogue Health Plan, Inc. – medical
ODS Health Plan, Inc. – medical and dental
Oregon’s Health CO-OP (incorporated as
Community Care of Oregon) – medical
PacificSource Health Plans – medical and
dental
Premier Access Insurance Company – dental
Providence Health Plan – medical
Regence BlueCross BlueShield of Oregon –
medical
Trillium Community Health Plan, Inc. –
medical and dental
UnitedHealthCare – medical
Willamette Dental Insurance, Inc. – dental
Media Inquiries:
Lisa Morawski Cover Oregon
16760 SW Upper Boones Ferry Road
Suite 200
Durham, OR 97224
503-373-9424
lmorawski@coveroregon.com
The Hidden
Truths behind Health Reform/Exchanges
An insurance agent
raises concerns about what health reform will mean to individuals, small
groups and how it will impact prices
By: John Gridley
OPINION – March
5, 2013 -- Outside of Medicaid, there are two groups of people in Oregon,
those with insurance, and those without. The group with insurance, for
the most part, has no clue that they will lose their existing coverage
next year and will have to purchase one of the new plans. The only exception
is those with grandfathered plans, of which there are very few in Oregon.
The other group
has been waiting for their free health care (we get calls weekly). What
will these people do when they find out they still have to pay a premium
and only 70 percent of their healthcare is covered? Add to that the 21-page
draft application, that looks more like an IRS form than a health application,
they will have to fill out to qualify for a subsidy.
The small group
situation is even more perplexing. Almost all small groups will have to
drop coverage to protect their employees’ access to the exchange as the
only economical way for employees to cover their family members. Many
employees will find they can cover their whole family on the exchange
with subsidies for less than half of the employee premium. Yet, if their
employer offers group insurance, they will be forced to buy expensive
dependent coverage through the group plan and denied access to the exchange.
Prices are perhaps
going to be the biggest shock. What is the 20-year old earning $30,000
going to do when he finds out he has to pay $301 after subsidy, for a
plan he can purchase today for $236 without a subsidy? I have included
a detailed analysis of the impact on prices here and on our website.
http://www.ehealthlink.com/exchange/aca-effects.aspx
The Internal Revenue Service on Friday unveiled its proposal to
raise billions of dollars through annual fees on health insurers,
a “$100 billion health insurance tax rule” that the industry says
will significantly drive up costs for consumers.
The rule as part of the Patient Protection and Affordable Care
Act imposes annual fees on health insurers that start at $8 billion
in 2014, increases to $14.3 billion in 2018, and will increase every
year after that. The Joint Committee on Taxation estimates the tax
will exceed $100 billion over the next ten years.
The proposed rule will be published Monday for public consideration
in the Federal Register. The IRS will accept comments for
90 days, beginning Monday.
Not paying on time will result in a $10,000 penalty for insurers,
plus $1,000 for every day they miss deadline.
America’s Health Insurance Plans blasted the rule as a tax that
will financially drown both employers and consumers. They warn that
the costs will have to be passed along to consumers in the form of
higher premiums, a claim that the Congressional Budget Office has
also verified in its analysis.
“Imposing a new sales tax on health insurance will add a financial
burden on families and employers at a time when they can least afford
it,” AHIP President and CEO Karen Ignagni said Friday. “This tax alone
will mean that next year an individual purchasing coverage on his
or her own will pay $110 in higher premiums, small businesses will
pay an additional $360 for each family they cover, seniors enrolled
in Medicare Advantage will face $220 in reduced benefits and higher
out-of-pocket costs, and state Medicaid managed care plans will incur
an additional $80 in costs for each person enrolled.”
There is currently legislation to repeal the fees, recently introduced
by Reps. Charles Boustany, R-La., and Jim Matheson, D-Utah, which
AHIP strongly supports.
A 2011 report by Oliver Wyman found that nationally the health
insurance tax alone “will increase premiums in the insured market
on average by 1.9 percent to 2.3 percent in 2014,” and by 2023 “will
increase premiums 2.8 percent to 3.7 percent.”
Families purchasing coverage in the individual market will be hit
the hardest in New York while those getting coverage from a small
employer will be most impacted in West Virginia, Oliver Wyman analysis
also found. Medicare Advantage beneficiaries in New Jersey and the
Medicaid managed care program in Washington, DC top their respective
lists of those that will be hardest hit by the tax.
What is the premium tax and how can this affect your clients?
You probably hear it all the time: Clients asking you “I’ve
heard that health insurance premiums are going to rise? What’s the story?”
Sound familiar? Chances are one reason could be because of the Health
Insurance Tax (HIT), otherwise known as the premium tax, a multi-billion
dollar tax on most of the nation’s health plans that will begin in 2014
as part of the Affordable Care Act (ACA).
While the premium tax already is spelled out in the ACA legislation,
its specifics still are being debated, and how the tax will be calculated
and implemented has not yet been determined. Adding to the uncertainty:
bipartisan legislation has been introduced to repeal the tax.
Despite the uncertainty, there are several fundamental facts about
the tax that are important for you to understand for your business –
and so you can answer that inquisitive client.
What’s the tax?
Beginning in 2014, the ACA mandates that most health plans be taxed
on their net premiums. This is estimated to collect more than $100 billion
over the next 10 years, with the annual amount increasing from $8 billion
in 2014 to $14.3 billion in 2018. The total in subsequent years will
depend on the rate of premium growth.
The premium tax applies to the fully insured market, while self-insured
plans are exempt. Non-profit health plans will receive a 50-percent
reduction to their portion of the tax.
Committed to affordability
Health Net is committed to making health care affordable for all
of our members and the communities in which we operate. Unfortunately,
the premium tax poses a major challenge to this goal, as Health Net
and other health plans will need to raise premiums on consumers, small
businesses and seniors to make up for the additional financial obligation.
In addition, state Medicaid budgets will face higher costs as a result
of this tax. It is estimated that, nationally, the tax could raise premiums
by an average of more than 2 percent in 2014 and more than 3 percent
by 2023.
One of Health Net’s key priorities for 2013 is addressing the challenges
posed by the premium tax. Our Government Relations team is working closely
with key stakeholders, advocates, representatives and others to address
the impact of the tax and advise on potential solutions.
“We are partnering with a diverse coalition of those who will be
impacted by the tax, including small businesses, to focus on repealing
or reworking this provision of the ACA before it goes into effect,”
said Adrienne Morrell, vice president, Government Relations.
For more information on the Health Insurance Tax and its impact on
consumers, watch
this short video by America’s Health Insurance Plans (AHIP).
Key Takeaways
The Health Insurance Tax (HIT) – also known as the premium tax
– is scheduled to begin in 2014.
Nationally, it’s estimated to increase premiums by more than 2
percent.
Health Net is working with key stakeholders to make health care
affordable by supporting efforts to repeal or rework the premium tax.
The Hidden
Truths behind Health Reform/Exchanges
An insurance agent
raises concerns about what health reform will mean to individuals, small
groups and how it will impact prices
By: John Gridley
OPINION – March
5, 2013 -- Outside of Medicaid, there are two groups of people in Oregon,
those with insurance, and those without. The group with insurance, for
the most part, has no clue that they will lose their existing coverage
next year and will have to purchase one of the new plans. The only exception
is those with grandfathered plans, of which there are very few in Oregon.
The other group
has been waiting for their free health care (we get calls weekly). What
will these people do when they find out they still have to pay a premium
and only 70 percent of their healthcare is covered? Add to that the 21-page
draft application, that looks more like an IRS form than a health application,
they will have to fill out to qualify for a subsidy.
The small group
situation is even more perplexing. Almost all small groups will have to
drop coverage to protect their employees’ access to the exchange as the
only economical way for employees to cover their family members. Many
employees will find they can cover their whole family on the exchange
with subsidies for less than half of the employee premium. Yet, if their
employer offers group insurance, they will be forced to buy expensive
dependent coverage through the group plan and denied access to the exchange.
Prices are perhaps
going to be the biggest shock. What is the 20-year old earning $30,000
going to do when he finds out he has to pay $301 after subsidy, for a
plan he can purchase today for $236 without a subsidy? I have included
a detailed analysis of the impact on prices here and on our website.
http://www.ehealthlink.com/exchange/aca-effects.aspx
ACA Glitch Could Mean Some Families Will Be "Priced Out"
Of Coverage in the Exchanges.
Feb 9, 2013
The
AP
(1/30, Alonso-Zaldivar) reports that a "glitch" in the Affordable Care
Act could mean that some families will be "priced out of health insurance."
According to the AP, "IRS regulations issued Wednesday failed to fix the
problem as liberal backers of the president's plan had hoped," and as
a result, "some families that can't afford the employer coverage that
they are offered on the job will not be able to get financial assistance
from the government to buy private health insurance on their own." The
Administration "says its hands were tied by the way Congress wrote the
law," noting that the "affordability glitch is one of a series of problems
coming into sharper focus as the law moves to full implementation."
For its part,
Bloomberg News
(1/31, Wayne, Rubin) reports that "an effort to allow looser rules for
calculating whether workers will be eligible for U.S. subsidies to buy
health insurance was rejected today by the Internal Revenue Service."
The article describes that "employees can receive government tax credits
to buy insurance for their families if the coverage their employers offer
would cost more than 9.5 percent of their income, the IRS said today in
final regulations," but "that calculation will be based on the cost of
self-only coverage, not family coverage, which is more expensive and would
give more people access to the credits." Democratic lawmakers, "including
U.S. Representatives Sander Levin of Michigan and Henry Waxman of California,
had called for the IRS to use the more generous calculation to give families
more access to policies on the insurance exchange, or marketplace."
For immediate release: Jan. 14,
2013
Oregonians will have variety of plan choices
through Cover Oregon
Salem – Sixteen health insurance carriers have
submitted applications to participate in Cover Oregon when it
launches for open enrollment in October.
“One of the Board’s key expectations is that individuals and
small employers throughout Oregon have multiple plans to choose
from, so they can enroll in coverage that works best for themselves
and their families,” said Liz Baxter, chair of the Cover Oregon
Board of Directors. “We are pleased with this initial response
from carriers, an early indicator that we will reach that goal.”
Cover Oregon is a central online marketplace where individuals
and small employers can shop for and compare health coverage
options and access financial assistance. Open enrollment will
begin Oct. 1, 2013, and coverage for plans purchased through
Cover Oregon will be effective January 1, 2014.
Of the carriers who have applied to participate in Cover Oregon,
14 have said they will offer plans in the individual market
and 13 plan to offer plans in the small group market. The applications
were due Dec. 31, 2012, and there are still several steps before
the plans are finalized. Cover Oregon must review the applications
and certify the carriers that meet its requirements this spring.
And the carriers must file the plan details and the rates with
the Oregon Insurance Division.
The carriers that have applied are: ATRIO Health Plans, Inc.,
BridgeSpan Health Company, Family Care Health Plans, Inc., Freelancers
CO-OP of Oregon, Health Net Health Plans of Oregon, Kaiser Foundation
Health Plan of the Northwest, LifeWise Health Plan of Oregon,
Inc., Mid Rogue Health Plan, Inc., ODS Health Plan, Inc., Oregon’s
Health CO-OP (incorporated as Community Care of Oregon), PacificSource
Health Plans, Providence Health Plan, Regence BlueCross BlueShield
of Oregon, Samaritan Health Plans, Inc., Trillium Community
Health Plan, Inc., and UnitedHealthCare.
“Some carriers that are not currently in the Oregon’s individual
and small group markets have expressed interest in participating
in Cover Oregon – we see this as a positive development for
consumers as it will bring more competition,” said Howard “Rocky”
King, Cover Oregon executive director.
Through Cover Oregon, individuals and families will be able
to easily compare plans, see quality grades for carriers and
plans, and access financial assistance to help pay for premiums.
Oregonians can find out if they may qualify for financial help
by visiting the calculator on the Cover Oregon website, at
http://www.coveroregon.com/calculator.php.
Small employers will be able to offer more options to their
employees through Cover Oregon, and some will qualify for tax
credits to help pay to cover their employees. To estimate how
much they may save, employers can use the small employer calculator
on the Cover Oregon website, at
http://www.coveroregon.com/shop_calculator.php.
February 7, 2013
IRS and HHS Issue Proposed Regulations on Individual
Mandate in the Exchange
On January 30, 2013, the Internal Revenue Service
(IRS) and the Department of Health and Human Services (HHS) issued two
sets of proposed regulations related to the individual mandate provision
of the Patient Protection and Affordable Care Act (PPACA).
The individual
mandate requires most individuals to have minimum essential coverage or
pay a penalty beginning in 2014. The penalty is now called
a “shared responsibility payment.” Some individuals may qualify for an
exemption so they will not be required to have coverage or pay a penalty.
The proposed regulations confirm the individual
mandate requirements and outline the process for requesting an exemption.
The proposed regulations cover:
What qualifies as minimum essential coverage
How penalties will be determined and paid
Who is exempt from paying the penalty
When individuals can apply for an exemption
1. What Qualifies as Minimum Essential
Coverage
An individual is considered to have minimum essential
coverage for any month in which he or she is enrolled in one of the following
types of coverage for at least one day:
An employer group health plan
An individual health insurance policy
A government plan such as Medicare, Medicaid,
Children’s Health Insurance Program (CHIP), TRICARE or veterans coverage
Student health coverage
Medicare Advantage plan
State high risk pool coverage
Coverage for non-U.S. citizens provided by
another country
Refugee medical assistance provided by the
Administration for Children and Families
Coverage for AmeriCorp volunteers
All these types of plans qualify as minimum essential
coverage, and there are no additional coverage requirements that must
be met.
2. How Penalties will be Determined and
Paid
The first penalties will be due when individuals
file their 2014 tax returns in 2015. A penalty is determined by calculating
the greater amount of either a flat dollar amount or set percentage of
income. The annual penalties for 2014 through 2016 are noted below. Beginning
in 2017, penalties will increase based on the cost of living.
2014: Greater of $95 per
adult and $47.50 per child under age 18 (maximum of $285 per family)
or 1% of income over the tax-filing threshold
2015: Greater of $325 per
adult and $162.50 per child under age 18 (maximum of $975 per family)
or 2% over the tax-filing threshold
2016: Greater of $695 per
adult and $347.50 per child under age 18 (maximum of $2,085 per family)
or 2.5% over the tax-filing threshold
If the penalty applies for less than a full calendar
year, the penalty will be 1/12 of the annual amount per month without
coverage.
3. Who is Exempt from Paying the Penalty
for Not Having Coverage
Individuals who meet the following criteria will
not pay a penalty if they do not have minimum essential coverage:
Individuals who cannot afford coverage. Coverage
is considered unaffordable if an individual’s contribution toward minimum
essential coverage is more than 8% of the annual household income. The
monthly contributions are calculated at 1/12 the annual household income
to determine if they exceed the 8%.
Taxpayers with income below the tax filing
threshold, which is the amount required to file a federal tax return
Individuals who qualify for a hardship exemption.
This exemption is available to individuals who are not eligible for
Medicaid because their state chose not to expand Medicaid, or to individuals
who have a personal or financial hardship that keeps them from being
able to afford coverage.
Individuals who have a gap in minimum essential
coverage of less than three consecutive months in a calendar year
Members of religious groups that object to
coverage on religious principles
Members of health care sharing ministries.
These are non-profit religious organizations where members share medical
costs.
Individuals in prison
Individuals who are not U.S. citizens
Members of Native American tribes
U.S. citizens residing in a foreign country are
typically exempt from having minimum essential coverage if they meet certain
requirements, such as residing abroad for an entire calendar year. And,
residents of U.S. territories (Guam, American Samoa, Northern Mariana
Islands, Puerto Rico, and Virgin Islands) are automatically deemed to
have minimum essential coverage.
4. When Individuals Can Apply for an
Exemption
There are times when a person may request exemption.
The Exchange will review the application, issue a certificate of exemption
and notify the IRS. Other types of exemptions are claimed when individuals
file their federal income tax returns.
Religious and hardship exemptions are only
available when applying through an Exchange.
Individuals who cannot afford coverage, who
experience short coverage gaps, who are not U.S. citizens and who have
household incomes below the filing threshold may apply for an exemption
through the IRS.
Members of a health care sharing ministry,
individuals in prison and members of Native American tribes may apply
for an exemption through either an Exchange or through the IRS when
filing a federal tax return.
Comments regarding the HHS regulations are due
by March 18, 2013. Comments regarding the IRS regulations are due by May
2, 2013 and a public hearing is scheduled for May 29, 2013.
For more details:
The Centers for Medicare and Medicaid Services
(CMS) has an online
Fact Sheet.
Oregon’s health insurance exchange, which
gets under way in October 2013 needs to make certain
consumers have easy access to information about the
total cost of a health plan, the author maintains
By:
Jesse Ellis O’Brien
OPINION – November 8, 2012 -- Earlier this
week, I took part in a trial run of the user interface system
for the website of the Oregon health insurance exchange—now
called Cover Oregon.
Cover
Oregon is a lot of things: a new marketplace for health insurance,
a means to leverage the buying power of hundreds of thousands
of Oregonians to drive a hard bargain with the insurance industry,
and a new way to spark competition between insurers, to the
benefit of consumers. But it’s also a website, and like all
big IT projects, it faces some real challenge. Especially
if it’s going to be ready to go by October 1, 2013—the first
day of exchange open enrollment.
How can Cover Oregon make a website that
everyone can use? How can it account for the different
preferences and needs of all Oregonians?
For the first time, Cover Oregon brought
in consumers and outside experts to review their designs for
their online marketplace. I was there, and here’s some of
what I learned.
The website will give consumers new tools
that should help them focus in on plans that meet their needs.
By asking a few simple questions, Cover Oregon hopes to narrow
down the long list of plans on the market to just a few. This
should enable consumers to more easily make meaningful comparisons
on cost and quality.
The website will sort plans by cost, quality
and overall value. If this is done well, consumers will find
it that much easier to identify the plans that give the best
bang-for-your-buck.
Cover Oregon’s website holds the promise
of providing an important new service for consumers, but some
of the details that haven’t yet been decided will prove instrumental
if Cover Oregon wishes to succeed:
Will consumers be able to make true apples-to-apples
comparisons? Or will insurers be able to continue to use
dizzying combinations of premiums, co-pays, deductibles
and co-insurance to trick consumers into paying more? Cover
Oregon has all the tools to make these comparisons possible,
but it’s unclear how the website will enable them.
Will Cover Oregon’s shopping portal give
consumers all the information they need, presented in a
way they understand? For example, will consumers have easy
access to information about the total cost of a
plan—not just premiums, but out-of-pocket costs?
Which plans will be presented to consumers
when they shop, and in what order? Will high-value plans
be given preference? Or top-selling plans? Or will they
be ordered randomly? This is important, because research
shows that buying behavior is strongly affected by the way
the options are ordered.
Cover Oregon has a golden opportunity to
use its huge new marketplace to help consumers find real value,
but the devil is still in the details. I’ll be sure to keep
pushing them to do what’s best for consumers.
Shopping for health insurance may always
be a chore, but it could be about to get a lot better, if
Cover Oregon plays its cards right.
Dr. Ora Botwinick examines
Dahlia Arbella, 5, at the Multnomah County's North Portland Health
Center in Portland, Ore.(Photo:
Rick Bowmer, AP)
Story Highlights
Ore. is testing out new care models in their
Medicaid and state health programs
In Calif., 33 health plans submitted bids to
be part of the health exchange
In Rhode Island, only four carriers exist, but
officials hope to build up their exchange
1:01AM EST November 10.
2012 - States should use their creation of health insurance
exchanges required by the 2010 health care law to create prevention
programs aimed at promoting long-term savings, expert say, but state
officials argue that those "wish lists" might have to wait so states
can meet their deadlines.
"To do something different, I sure wish we had an
extra year," said Howard "Rocky" King, executive director of Cover
Oregon, Oregon's health insurance exchange. "Our first priority is
to come up with something that works."
That means states such as Oregon hope to build the
foundation of their exchanges first and then add the extras over the
next few years.
"States could play a huge, important role in prevention
and care coordination," said Ken Thorpe, head of Emory University's
health policy department. "But if we're looking at yesterday's benefits,
we'll get yesterday's problems. We need to pull costs out of the system."
Otherwise, more people will be covered through the
2010 health care law, also known as the Affordable Care Act, but premiums
will continue to go up, Thorpe said.
Rather than focusing purely on making insurance
available, states could build evidence-based prevention and lifestyle-change
options into the plans. They could insist that their insurers pay
teams of hospitals, primary-care physicians, home health care professionals
and hospice providers a set price to care for a consumer, rather than
pay by the injection, scan or visit.
Without such changes, Thorpe said, health care costs
will keep rising.
So far, Thorpe said, California has done the most
to promote innovation in its health care exchange.
Health exchanges are state- or federally run websites
that allow consumers to choose a health plan, as well as to compare
benefits and costs of each plan. Some states will allow all insurers
to participate; others have asked insurers to bid to participate;
and some states are creating a list of requirements insurers must
meet to participate.
Peter Lee, California Health Benefit Exchange's
executive director, said that insurance has "been a game of avoiding
sick people" to keep insurers' costs low. Now insurers must take everyone,
and that means keeping chronically ill people stable and trying to
prevent people from becoming sick in the first place.
In part, California can push for change because
there are so many players: 33 health plans submitted bids to be part
of the health exchange.
"The exchange has asked the plans not just for the
lowest cost on Day One, but the lowest costs over the long term,"
Lee said. "Our board said one of our values is to be a catalyst for
change."
California officials wanted health plans to show
how they pay for and reward primary care, provide better care for
the chronically ill and build in preventive services, Lee said.
Not every state is moving this direction. C.J. Bawden,
spokesman for the Silver State (Nevada) Health Insurance Exchange,
said their main goal is to take as little money from the federal government
as possible by outsourcing much of the technology of their exchange
to Xerox, rather than building from the ground up.
"A lot of states want to build it from the ground
up and keep it in-house," Bawden said. "We came out with a good business
plan."
Everyone with plans that meet federal and state
requirements may participate in what Bawden called a "free-market"
approach.
"We're trying to facilitate without doing a lot
of market disruption," he said.
Washington, D.C., exchange officials are waiting
to hear what the plans will come up with, but they included preventive
services, health club memberships and coordinated care included in
the plans on their wish list.
Mohammad Akhter, the chairman of the exchange, said
Washington's main innovation was that exchange board members are experts
in medicine and education and not politicians.
"We expect more innovations because of that," he
said.
Negotiating possibilities with insurers is difficult
until everyone knows just how many people are enrolled in the exchanges,
Oregon's King said.
Oregon officials have asked that each carrier offer
several plans, so that they'll end up with 10 or so carriers with
five or six possibilities each for the small group market. That way,
someone who knows she probably won't need a lot of time with the doctor
can choose a high-deductible plan.
In the meantime, the state is testing out new care
models in their Medicaid and state health programs to see what works
to keep costs down, King said. These things include preventive-care
programs, as well as making sure doctors are paid to keep people healthy,
rather than through a fee-for-service program.
In Rhode Island, only four carriers exist, but officials
still hope to set up different products than were available before.
They'll be negotiating with the insurers over the next month.
Christine Ferguson, Rhode Island's director of the
health benefit exchange, said the plans will be able to do more with
a higher concentration of people.
The state hopes to build the exchange, collect data
about what works and what doesn't, and then re-evaluate. For example,
do cancer screenings and immunizations affect the number of days people
go to work or children go to school?
"So we're looking at improvement," she said. "The
exchange is a catalyst to move the debate to reform."
Published:
Tuesday, August 21, 2012, 6:14 AM
By Mike Roach
As a co-owner of an independent clothing retailer in Portland, I've
experienced firsthand the evolution of health care insurance for small
businesses and their employees. When our store first opened 37 years
ago, providing health insurance to our employees wasn't a priority because
they had other options. Today, it's a different story. To stay competitive
with larger employers and meet the needs of our staff, we offer health
insurance. This helps us retain top-notch employees who in turn help
us to deliver the level of service our customers deserve and expect.
With fewer than a dozen employees, it was tough
for us to find a plan that worked for the needs of the business and
our employees. Our small size put us at a disadvantage. We could only
afford to offer our employees one choice of carrier and one plan type.
As the years have passed and the premiums have skyrocketed -- in 2011
our premiums went up 50 percent -- we're still stuck paying a significant
amount of money with no greater choices.
Luckily, Oregon was one of the first states to embrace and plan for
the provisions of the Affordable Care Act. One of those provisions
includes the development of a health insurance exchange to make it
easier for small businesses to give their employees a choice in their
health coverage. According to a Field Poll in Oregon, just one in
four small employers currently offers health benefits to all of its
employees. But when small-business owners are told that Oregon's exchange
opens in 2014, the proportion of those who are likely to offer health
coverage to their employees jumps to 42 percent.
We see the health insurance exchange as an opportunity to offer our
employees real choices of insurance carriers, doctors and disease-prevention
programs. Other small-business owners apparently agree. The poll found
that two-thirds of us who plan to offer health benefits in 2014 want
to offer our employees a choice of competing insurance carriers. If
Oregon's small-business exchange is set up right, the exchange will
do just that: let our employees pick from multiple carriers, with
easily comparable plans. And it will handle enrollment and provide
us a single, consolidated bill, regardless of the different number
of insurance carriers our employees select.
Right now Oregon leaders are making important decisions on what the
small-business exchange will offer. These decisions will determine
whether the exchange provides a clear alternative that's easy to understand
with a choice of carrier. For that reason, I joined the Employee Choice
Coalition (employeechoicecoalition.org). The coalition members believe
that the current small-employer insurance market would be more competitive
if exchanges offer this type of choice, forcing insurance companies
to compete one consumer at a time.
Let's do it right in Oregon. Let small businesses give employees the
choices they deserve.
Mike Roach is the co-owner of Paloma Clothing in Southwest
Portland.
The Affordable Care Act: Immediate
Benefits for Oregon
Small business tax credits.
67,000 small businesses in Oregon could be helped by a new small
business tax credit that makes it easier for businesses to provide
coverage to their workers and makes premiums more affordable.1
Small businesses pay, on average, 18 percent more than large businesses
for the same coverage, and health insurance premiums have gone up
three times faster than wages in the past 10 years. This tax credit
is just the first step towards bringing those costs down and making
coverage affordable for small businesses.
Closing the Medicare Part
D donut hole. Last year, roughly 49,600 Medicare beneficiaries
in Oregon hit the donut hole, or gap in Medicare Part D drug coverage,
and received no extra help to defray the cost of their prescription
drugs.2 Medicare beneficiaries in Oregon who hit the
gap this year will automatically be mailed a one-time $250 rebate
check. These checks will begin to be mailed to beneficiaries in
mid-June and will be mailed monthly throughout the year as new beneficiaries
hit the donut hole. The new law continues to provide additional
discounts for seniors on Medicare in the years ahead and completely
closes the donut hole by 2020.
Support for health coverage
for early retirees. An estimated 70,100 people from Oregon retired
before they were eligible for Medicare and have health coverage
through their former employers. Unfortunately, the number of firms
that provide health coverage to their retirees has decreased over
time.3 Beginning June 1, 2010, a $5 billion temporary
early retiree reinsurance program will help stabilize early retiree
coverage and help ensure that firms continue to provide health coverage
to their early retirees. Companies, unions, and state and local
governments are eligible for these benefits.
New consumer protections in
the insurance market beginning on or after September 23, 2010.
Insurance companies will no longer be able
to place lifetime limits on the coverage they provide, ensuring
that the 2 million Oregon residents with private insurance coverage
never have to worry about their coverage running out and facing
catastrophic out-of-pocket costs.
Insurance companies will be banned from dropping
people from coverage when they get sick, protecting the 257,000
individuals who purchase insurance in the individual market from
dishonest insurance practices.
Insurance companies will not be able to exclude
children from coverage because of a pre-existing condition, giving
parents across Oregon peace of mind.
Insurance plans’ use of annual limits will
be tightly regulated to ensure access to needed care. This will
protect the 1.7 million residents of Oregon with health insurance
from their employer, along with anyone who signs up with a new
insurance plan in Oregon.
Health insurers offering new plans will have
to develop an appeals process to make it easy for enrollees to
dispute the denial of a medical claim.
Patients’ choice of doctors will be protected
by allowing plan members in new plans to pick any participating
primary care provider, prohibiting insurers from requiring prior
authorization before a woman sees an ob-gyn, and ensuring access
to emergency care.
Extending coverage to
young adults. Beginning on or after September 23, 2010, plans
and issuers that offer coverage to children on their parents’ policy
must allow children to remain on their parents’ policy until they
turn 26, unless the adult child has another offer of job-based coverage
in some cases. This provision will bring relief to roughly 15,000
individuals in Oregon who could now have quality affordable coverage
through their parents.4 Some employers and the vast majority
of insurers have agreed to cover adult children immediately.
Affordable insurance
for uninsured with pre-existing conditions. $66 million federal
dollars are available to Oregon starting July 1 to provide coverage
for uninsured residents with pre-existing medical conditions through
a new transitional high-risk pool program, funded entirely by the
Federal government. The program is a bridge to 2014 when Americans
will have access to affordable coverage options in the new health
insurance exchanges and insurance companies will be prohibited from
denying coverage to Americans with pre-existing conditions. If states
choose not to run the program, the Federal government will administer
the program for those residents.
Strengthening community
health centers. Beginning October 1, 2010, increased funding
for Community Health Centers will help nearly double the number
of patients seen by the centers over the next five years. The funding
could not only help the 179 Community Health Centers in Oregon but
also support the construction of new centers.
More doctors where people
need them. Beginning October 1, 2010, the Act will provide funding
for the National Health Service Corps ($1.5 billion over five years)
for scholarships and loan repayments for doctors, nurses and other
health care providers who work in areas with a shortage of health
professionals. This will help the 7% of Oregon’s population who
live in an underserved area.
New Medicaid options for states.
For the first time, Oregon has the option of Federal Medicaid funding
for coverage for all low-income populations, irrespective of age,
disability, or family status.
For Immediate Release:
Wednesday, January 30, 2013
Contact:
CMS
Media Relations
202-690-6145
FACT SHEET: INDIVIDUAL SHARED RESPONSIBILITY FOR HEALTH INSURANCE
COVERAGE AND MINIMUM ESSENTIAL COVERAGE PROPOSED RULES
Under the Affordable Care Act, the Federal government, State governments,
insurers, employers, and individuals are given shared responsibility
to reform and improve the availability, quality, and affordability of
health insurance coverage in the United States. Starting in 2014, the
individual shared responsibility provision calls for each individual
to have basic health insurance coverage (known as
minimum essential coverage), qualify for an exemption, or make a
shared responsibility payment when filing a federal income tax return.
Individuals will not have to make a payment if coverage is unaffordable,
if they spend less than three consecutive months without coverage, or
if they qualify for an exemption for several other reasons, including
hardship and religious beliefs.
Today, the Treasury Department and
Internal Revenue Service (IRS), as well as the Centers for Medicare
& Medicaid Services at the Department of Health and Human Services (HHS),
issued two sets of proposed regulations. The regulations explain the
shared responsibility provision and lay out the eligibility rules for
receiving an exemption and the process by which individuals can receive
certificates of exemption. Both agencies’ proposed regulations include
rules that will ease implementation and help to ensure that the payment
applies only to the limited group of taxpayers who choose to spend a
substantial period of time without coverage despite having ready access
to affordable coverage.
According to the Congressional Budget
Office, less than two percent of Americans will owe a shared responsibility
payment.
Highlights of the Proposed Regulations
A principle in implementing the individual
shared responsibility provision is that the shared responsibility payment
should not apply to any taxpayer for whom coverage is unaffordable,
who has other good cause for going without coverage, or who goes without
coverage for only a short time. The proposed regulations include several
rules to implement this principle. For example:
Hardship Exemption Clarified to Protect Taxpayers, Address
Key Concerns. The statute gives HHS authority to exempt individuals
determined to “have suffered a hardship with respect to the capability
to obtain coverage.” In developing these proposed regulations, HHS
considered several particular circumstances that provide good cause
to go without coverage. To provide clarity for taxpayers facing these
circumstances, the HHS proposed regulations enumerate several situations
that will always be treated as constituting a hardship and therefore
allow for an exemption. Hardship exemptions include:
Individuals whom an Exchange projects will have no offer of
affordable coverage (even if, due to a change in circumstance during
the year, it turns out that the coverage would have been affordable).
This rule will protect individuals who turn down coverage because
the Exchange projects it will be unaffordable but whose actual income
for the year turns out to be higher so they are not eligible for
the affordability exemption;
Certain individuals who are not required to file an income tax
return but who technically fall outside the statutory exemption
for those with household income below the filing threshold; and
Individuals who would be eligible for Medicaid but for a state’s
choice not to expand Medicaid eligibility. This rule will protect
individuals in states that, pursuant to the Supreme Court decision,
choose not to expand Medicaid eligibility;
The HHS regulations also provide that the hardship
exemption will be available on a case-by-case basis for individuals
who face other unexpected personal or financial circumstances that prevent
them from obtaining coverage.
Partial-Month Coverage Counts for the Month. The Treasury
regulations provide that an individual is treated as having coverage
for a month so long as he or she has coverage for any one day of that
month. For example, an individual who starts a new job on March 27
and is enrolled in employer-sponsored coverage on that day is treated
as having coverage for the month of March. Similarly, an individual
who is eligible for an exemption for any one day of a month is treated
as exempt for the entire month.
Payment Waived for First Part of Coverage Gap Spanning Multiple
Years. The statute provides an exemption for gaps in coverage
of less than three months. It generally specifies that such gaps be
measured without regard to the calendar years in which the gap occurs.
For example, a gap lasting from November through February lasts four
months and therefore generally would not qualify for the exemption.
However, recognizing that many individuals file their tax returns
as early as January, before the length of an ongoing gap may be known,
the Treasury regulations provide that if the part of a gap in the
first tax year is less than three months, then no shared responsibility
payment is due for the part of the gap that occurs during the first
calendar year, regardless of the eventual length of the gap. For example,
for a gap lasting from November through February, no payment would
be due for November and December.
Additional Details about the Proposed
Regulations
The proposed regulations explain that minimum
essential coverage includes, at a minimum, all of the following statutory
categories:
Employer-sponsored coverage (including COBRA coverage and retiree
coverage)
Coverage purchased in the individual market
Medicare Part A coverage
Medicaid coverage
Children's Health Insurance Program (CHIP) coverage
Certain types of Veterans health coverage
TRICARE
Minimum essential coverage does not include certain
specialized coverage, such as coverage only for vision care or dental
care, workers’ compensation, or coverage only for a specific disease
or condition. Under the law, minimum essential coverage also includes
any additional types of coverage that are designated by the Department
of Health and Human Services (HHS) or, as detailed by the proposed regulation,
when the sponsor of the coverage follows a process outlined in the regulations
to be recognized as minimum essential coverage.
Specific Rules and Process for Receiving an
Exemption
The proposed regulations also codify the statute’s
nine categories of individuals who are exempt from the shared responsibility
payment. These categories are as follows:
Individuals who cannot afford coverage;
Taxpayers with income below the filing threshold;
Members of Indian tribes;
Hardship;
Individuals who experience short coverage gaps.
Religious conscience;
Members of a health care sharing ministry;
Incarcerated individuals; and
Individuals who are not lawfully present;
The statute specifies that the religious
conscience exemption and the hardship exemption are available exclusively
through a Health Insurance Marketplace or Exchange. Four categories
of exemptions are proposed to be available exclusively from the IRS
through the filing process – the exemptions for individuals who are
not lawfully present, taxpayers with household income below the filing
threshold, individuals who cannot afford coverage, and individuals who
experience short coverage gaps. The rule provides a choice to individuals
for the exemptions in the three remaining categories – members of a
health care sharing ministry, individuals who are incarcerated, and
members of Indian tribes. Such exemptions could be provided either through
a Heath Insurance Marketplace or through the tax filing process.
Starting in 2015, individuals filing a tax
return for the previous tax year will indicate which members of their
family (including themselves) are exempt from the provision. For family
members who are not exempt, the taxpayer will indicate whether they
had insurance coverage. For each non-exempt family member who doesn’t
have coverage, the taxpayer will owe a payment.
HHS and IRS are seeking comments on these
proposals. Comments on the Treasury proposed regulations are due by
May 2, 2013, and a public hearing will be held May 29, 2013. Comments
on the HHS proposed regulations are due by March 18, 2013.
For questions and answers on the Individual Shared
Responsibility Provision, visit
IRS.gov
For more information about health insurance
through the Health Insurance Marketplace, including how to sign up for
email updates and tips on how to prepare for open enrollment in October
2013, visit:
http://www.healthcare.gov/marketplace/index.html.
ACA Glitch Could Mean Some Families Will Be "Priced Out"
Of Coverage in the Exchanges.
Feb 9, 2013
The
AP
(1/30, Alonso-Zaldivar) reports that a "glitch" in the Affordable Care
Act could mean that some families will be "priced out of health insurance."
According to the AP, "IRS regulations issued Wednesday failed to fix the
problem as liberal backers of the president's plan had hoped," and as
a result, "some families that can't afford the employer coverage that
they are offered on the job will not be able to get financial assistance
from the government to buy private health insurance on their own." The
Administration "says its hands were tied by the way Congress wrote the
law," noting that the "affordability glitch is one of a series of problems
coming into sharper focus as the law moves to full implementation."
For its part,
Bloomberg News
(1/31, Wayne, Rubin) reports that "an effort to allow looser rules for
calculating whether workers will be eligible for U.S. subsidies to buy
health insurance was rejected today by the Internal Revenue Service."
The article describes that "employees can receive government tax credits
to buy insurance for their families if the coverage their employers offer
would cost more than 9.5 percent of their income, the IRS said today in
final regulations," but "that calculation will be based on the cost of
self-only coverage, not family coverage, which is more expensive and would
give more people access to the credits." Democratic lawmakers, "including
U.S. Representatives Sander Levin of Michigan and Henry Waxman of California,
had called for the IRS to use the more generous calculation to give families
more access to policies on the insurance exchange, or marketplace."
HSA's (Health
Savings Accounts) a new, old way, to fight the coming effects of health
care exchange:
Cigna CDHP participation jumps 26 percent
Insurer's research finds CDHP consumers lower costs, make better health
decisions By Kathryn Mayer
February 14, 2013
Cigna’s consumer-driven
health plan participation grew by 26 percent in 2012, with one in five
Cigna customers now participating in a health savings account or health
reimbursement account, the health insurer said this week.
The growth of CDHPs has been well-documented lately, and Cigna president
and CEO David Cordani says it’s no surprise as to why.
“The growth of consumer-driven health plans continues because they help
customers reduce their health risks and improve the quality and efficiency
of their care, which result in lowering their total medical costs,”
he said. “Our CDHP customers are more engaged with their health and
health spending, they spend less to receive the same levels of recommended
care, and are more satisfied with their health care experience.”
In a study, Cigna compared actual claims experience of more than 2.5
million Cigna customers who are enrolled in either a CDHP, a traditional
PPO or HMO health plan. The study found that when compared to customers
in traditional PPO and HMO plans, those in a CDHP both lowered their
health risks while reducing total medical costs.
According to the study, when employers fully transitioned to offering
only a CDHP option, individuals improved their health risk profile by
12 percent in the first year compared to customers in a traditional
plan. Cigna CDHP medical cost trend was 13 percent lower than traditional
plans during the first year: costs were 20 percent lower for HSA customers
and 11 percent lower for HRA participants. Cost reductions were achieved
without employers shifting out-of-pocket health expenses to their employees.
Notably 75 percent of HSA customers contribute more to their accounts
than they spend.
Not only that, CDHP customers were more invested and engaged in their
own health care. They were more likely to participate in wellness programs
and health assessments and were 59 percent more likely to access cost
and procedure information to help them review potential medical costs.
Cigna CDHP customers also sought preventive care, such as annual office
visits and mammograms, more frequently than customers enrolled in a
traditional plan.
Oregon’s Health Insurance Exchange Leads the Nation
People can begin signing up in October and learn the amount
of their federal subsidy, while coverage kicks in next January
By:
Diane Lund-Muzikant
March
8, 2013 – Oregon is among the leading states to get its health
insurance exchange off the ground, according to Rocky King, executive
director of Cover Oregon.
“Everybody is scrambling just like we are,” said King, who
attended a national conference in Washington DC recently. “We’re
trying to build a Mercedes on day one – without heated seats --
while everyone expects us to have as much out there as we can.
This is an incredible project. When people see what we’re doing
in Oregon compared to Idaho, Maine or Florida, they’ll be proud
of what we’ve been able to accomplish.”
Starting next October, individuals and small employers can
sign up for health coverage under the exchange and qualify for
federal tax subsidies if their income falls below 400 percent
of the federal poverty level. For example, a family of four can
earn up to $92,500 and qualify for such a subsidy.
The health insurers that participate in the exchange must submit
their rates to the Oregon Insurance Division by April 30, while
the division expects to hold public hearings in late May and early
June.
An administrative fee – paid by insurers to keep the exchange
afloat once the federal grants run out – will be included in those
rates. The amount of that fee will be decided when the board of
Cover Oregon meets next Thursday. Those fees will be collected
starting next January so the exchange can build up a six month
reserve.
“We all want to make that fee as low as possible so that it
will have the least impact on the market,” said Lisa Morawski,
spokesperson.
Cover Oregon’s finance committee has recommended a 2.68 percent
administrative fee, which comes out to $9.38 per person per month.
Earlier, staff recommended a higher fee of 3.47 percent – or $12.14
per member per month. Both Regence BlueCross BlueShield and Kaiser
Permanente favor the lower fee.
To recoup that fee, insurers are expected to include that amount
in the premiums they charge to policyholders. Because they must
charge the same rates for policies sold both inside and outside
the exchange, insurance companies are expected to spread that
fee across their entire individual and/or small group market.
Some observers argue that this will lead insurers to game the
system, but King defended that decision, which was made by the
Insurance Division, saying it allows insurers to spread their
risk.
Besides collecting the administrative fee, Cover Oregon also
expects to recoup $15 million from the Oregon Health Authority
in 2014 to enroll Medicaid members. Earlier projections were $10
million.
Although people can sign up for the exchange in October, coverage
doesn’t kick in until next January. People can also keep their
individual policies intact until March 30, 2014.
“The individual market will have to comply with the Affordable
Care Act by April 1, 2014,” Savage told The Lund Report. “We want
people to have access to such plans as soon as possible and have
an opportunity to join the exchange and make certain people are
eligible for the subsidies. The success of the exchange is important
to us.”
No longer can people be turned away because of pre-existing
health conditions. “For the past 25 years we’ve had to watch and
say no to people who are sick and tell them they earn too much
money for Medicaid even though they can’t afford coverage – or
that we have a waiting list,” King said, “Now everyone will have
an opportunity for coverage – sick or not sick, healthy or not
– they’ll have the same options everyone else has. No longer will
people be denied because they have cancer. And, if they don’t
earn as much as the guy down the block, the federal government
will provide tax credits.”
Starting in October 2015, school districts can join the exchange,
assuming the state gets the nod from the federal government. This
is allowed under House Bill 4164, which was passed last year.
“I think we’ll get a positive response, but this is not something
we’re working on today,” King said. However, trade associations
are not allowed in the exchange, he added.
Agents vital to success
King believes insurance agents are vital to the success of
the exchange, and predicts they’ll sell 95 percent of small employer
coverage. “The exchange doesn’t work without agents; they’re the
lifeblood to get the people into the exchange.”
As part of its work, the exchange is also building a system
for the entire family, King said – they may have a child on Medicaid,
in the Children’s Health Insurance Program, yet the parents buy
their own individual coverage or receive such benefits from their
employer.
“We’ll be able to handle all their needs, including eligibility
criteria – that’s not true in California, for example, where a
family with a child on CHIP will have to contact their local county
Medicaid office,” King said. ”
Initially, benefits will include physical, prescription and
dental coverage and, eventually disability, long-term care, life
insurance, vision and alternative care providers. “We want to
do this but first want to make sure the car starts and goes around
the block and don’t want get out there too early,” he said.
King isn’t proposing any legislation this session on behalf
of Cover Oregon. “We’re zeroing in on making this thing work next
year; to me that’s much more important than doing any fine tuning.
Our agenda is somewhat defensive, and I want to make sure we don’t
get sidetracked.”
In 2014, the exchange has projected a $105.7 million budget,
with those dollars coming from federal grants. The following year
its budget drops down to $62.4 million, and includes $12.9 million
for consumer and stakeholder outreach such as all printed materials
and communications with enrollees, marketing, community outreach
and education, enrollment assistance and staffing for those areas,
Morawski said.
Cover Oregon receives $226 million federal grant
Health and Human Services (HHS) announced today that Cover
Oregon will receive more than $226 million in grant funding
for 2013 and 2014 to help the organization become fully
operational. Cover Oregon is a central online marketplace
where individuals, families, and small businesses can
shop for and compare health coverage options and access
financial assistance, starting in October 2013. Coverage
for plans purchased through Cover Oregon will be effective
January 1, 2014.
The grant will cover expenses until Cover Oregon is self-sustaining
beginning in 2015. The two-year award will cover costs
associated with testing, training, and implementation
of the IT user interface. Funding will also allow the
Cover Oregon service call center to be fully staffed and
trained on the Affordable Care Act, Medicaid, and health
insurance options for the individual market and small
employers. Cover Oregon is one of just five states to
receive a multi-year award.
Oregonians will have variety of plan choices through Cover
Oregon
Salem – Sixteen health insurance carriers have submitted
applications to participate in Cover Oregon when it launches
for open enrollment in October.
“One of the Board’s key expectations is that individuals
and small employers throughout Oregon have multiple plans
to choose from, so they can enroll in coverage that works
best for themselves and their families,” said Liz Baxter,
chair of the Cover Oregon Board of Directors. “We are pleased
with this initial response from carriers, an early indicator
that we will reach that goal.”
Cover Oregon is a central online marketplace where individuals
and small employers can shop for and compare health coverage
options and access financial assistance. Open enrollment
will begin Oct. 1, 2013, and coverage for plans purchased
through Cover Oregon will be effective January 1, 2014.
Of the carriers who have applied to participate in Cover
Oregon, 14 have said they will offer plans in the individual
market and 13 plan to offer plans in the small group market.
The applications were due Dec. 31, 2012, and there are still
several steps before the plans are finalized. Cover Oregon
must review the applications and certify the carriers that
meet its requirements this spring. And the carriers must
file the plan details and the rates with the Oregon Insurance
Division.
The carriers that have applied are: ATRIO Health Plans,
Inc., BridgeSpan Health Company, Family Care Health Plans,
Inc., Freelancers CO-OP of Oregon, Health Net Health Plans
of Oregon, Kaiser Foundation Health Plan of the Northwest,
LifeWise Health Plan of Oregon, Inc., Mid Rogue Health Plan,
Inc., ODS Health Plan, Inc., Oregon’s Health CO-OP (incorporated
as Community Care of Oregon), PacificSource Health Plans,
Providence Health Plan, Regence BlueCross BlueShield of
Oregon, Samaritan Health Plans, Inc., Trillium Community
Health Plan, Inc., and UnitedHealthCare.
“Some carriers that are not currently in the Oregon’s individual
and small group markets have expressed interest in participating
in Cover Oregon – we see this as a positive development
for consumers as it will bring more competition,” said Howard
“Rocky” King, Cover Oregon executive director.
Through Cover Oregon, individuals and families will be able
to easily compare plans, see quality grades for carriers
and plans, and access financial assistance to help pay for
premiums. Oregonians can find out if they may qualify for
financial help by visiting the calculator on the Cover Oregon
website, at
http://www.coveroregon.com/calculator.php.
Small employers will be able to offer more options to their
employees through Cover Oregon, and some will qualify for
tax credits to help pay to cover their employees. To estimate
how much they may save, employers can use the small employer
calculator on the Cover Oregon website, at
http://www.coveroregon.com/shop_calculator.php.
NEWS RELEASE
DECEMBER 10, 2012
Media Contact:
Tim Raphael, 503-689-6117
Amy Wojcicki, 503-689-5324
Cover Oregon gets Federal Nod for Health Insurance
Exchange
(Salem, OR) — Today, the Centers for Medicare
& Medicaid Services (CMS) gave Oregon conditional approval
for its plan to operate a health insurance exchange
– called Cover Oregon – which will help connect thousands
of Oregonians to health coverage. Oregon was among the
first six states in the nation to receive conditional
approval of its “blueprint” application.
“Cover Oregon is a key piece of Oregon’s efforts to
transform our health care system,” said Governor Kitzhaber.
“With transparency about quality and prices and the
ability to make apples-to-apples comparisons, Oregonians
will be empowered to make decisions about their health
coverage.”
Cover Oregon is a central online marketplace where individuals
and small businesses can shop for and compare health
coverage options and access financial assistance, starting
in October 2013. Coverage for plans purchased through
Cover Oregon will be effective January 1, 2014.
Through Cover Oregon, individuals and families will
be able to easily compare plans, see quality grades
for carriers and plans, and access financial assistance
to help pay for premiums. Oregonians can find out if
they may qualify for financial help by visiting the
calculator on the Cover Oregon website, at
http://www.coveroregon.com/calculator.php.
Small businesses will be able to offer more options
to their employees through Cover Oregon, and some will
qualify for tax credits to help pay to cover their employees.
Cover Oregon’s blueprint application details how it
will operate in areas such as technology, eligibility
and enrollment, and consumer and stakeholder engagement.
According to CMS, conditional approval indicates that
a state has not completed all blueprint exchange activity
requirements but will be operationally ready for the
initial open enrollment period in October 2013.
“We are pleased to have completed this important step
in developing a state-based exchange,” said Liz Baxter,
chair of the Cover Oregon Board of Directors. “As we
prepare for our launch next fall, we will continue to
engage the public to ensure Cover Oregon meets the unique
needs of Oregonians.”
To learn more about Cover Oregon, including schedules
of public meetings, visit
www.coveroregon.com.
1:01AM EST November 10. 2012 -
States should use their creation of health insurance exchanges required
by the 2010 health care law to create prevention programs aimed at promoting
long-term savings, expert say, but state officials argue that those
"wish lists" might have to wait so states can meet their deadlines.
"To do something different, I sure wish we had an extra year," said
Howard "Rocky" King, executive director of Cover Oregon, Oregon's health
insurance exchange. "Our first priority is to come up with something
that works."
That means states such as Oregon hope to build the foundation of
their exchanges first and then add the extras over the next few years.
"States could play a huge, important role in prevention and care
coordination," said Ken Thorpe, head of Emory University's health policy
department. "But if we're looking at yesterday's benefits, we'll get
yesterday's problems. We need to pull costs out of the system."
Otherwise, more people will be covered through the 2010 health care
law, also known as the Affordable Care Act, but premiums will continue
to go up, Thorpe said.
Rather than focusing purely on making insurance available, states
could build evidence-based prevention and lifestyle-change options into
the plans. They could insist that their insurers pay teams of hospitals,
primary-care physicians, home health care professionals and hospice
providers a set price to care for a consumer, rather than pay by the
injection, scan or visit.
Without such changes, Thorpe said, health care costs will keep rising.
So far, Thorpe said, California has done the most to promote innovation
in its health care exchange.
Health exchanges are state- or federally run websites that allow
consumers to choose a health plan, as well as to compare benefits and
costs of each plan. Some states will allow all insurers to participate;
others have asked insurers to bid to participate; and some states are
creating a list of requirements insurers must meet to participate.
Peter Lee, California Health Benefit Exchange's executive director,
said that insurance has "been a game of avoiding sick people" to keep
insurers' costs low. Now insurers must take everyone, and that means
keeping chronically ill people stable and trying to prevent people from
becoming sick in the first place.
In part, California can push for change because there are so many
players: 33 health plans submitted bids to be part of the health exchange.
"The exchange has asked the plans not just for the lowest cost on
Day One, but the lowest costs over the long term," Lee said. "Our board
said one of our values is to be a catalyst for change."
California officials wanted health plans to show how they pay for
and reward primary care, provide better care for the chronically ill
and build in preventive services, Lee said.
Not every state is moving this direction. C.J. Bawden, spokesman
for the Silver State (Nevada) Health Insurance Exchange, said their
main goal is to take as little money from the federal government as
possible by outsourcing much of the technology of their exchange to
Xerox, rather than building from the ground up.
"A lot of states want to build it from the ground up and keep it
in-house," Bawden said. "We came out with a good business plan."
Everyone with plans that meet federal and state requirements may
participate in what Bawden called a "free-market" approach.
"We're trying to facilitate without doing a lot of market disruption,"
he said.
Washington, D.C., exchange officials are waiting to hear what the
plans will come up with, but they included preventive services, health
club memberships and coordinated care included in the plans on their
wish list.
Mohammad Akhter, the chairman of the exchange, said Washington's
main innovation was that exchange board members are experts in medicine
and education and not politicians.
"We expect more innovations because of that," he said.
Negotiating possibilities with insurers is difficult until everyone
knows just how many people are enrolled in the exchanges, Oregon's King
said.
Oregon officials have asked that each carrier offer several plans,
so that they'll end up with 10 or so carriers with five or six possibilities
each for the small group market. That way, someone who knows she probably
won't need a lot of time with the doctor can choose a high-deductible
plan.
In the meantime, the state is testing out new care models in their
Medicaid and state health programs to see what works to keep costs down,
King said. These things include preventive-care programs, as well as
making sure doctors are paid to keep people healthy, rather than through
a fee-for-service program.
In Rhode Island, only four carriers exist, but officials still hope
to set up different products than were available before. They'll be
negotiating with the insurers over the next month.
Christine Ferguson, Rhode Island's director of the health benefit
exchange, said the plans will be able to do more with a higher concentration
of people.
The state hopes to build the exchange, collect data about what works
and what doesn't, and then re-evaluate. For example, do cancer screenings
and immunizations affect the number of days people go to work or children
go to school?
"So we're looking at improvement," she said. "The exchange is a catalyst
to move the debate to reform."
A New Way of Shopping for Health Insurance Gets a
Trial Run
Oregon’s health insurance exchange, which gets under way
in October 2013 needs to make certain consumers have easy
access to information about the total cost of a health plan,
the author maintains
By:
Jesse Ellis O’Brien
OPINION – November 8, 2012 -- Earlier this week, I took part
in a trial run of the user interface system for the website of
the Oregon health insurance exchange—now called Cover Oregon.
Cover
Oregon is a lot of things: a new marketplace for health insurance,
a means to leverage the buying power of hundreds of thousands
of Oregonians to drive a hard bargain with the insurance industry,
and a new way to spark competition between insurers, to the benefit
of consumers. But it’s also a website, and like all big IT projects,
it faces some real challenge. Especially if it’s going to be ready
to go by October 1, 2013—the first day of exchange open enrollment.
How can Cover Oregon make a website that everyone
can use? How can it account for the different preferences and
needs of all Oregonians?
For the first time, Cover Oregon brought in consumers and outside
experts to review their designs for their online marketplace.
I was there, and here’s some of what I learned.
The website will give consumers new tools that should help
them focus in on plans that meet their needs. By asking a few
simple questions, Cover Oregon hopes to narrow down the long list
of plans on the market to just a few. This should enable consumers
to more easily make meaningful comparisons on cost and quality.
The website will sort plans by cost, quality and overall value.
If this is done well, consumers will find it that much easier
to identify the plans that give the best bang-for-your-buck.
Cover Oregon’s website holds the promise of providing an important
new service for consumers, but some of the details that haven’t
yet been decided will prove instrumental if Cover Oregon wishes
to succeed:
Will consumers be able to make true apples-to-apples comparisons?
Or will insurers be able to continue to use dizzying combinations
of premiums, co-pays, deductibles and co-insurance to trick
consumers into paying more? Cover Oregon has all the tools to
make these comparisons possible, but it’s unclear how the website
will enable them.
Will Cover Oregon’s shopping portal give consumers all the
information they need, presented in a way they understand? For
example, will consumers have easy access to information about
the total cost of a plan—not just premiums, but out-of-pocket
costs?
Which plans will be presented to consumers when they shop,
and in what order? Will high-value plans be given preference?
Or top-selling plans? Or will they be ordered randomly? This
is important, because research shows that buying behavior is
strongly affected by the way the options are ordered.
Cover Oregon has a golden opportunity to use its huge new marketplace
to help consumers find real value, but the devil is still in the
details. I’ll be sure to keep pushing them to do what’s best for
consumers.
Shopping for health insurance may always be a chore, but it
could be about to get a lot better, if Cover Oregon plays its
cards right.
Jesse Ellis O’Brien is the healthcare advocate for OSPIRG
Oregon health insurance exchange: Small businesses
push for choices
As a co-owner of an independent clothing retailer in Portland, I've
experienced firsthand the evolution of health care insurance for small
businesses and their employees. When our store first opened 37 years
ago, providing health insurance to our employees wasn't a priority
because they had other options. Today, it's a different story. To
stay competitive with larger employers and meet the needs of our staff,
we offer health insurance. This helps us retain top-notch employees
who in turn help us to deliver the level of service our customers
deserve and expect.
With fewer than a dozen employees, it was tough for us to find
a plan that worked for the needs of the business and our employees.
Our small size put us at a disadvantage. We could only afford to offer
our employees one choice of carrier and one plan type. As the years
have passed and the premiums have skyrocketed -- in 2011 our premiums
went up 50 percent -- we're still stuck paying a significant amount
of money with no greater choices.
Luckily, Oregon was one of the first states to embrace and plan for
the provisions of the Affordable Care Act. One of those provisions
includes the development of a health insurance exchange to make it
easier for small businesses to give their employees a choice in their
health coverage. According to a Field Poll in Oregon, just one in
four small employers currently offers health benefits to all of its
employees. But when small-business owners are told that Oregon's exchange
opens in 2014, the proportion of those who are likely to offer health
coverage to their employees jumps to 42 percent.
We see the health insurance exchange as an opportunity to offer our
employees real choices of insurance carriers, doctors and disease-prevention
programs. Other small-business owners apparently agree. The poll found
that two-thirds of us who plan to offer health benefits in 2014 want
to offer our employees a choice of competing insurance carriers. If
Oregon's small-business exchange is set up right, the exchange will
do just that: let our employees pick from multiple carriers, with
easily comparable plans. And it will handle enrollment and provide
us a single, consolidated bill, regardless of the different number
of insurance carriers our employees select.
Right now Oregon leaders are making important decisions on what the
small-business exchange will offer. These decisions will determine
whether the exchange provides a clear alternative that's easy to understand
with a choice of carrier. For that reason, I joined the Employee Choice
Coalition (employeechoicecoalition.org). The coalition members believe
that the current small-employer insurance market would be more competitive
if exchanges offer this type of choice, forcing insurance companies
to compete one consumer at a time.
Let's do it right in Oregon. Let small businesses give employees the
choices they deserve.
Mike Roach is the co-owner of Paloma Clothing in Southwest Portland.
The Affordable Care Act: Immediate Benefits
for Oregon
Small business tax credits. 67,000
small businesses in Oregon could be helped by a new small business tax
credit that makes it easier for businesses to provide coverage to their
workers and makes premiums more affordable.1 Small businesses
pay, on average, 18 percent more than large businesses for the same
coverage, and health insurance premiums have gone up three times faster
than wages in the past 10 years. This tax credit is just the first step
towards bringing those costs down and making coverage affordable for
small businesses.
Closing the Medicare Part D donut hole.
Last year, roughly 49,600 Medicare beneficiaries in Oregon hit the donut
hole, or gap in Medicare Part D drug coverage, and received no extra
help to defray the cost of their prescription drugs.2 Medicare
beneficiaries in Oregon who hit the gap this year will automatically
be mailed a one-time $250 rebate check. These checks will begin to be
mailed to beneficiaries in mid-June and will be mailed monthly throughout
the year as new beneficiaries hit the donut hole. The new law continues
to provide additional discounts for seniors on Medicare in the years
ahead and completely closes the donut hole by 2020.
Support for health coverage for early retirees.
An estimated 70,100 people from Oregon retired before they were eligible
for Medicare and have health coverage through their former employers.
Unfortunately, the number of firms that provide health coverage to their
retirees has decreased over time.3 Beginning June 1, 2010,
a $5 billion temporary early retiree reinsurance program will help stabilize
early retiree coverage and help ensure that firms continue to provide
health coverage to their early retirees. Companies, unions, and state
and local governments are eligible for these benefits.
New consumer protections in the insurance
market beginning on or after September 23, 2010.
Insurance companies will no longer be able to place lifetime limits
on the coverage they provide, ensuring that the 2 million Oregon residents
with private insurance coverage never have to worry about their coverage
running out and facing catastrophic out-of-pocket costs.
Insurance companies will be banned from dropping people from coverage
when they get sick, protecting the 257,000 individuals who purchase
insurance in the individual market from dishonest insurance practices.
Insurance companies will not be able to exclude children from
coverage because of a pre-existing condition, giving parents across
Oregon peace of mind.
Insurance plans’ use of annual limits will be tightly regulated
to ensure access to needed care. This will protect the 1.7 million
residents of Oregon with health insurance from their employer, along
with anyone who signs up with a new insurance plan in Oregon.
Health insurers offering new plans will have to develop an appeals
process to make it easy for enrollees to dispute the denial of a medical
claim.
Patients’ choice of doctors will be protected by allowing plan
members in new plans to pick any participating primary care provider,
prohibiting insurers from requiring prior authorization before a woman
sees an ob-gyn, and ensuring access to emergency care.
Extending coverage to young adults.
Beginning on or after September 23, 2010, plans and issuers that offer
coverage to children on their parents’ policy must allow children to
remain on their parents’ policy until they turn 26, unless the adult
child has another offer of job-based coverage in some cases. This provision
will bring relief to roughly 15,000 individuals in Oregon who could
now have quality affordable coverage through their parents.4
Some employers and the vast majority of insurers have agreed to cover
adult children immediately.
Affordable insurance for uninsured with
pre-existing conditions. $66 million federal dollars are available
to Oregon starting July 1 to provide coverage for uninsured residents
with pre-existing medical conditions through a new transitional high-risk
pool program, funded entirely by the Federal government. The program
is a bridge to 2014 when Americans will have access to affordable coverage
options in the new health insurance exchanges and insurance companies
will be prohibited from denying coverage to Americans with pre-existing
conditions. If states choose not to run the program, the Federal government
will administer the program for those residents.
Strengthening community health centers.
Beginning October 1, 2010, increased funding for Community Health Centers
will help nearly double the number of patients seen by the centers over
the next five years. The funding could not only help the 179 Community
Health Centers in Oregon but also support the construction of new centers.
More doctors where people need them.
Beginning October 1, 2010, the Act will provide funding for the National
Health Service Corps ($1.5 billion over five years) for scholarships
and loan repayments for doctors, nurses and other health care providers
who work in areas with a shortage of health professionals. This will
help the 7% of Oregon’s population who live in an underserved area.
New Medicaid options for states. For
the first time, Oregon has the option of Federal Medicaid funding for
coverage for all low-income populations, irrespective of age, disability,
or family status.
Two Portland-based U.S.
health research centers will advise doctors, health plans
Published: Thursday, October 18, 2012, 5:55 AM Updated:
Thursday, October
18, 2012, 6:43 AM
Randy
L. Rasmussen / The OregonianOregon
Health & Science University
For the next five years, the U.S. government will rely on just
11 health research centers to evaluate which medical practices and
treatments work best. And two are based less than five miles apart,
in Portland.
In August, the Agency for Healthcare Research and Quality announced
the results of the latest round contracting for
evidence-based practice centers, essentially Uncle Sam's
scientific advisors when it comes to medical guidelines such as
for
mammograms and
prostate screening.
As in past years, one winner was based at Oregon Health & Science
University, amid the sweeping medical complex at Pill Hill. But
for the first time, a second contract went to a network headed by
Kaiser Permanente's
Center for Health Research, housed
in a squat white building across the Willamette River on North Interstate
Ave.
It's highly unusual for one city to be home to two centers, so you
can forgive a bit of swagger among those involved.
"Pretty good, huh?" says Dr.
Evelyn Whitlock, lead investigator
of Kaiser's center. "Makes you feel you're in the middle of something
important, maybe?"
Photo
courtesy of Kaiser PermanenteKaiser
Permanente Center for Health Research
And more research funds could flow into the city as a result.
The OHSU-based center brought in over $50 million over the last
12 years, says Dr.
Roger Chou of OHSU, "so that's
a significant amount of money."
Having research institutions plugged into the latest science means
best practices can trickle down sooner to Oregonians. In the past,
the Oregon center helped state officials evaluate drugs for the
Oregon Health Plan and develop guidelines on the treatment of lower
back pain, among other things. "I think all this stuff has a direct
impact on Oregonians," Chou says.
The centers are essentially research networks. Kaiser and OHSU had
collaborated in Oregon's only center, based at OHSU, ever since
the federal government set up the system of research partners in
1997. But last year, looking ahead at the next round of contracts
with AHRQ, they decided it was time for an amicable split.
OHSU was focused on basic science and biomedical research, while
Kaiser, a managed care system, was more interested in putting that
research to use on things like prevention and health economics.
The two had long used their differences as an advantage. But they
decided they had each grown enough to go it alone; it was time to
seek new partners.
When OHSU and Kaiser Permanente decided to part ways, they did so
knowing they were competing for the same round of contracts, and
the government was reducing the number of centers from the previous
14. So there was a possibility one would be awarded a contract and
not the other.
"There was anxiety," says Chou. "There was also anxiety knowing
that they were going to cut some (centers) and not everyone was
going to be renewed."
He and Whitlock say Kaiser and OHSU will continue to collaborate
on specific studies. In the world of research, it's not unusual
to change partners and find yourself competing with old allies for
the same research funds.
"You try to put your best foot forward and you have to just kind
of wait and hope," says Chou. "And luckily, both of us got the awards."
October 9th, 2012
- We recently published new content on the Oregon Healthcare News
web site and you can view it by visiting
www.orhcnews.com
The government hopes bundled payments—a lump sum paid, either
prospectively or retrospectively, for a specific set of medical
services defined by an episode of care—will increase operational
efficiencies and bring health care costs down through standard
care protocols, greater coordination, and shared accountability.
Barbara Letts and Paul Holden of Moss Adams LLP explain why bundled
payments may work well for some providers in "Bundled Payments:
A Meaningful and Middle-Ground Solution."
Our other content includes:
Thirteen Oregon domestic health plans
recently reported YTD second quarter 2012 financial reports
and most plans did worse than the same time period in 2011.
See how all the plans did by downloading our spreadsheet of
summarized financial results.
Check out the
Consultant Marketplace
to find companies that can help make your organization more
efficient and effective.
See our
Job Board
for the best healthcare opportunities in the U.S.
Visit our
Library
to read all articles published on our web site.
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as from other healthcare recruiters.
Oregon health insurance exchange unveils
new name, website
Salem — In one year from today, Oregonians can visit a new marketplace
to shop for health coverage. The name for that marketplace, Cover
Oregon, was announced today by the Oregon Health Insurance Exchange
Corporation. The corporation was formed by the Oregon Legislature
to implement a health insurance exchange in Oregon.
“Cover Oregon will provide a new and better way for Oregonians to
shop for health insurance,” said Howard “Rocky” King, Cover Oregon
executive director. “We are working hard to ensure we can offer meaningful
choice in health coverage options and an easy way to compare plans
and enroll through our website.”
Cover Oregon will open on Oct. 1, 2013. Through Cover Oregon, individuals,
families, and small employers will be able to compare health insurance
plans, access financial assistance to help pay for coverage, and enroll
in a plan that best meets their needs. Coverage for plans purchased
through Cover Oregon begins on Jan. 1, 2014.
In the meantime, Oregonians can learn more by visiting
www.CoverOregon.com. The newly launched
site features a
calculator where individuals can
find out if they might qualify for financial assistance through Cover
Oregon, schedules for Cover Oregon’s public meetings, and
stories about Oregonians’ experience
with health insurance.
“Our goal is to design Cover Oregon in a way that meets the unique
needs of Oregonians,” King said. “To that end, we encourage you to
visit our website to find out how Cover Oregon may be able to help
you and how you can get involved.”
Officials say Court won't derail Oregon
health law
SALEM, Ore. (AP) — No matter what the U.S. Supreme Court decides about
the future of the federal health care law, Gov. John Kitzhaber's
ambitious Medicaid overhaul will go forward, state officials said
Monday.
But if the court throws out the entire federal law — not just
the most controversial parts — officials said the ruling could jeopardize
a new health insurance exchange, a marketplace where individuals
and small business can shop for coverage starting in 2014.
The Supreme Court is expected to rule this month on the constitutionality
of the federal health law's individual mandate requiring everyone
to have health insurance or pay a fine.
State officials say the ruling will have only a minimal impact
on Kitzhaber's plan to create new coordinated care organizations
to manage the care of low-income patients on the Oregon Health Plan.
The first coordinated care organizations begin operating Aug. 1,
and Kitzhaber hopes they'll slow the growth of health care costs
by preventing avoidable hospital visits and reducing waste.
"Whatever happens, we're still moving full steam ahead, and we
feel like this is going to be essential regardless of the outcome"
at the Supreme Court, said Mike Bonetto, Kitzhaber's health policy
adviser.
Federal health officials have tentatively agreed to give Oregon
$1.9 billion over the next five years to help pay for the transition
to the new model of delivering health care. That money would be
unaffected by the Supreme Court's decision, officials insist, because
it is authorized under federal laws that predate President Barack
Obama's 2010 health law.
The Supreme Court's decision has little bearing on the work to
build a coordinated care organization, said Jeff Heatherington,
chief executive of Family Care, which has applied to cover Medicaid
patients in the Portland area.
"I really believe that we'll just continue to go forward on the
CCO development," Heatherington said.
The court's impact on a separate Kitzhaber health care initiative
is less clear. The Oregon Health Insurance Exchange will provide
a place for small employers, along with individuals who don't get
health coverage from a job, to compare plans and shop for coverage.
The federal law will give many lower-income Americans a subsidy
to help pay for coverage.
If the Supreme Court strikes down the entire federal law, the
decision would wipe out more than $60 million in grants that are
paying for the development of the exchange. The loss of federal
funding would make it very difficult to keep the exchange alive,
director Rocky King said.
However, if the court slices up the health care law, throwing
out the individual mandate and related provisions but leaving alone
the rest of the law, the exchange can still work, King said. But
prices would probably be higher, he said.
"As long as the subsidy money is there, I can still get enough
enrollments to make the exchange work very well," King said.
Insurance Exchange’s Small Employer
Program Takes Shape
Easing administrative burden for employers is a main focus
By:
Amanda Waldroupe
June 19, 2012—The program and technological infrastructure
allowing small employers to purchase health insurance through
Oregon’s exchange is beginning to take shape. Making the process
easy for employers and reducing administrative burden will be
key to its success, according to its staff.
Called
the Small Employer Health Options Program and colloquially referred
to as the “SHOP Exchange,” employers with 50 or fewer employees
will be able to compare and purchase health plans. The exchange,
which will act as a one-stop shopping place for individuals and
small businesses to purchase affordable health insurance in January
2014, could serve as many as 700,000 uninsured individuals and
small businesses—or more, if employers and individuals decide
they would rather purchase insurance through the exchange.
A survey released on June, commissioned by the Small Business
Majority and Kaiser Permanente, found enormous interest in Oregon’s
exchange among small businesses. According to the survey, the
number of small employers that would offer health insurance once
the
exchange gets underway would jump from 26 percent to 42 percent.
“The goal of the small employer is to create what would be the
most desirable marketplace in Oregon for small employers and their
agents to access health benefits that offer meaningful choice
to their employees,” Damien Brayko, the exchange’s staff person
working on the project,
said during a board meeting last week.
Much of the program’s design so far, Brayko told board members,
is based on market research and numerous conversations with small
business owners, insurance companies, and agents about how employers
go about purchasing insurance, what they value in health plans,
and what they want in terms of choice.
The SHOP Exchange, Brayko explained with no pun intended, will
be a lot like a shopping experience. After employers enter basic
information about their business, including income and number
of employees, they’ll be able to see, sort and compare the various
health plans.
“We don’t want to force them into any one path,” Brayko said.
Employers will choose the plans available to employees, and
will be the only ones that employees can choose from.
“It’s the employer’s choice for how much choice to allow their
employees,” Brayko said.
The Small Business Majority/Kaiser Permanente survey backs
up the emphasis Oregon’s exchange is placing on choice: 63 percent
of surveyed businesses want their employees to be able to choose
among multiple health plans.
Brayko and other exchange staff are working on ways to make
the process as streamlined and simple as possible to reduce the
administrative burden. That includes making it easy for employers
to renew their health plans, and simplifying invoicing and the
payment process.
The exchange staff is also taking a close look at ways to notify
business owners about their eligibility for tax credits, Brayko
said. The Small Business Majority/Kaiser Permanente survey also
found that the majority of small businesses, both in Oregon and
California, are not aware of the tax credits currently available
to them. In Oregon, 55 percent of businesses were either unaware
of the tax credit, or did not apply for it.
“We want to inform every small business,” Brayko said, in part
because it could help entice businesses to purchase insurance
through the exchange.
AP
Photo/Don RyanOregon Gov. John Kitzhaber
signed legislation creating the Oregon Health Insurance Exchange Corporation
on July 1, 2011.
About 30 percent of small business owners surveyed in Oregon said
they're likely to use the state health insurance exchange when coverage
begins in 2014. That's a higher proportion than the 26 percent offering
coverage now, the survey found, suggesting that the availability of
the exchange could help increase the number of small companies offering
health benefits.
Anticipated usage was 49 percent among business owners who are Democrats,
compared with 28 percent among those who are Republicans. The survey,
commissioned by
Kaiser Permanente and the
Small Business Majority, gathered
opinions from 200 small business owners in Oregon interviewed by telephone
in April and May.
Health insurance exchanges outlined in the federal Affordable Care
Act are regulated online marketplaces for state residents to comparison
shop for coverage.
Oregon's exchange will serve individuals
and businesses with 50 or fewer employees. In 2016, the exchange will
open to businesses with up to 100 employees.
Among small employers who plan to offer coverage in 2014, 63 percent
said they liked the idea of letting small companies set a defined
contribution for health insurance and having employees choosing from
among all the insurance carriers in the exchange. Oregon's insurance
exchange board
plans to offer that feature.
Many small businesses aren't taking advantage of
a new health insurance tax credit
because they don't know about it, the survey found. Under the Affordable
Care Act, companies with 25 or fewer employees and paying average
annual wages below $50,000, can qualify for tax credits worth up to
35 percent of the cost of health coverage. (The tax credit rises to
50 percent in 2014.)
Among Oregon small business owners likely eligible for the credit,
only 45 percent knew it existed. Kaiser Permanente found a comparable
lack of awareness in California.
About half of those potentially eligible for the tax credit in Oregon
don't offer health benefits. Among these owners, 61 percent said they
would be more likely to use the state health insurance exchange to
shop for health benefits if they knew their company qualified for
the credit.
Insurance Agents to Play Critical
Role in Oregon’s Insurance Exchange
At the same time, agents will need special training and
have to meet specific criteria to become eligible
By:
Amanda Waldroupe
April 16, 2012--The Oregon Health Insurance Exchange wants
to train and use insurance agents to help uninsured individuals
and small businesses purchase insurance starting in 2014. But
questions remain about the role of insurance agents and their
impact on consumers who may rely on them for advice.
During
the board’s meeting on Thursday, exchange staff member Kim Wirtz
explained that using insurance agents will ensure that the exchange
will be able to reach people throughout every part of Oregon,
and “assure connection with hard-to-reach populations in the most-cost-effective
manner.”
Insurance agents help individuals and businesses pick a health
insurance plan that best fits that person or business’ needs.
They typically work for insurance companies and are paid a commission,
by that insurance company, depending upon how many plans they
sell. There are approximately 13,000 licensed agents in the state.
Using the agents makes business sense for the exchange, which
can use agents to help people find out about the exchange once
it begins providing coverage in 2014, and buy insurance through
it. That is essential to the exchange’s long-term success: the
exchange is currently funded by a federal grant, but it will have
to generate enough revenue to be financially self-sustaining starting
in 2014.
According to the exchange’s business plan, a 2.52 percent administrative
fee will be the source of that revenue. It equates to about $16
charged to each individual participating in the exchange to remain
financially self-sustaining. The exchange must have between 100,000
and 125,000 people enrolled by the end of 2015.
The agents working for the exchange, Wirtz said, will be paid
by the exchange itself, which will take the commissions from insurance
companies and pay them directly to agents. She also said that
agents would be given a special training about the exchange and
the plans the exchange will offer. The exchange would also develop
criteria that would determine whether an agent would work for
the exchange.
Dr. George Brown, the CEO and president of Legacy Health System,
and Bruce Goldberg, director of the Oregon Health Authority, both
voiced concerns about how much the general public knows about
insurance and how insurance agents work.
“There is very little the public, excluding those within the
industry, understands or knows about how commissions are paid,
what they are, and how they’re paid,” Goldberg said, urging the
exchange develop a way for people to “Have the ability for anybody
to see what commission is paid for service they gave and how.”
Liz Baxter, who chairs the exchange board, questioned whether
people would pay the same premiums regardless of whether they
use an agent or not. That same concern was voiced last year by
Rep. Mitch Greenlick (D-Portland) during an interim legislative
session. “I have a problem with people being charged when they
don’t use an agent,” he said. ““They ought to know what they’re
paying for. It should not be hidden, or buried in the costs.”
That issue, as well as many other parts of the agent program,
is “something we do need to work on,” said Wirtz.
Baxter, the executive director of We Can Do Better, asked how
agents will be “removed,” or fired, if they do not perform adequately.
She also wondered how the exchange could find particular information
about an agent, such as if they speak a second language and could
do outreach to minority communities.
Agents, similar to a typical subcontractor, will sign a contract
with the exchange that will detail their working relationship
and responsibilities with the exchange, Wirtz said, adding that
the exchange intends to build “a robust profile” about each agent.
Health Insurance Exchange Seeks
Public Input on Specifics
Exchange staff expect that getting specific feedback about
particular areas of the exchange will help them craft the
exchange
By:
Amanda Waldroupe
April 2, 2012 -- People have until April 13 to submit responses
to Oregon’s health insurance exchange about the top three things
they consider most important when choosing a health plan. The
exchange launched this survey to get constructive feedback from
the public as it begins developing the website that people will
use to purchase coverage in 2014.
The exchange staff hopes the answers will guide them to understand
how people search for insurance plans, distinguish plans from
one another, and their priorities in choosing a plan. Thus far,
65 people have submitted comments.
Lisa Morawski, the exchange’s spokesperson, said the exchange
is intentionally asking specific questions to help “guide” the
exchange’s development throughout 2012. “We felt like there are
certain areas that we want public input on,” she said.
Such a public comment process is expected to be more helpful
in getting targeted responses, she said. “We thought we’d get
more specific comments if we were asking a specific question.”
Specific questions will be asked “on a regular basis” that
reflect what staff members are working on as they prepare to get
the exchange ready to offer health insurance to individuals and
small employers by January 2014.
People can still give broad comments about the exchange on
its website, and during board and community advisory committee
meetings. People can also
sign up to be on the email list
and receive updated information including future meetings.
Having a public comment process with specific questions is
another way to reach the general public, said Liz Baxter, who
chair’s the exchange’s board of directors and is the executive
director of the advocacy organization We Can Do Better.
“So far, [the people giving comment] have really been the folks
who have been coming to the board meetings,” Baxter said. “We’re
trying to find ways to see how we can open it up. It’s not in
place of other strategies.”
If people want a say in what the exchange looks like, the time
is now, even though they may not see the result of those decisions
until the exchange is launched in 2014. “It will be hard to change
some of those decisions in the future,” Baxter said.
Consumer advocates praised the decision by the exchange board
to seek public comment on particular topic areas. “It helps focus
the conversation,” said Jim Houser, the owner of Hawthorne Auto
Clinic and a member of its community advisory committee.
John Mullin, the Oregon Law Center’s lobbyist, said the exchange’s
public comment process is “more open-ended and inclusive” than
typical public comment processes, which simply seek general feedback.
“It is important to engage the middle class in a way that they
will feel welcomed to respond,” he said, particularly because
families making up to 400 percent of the federal poverty level
(for a family of four, approximately $92,000) will be eligible
for the tax credits that will be offered to people who buy insurance
through the exchange.
Janice Thompson, executive director of the government watchdog
agency Common Cause Oregon, also thinks asking such questions
during this stage of the game is appropriate. “Given their stage
of development, the kind of targeted public input questions they
are asking does not seem inappropriate,” she said. “If there are
specific questions that are helpful during program development
then you’re not going to get those answers through an open-ended
comment period.”
But she also said it’s important to have a more general, open-ended
public comment period in the future. “Including an open ended
comment period on a draft plan provides opportunities to get input
on questions that weren’t asked during the initial program development
process,” she said.
Oregon is one of
many states moving forward with the federally
mandated
Health Insurance Exchange, an online
site for comparing health insurance plans — like how travelocity and orbitz
sites compare air fares and travel packages. Oregon was working on an
exchange even before Congress passed the Affordable Care Act. We got an
update earlier this year from the exchange's
executive director, Rocky King, about how close the site was to launching.
Now that the constitutionality of the Affordable Care Act is being considered
by the U.S. Supreme Court, we asked King back so we could ask: what if
. . . ?
What questions do you have about the Oregon Health Insurance Exchange?
Governor John Kitzhaber signed Oregon's new Health Insurance Exchange
into law today. Kristian Foden-Vencil was at the signing in Portland
he’s with me now.
Good afternoon Kristian.
Kristian: Hi.
Beth: The Health Insurance Exchange is one of the Governor's key health
policies -- both for the 2012 legislature and for his third term in
office. Can you remind us what the 'Health Insurance Exchange' is?
Kristian: Yes. Essentially, President Obama's health care reform asks
states to set up their own health insurance exchanges.
Think of them like a 'Travelocity' or 'Expedia' website. But instead
of selling vacations, they allow individuals and small businesses
to comparison shop for health insurance.
The hope is the exchanges will give small customers the kind of
buying power bigger businesses enjoy.
Just to be clear. If you have a job with health insurance, you're
not going to need the exchange. But if you're self employed and you
want to get coverage, you'll go to the website, or call them up or
drop in.
It's a little like a whole new government agency. About 25 people
have been hired so far, but to bring in the 300,000 Oregonians who're
likely to sign-up in the first year, there could be 150 employees
at some stage.
That said, the exchange is not expected to cost the state anything.
It'll be paid for by adding a surcharge to the insurance plans that
are purchased on the exchange.
Beth: What does the bill Kitzhaber signed Thursday actually do?
Kristian: Well, it's really just another step in the road. The
bill that actually set up Oregon's exchange was passed in 2011. A
board of directors was chosen and they've wrestling with things like
what benefits each insurance company has to offer -- if they want
to be on the exchange.
Now, the way to think of it is that the board of directors drew
up a business plan. The legislature and now the Governor have given
that plan the green light.
So, they'll now have to start setting everything up, like buying
all the computers they need.
Beth: What did the governor say as he signed it into law?
Kristian: Well he called it a great day for Oregon. He said the
exchange is going to provide significant benefits to small businesses
and individuals. It's going to allow people to compare the quality
and cost of insurance plans. And, he says it's going to be a great
resource for Oregonians:
John Kitzhaber: "It is going to be a central contributor to the
success of our larger health care reform effort, by setting the setting
the standards for plans that they reduce cost, that they maintain
quality and that everyone has access to the kind of coverage that
they need and deserve in this state."
Kristian: As you know, changing health care is very contentious.
About 20 states, primarily those that lean conservative, are not
implementing their own exchanges.
Instead, they're appealing the Affordable Care Act — the federal
overhaul -- up to the U.S. Supreme Court. They particularly don't
like the requirement that everybody buy health insurance.
That issue is scheduled for oral arguments later this month.
Meanwhile, Oregon and several other states, are moving forward.
The White House has distributed about $700 million to set up the
exchanges. Oregon has received about a tenth of that.
But it's no good going on line to look for the exchange yet. They're
not scheduled to start until 2014.
Beth: Thank you Kristian. And by the way, we're going to hear more
from you in about half an hour. NPR is running a feature on Oregonians
and the medical options they choose at the end of their lives?
Kristian: That's right. Oregon's so-called POLST form allows sick
and elderly people to say whether they want the full power of medicine
brought to bear during their final days, or whether they'd be happier
to stay at home and receive comfort measures only.
14 states have already adopted Oregon's POLST form and another
20 are looking at it.
If there's one area of life that will nevercease
to be a topic of conversation, it's got to be your health. Last week week
we spoke with the head of the Oregon Health Authority about
what they mean when they talk about "transforming"
health care.
Now we're moving on to the latest on health insurance. The federal
governmnent is
providing cash for states to set up
health insurance exchanges. Oregon was
moving on this idea even before it was mandated by federal law. The idea
is simple: you should be able to go online, key in some information and
come away with a substantive comparison of what kind of health insurance
coverage you could buy for what money.
In order for it to go forward, Oregon lawmakers must approve the business
plan that the Oregon Health Insurance Exchange (ORHIX) is submitting.
The 2012 short session of the legislature begins Wednesday. If it all
goes as planned, ORHIX executive director Rocky King says they could have
a functioning system to test by about this time next year, with the grand
opening in October 2013.
Have you had difficulty in the past deciding on health insurance? If
you're currently in the market to buy health insurance, what do you hope
the new system will provide?
GUEST:
Rocky King: Executive director
of the Oregon Health Insurance Exchange
January 12th, 2012 - http://www.thelundreport.org/resource/consumer_groups_begin_showing_support_for_insurance_exchange
Consumer Groups Begin Showing
Support for Insurance Exchange
Last session, when Senate Bill 99 passed the Legislature,
consumer groups expressed disappointment because the exchange
wouldn’t have the ability to negotiate insurance rates
By:
Amanda Waldroupe
January 12, 2012 — Leaders of some of Oregon’s most progressive
consumer groups signed onto a letter this week advocating for
six priorities the staff and board of directors of Oregon's health
insurance exchange should have this year as they work to create
the exchange.
They include leveraging the buying power of individuals and
small businesses to improve the quality of insurance plans and
lower costs; accountability and transparency; offering more than
one insurance plan; consumer-friendly enrollment processes, and
the ability for as many Oregonians as possible to use the exchange.
Rick Bennett, the lobbyist for AARP Oregon, voiced his organization’s
strong support when the exchange board met yesterday to discuss
the business plan that goes before the Legislature next month.
“We believe that this exchange [has] a tremendous opportunity
to provide benefit to our citizens,” Bennett said. “We want
to be as supportive as we can of your work.”
For organizations such as AARP Oregon, this represents an
about face from what occurred last year when Senate Bill 99,
which created the exchange, worked its way through the Legislature.
The other organizations include the Oregon Center for Public
Policy, Oregon Health Action Campaign, Children First for Oregon,
the Oregon Primary Care Association and OSPIRG.
At the time, those organizations refused to support that
bill because there were no assurances the exchange would be
able to negotiate rates with insurance companies.
“We wanted to see a very strong piece of legislation passed.
We were disappointed, and in the end, we could not actually
come to support the bill,” Bennett said. “That’s in the past.”
The exchange will become a one-stop shopping place for uninsured
individuals and small businesses to learn about, compare and
purchase affordable healthcare coverage. It will become operational
in January 2014.
“If the exchange is done right, it can help consumers find
affordable coverage, and better coverage,” said Laura Etherton,
OSPIRG’s healthcare advocate. “We have a lot of hope. It could
be top notch.”
Etherton, and other consumer groups, view the exchange’s
work as critical this year. Aside from finishing the business
plan, its board and staff are laying out the groundwork for
developing the web infrastructure needed for consumers to easily
navigate and compare plans, as well as other components.
With healthcare costs and insurance rates quickly rising,
Etherton said the exchange will play a key role in determining
whether costs will continue to rise to the point of collapsing
with no one able to afford coverage.
Because of rising rates and premiums, “Individuals and small
businesses are hanging on by their fingernails,” Etherton said.
If the exchange can permanently lower rates and, thereby,
healthcare costs, it could be a game changer, she added. The
worse case scenario is that the exchange turns into a “fancy
website making it easier to sell insurance.”
Now Etherton and other consumer advocates seem more convinced
that’s unlikely to happen. “It’s clear the exchange is heading
in a good direction,” she said.
Press Releases:
October 1st, 2012 News Release "Source
from CoverOregon.com"
Oregon health insurance exchange unveils new
name, website
Salem — In one year from today, Oregonians can visit a new marketplace
to shop for health coverage. The name for that marketplace, Cover Oregon,
was announced today by the Oregon Health Insurance Exchange Corporation.
The corporation was formed by the Oregon Legislature to implement a health
insurance exchange in Oregon.
“Cover Oregon will provide a new and better way for Oregonians to shop
for health insurance,” said Howard “Rocky” King, Cover Oregon executive
director. “We are working hard to ensure we can offer meaningful choice
in health coverage options and an easy way to compare plans and enroll
through our website.”
Cover Oregon will open on Oct. 1, 2013. Through Cover Oregon, individuals,
families, and small employers will be able to compare health insurance
plans, access financial assistance to help pay for coverage, and enroll
in a plan that best meets their needs. Coverage for plans purchased through
Cover Oregon begins on Jan. 1, 2014.
In the meantime, Oregonians can learn more by visiting
www.CoverOregon.com. The newly launched
site features a
calculator where individuals can find
out if they might qualify for financial assistance through Cover Oregon,
schedules for Cover Oregon’s public meetings, and
stories about Oregonians’ experience
with health insurance.
“Our goal is to design Cover Oregon in a way that meets the unique needs
of Oregonians,” King said. “To that end, we encourage you to visit our
website to find out how Cover Oregon may be able to help you and how you
can get involved.”
June 28th, 2012 News Release "Source CoverOregon.com"
Health Insurance Exchange prepares to serve Oregonians
next year
Salem – Starting in October 2013, Oregonians will be able to shop for
health insurance in a new way. The Oregon Health Insurance Exchange will
be a central marketplace where individual consumers and small employers
can easily compare plans, enroll, and receive help paying for coverage.
Today, the U.S. Supreme Court ruled to uphold the Affordable Care Act,
which provides the start-up funding necessary for the Exchange to be ready
for open enrollment and provides Oregonians with tax credits and other
financial assistance to help pay for plans through the Exchange.
“The Exchange will help make insurance more accessible for Oregonians,
including the more than 600,000 who are uninsured,” said Howard “Rocky”
King, executive director of the Oregon Health Insurance Exchange. “We
are committed to continue working with consumers, small employers, insurance
carriers, and others to ensure we develop an Exchange that meet’s Oregon’s
unique needs.”
The Exchange has recently added a calculator on its website where Oregonians
can estimate how much they may be able to save through the tax credits
and other assistance that will be available through the Exchange in 2014.
The calculator is available at
http://www.orhix.org/calculator.php.
In addition to connecting Oregonians with financial assistance, the
Exchange will provide:
Ability to compare plans “apples to
apples” and sort plans by criteria that is important to individual
consumers.
Trusted information and assistance.
The Exchange will provide information on how to best use health benefits
to improve health as well as a network of specially trained customer
service staff, insurance agents, and community partners that will help
guide Oregonians in all parts of the state.
Seamless eligibility and enrollment
process. With a single application, Oregonians can find and
enroll in the health plan that best meets their needs.
Innovative plan options and simplified
plan administration for small employers. Small employers with
50 or fewer employees can allow their employees to choose an insurance
company and plan through a defined contribution model.
For more information about the Exchange, including public meeting schedules
and contact information, visit
http://www.coveroregon.com.
May 16th, 2012 News Release "Source from HHS.gov website
FOR IMMEDIATE RELEASE
May 16, 2012
Contact: HHs Press Office
(202) 690-6343
More states work to implement health care law
Illinois, Nevada, Oregon, South Dakota,
Tennessee and Washington receive grants to establish Affordable Insurance
Exchanges
Health and Human Services (HHS) Secretary Kathleen Sebelius announced
today that Illinois, Nevada, Oregon, South Dakota, Tennessee and Washington
will receive more than $181 million in grants to help implement the new
health care law. The grants will help states establish Affordable Insurance
Exchanges. Starting in 2014, Affordable Insurance Exchanges will help
consumers and small businesses in every state to choose a private health
insurance plan. These comprehensive health plans will ensure consumers
have the same kinds of insurance choices as members of Congress. Including
today’s awards, 34 states and the District of Columbia have received Establishment
grants to fund their progress toward building Exchanges.
HHS also issued two guidance documents today to help states build Affordable
Insurance Exchanges.
“States across the country are implementing the new health care law,”
said Secretary Sebelius. “In 2014, consumers in every state will have
access to a new marketplace where they will be able to easily purchase
affordable insurance.”
Today, the Department released:
New resources for states:
The six new Exchange Establishment grant awards to Illinois, Nevada,
Oregon, South Dakota, Tennessee and Washington total more than $181
million. This round of awards brings the total of Exchange-related grants
provided to states over the last two years to more than $1 billion.
Illinois, Nevada, Oregon, South Dakota and Tennessee today have been
awarded Level One Exchange Establishment grants, which provide one year
of funding to states that have begun the process of building their Exchange.
Washington is the second state to be awarded a Level Two Establishment
grant, which is provided to states that are further along in building
their Exchange and offers funding over multiple years.
In 2010, 49 states and the District of Columbia
received Exchange Planning grants totaling more than $54 million; in
2011, seven states received more than $249 million in Early Innovator
grants; and to date, 34 states and the District of Columbia have received
more than $856 million in Establishment grants.
States can apply for Exchange grants through
the end of 2014, and these funds are available for states to use beyond
2014 as they continue to establish Exchange functionality. This ensures
that states have the support and time necessary to build the best Exchange
for their residents.
New guidance for states:
Today’s guidance includes an Exchange Blueprint states may use to demonstrate
how their Affordable Insurance Exchange will work to offer a wide range
of competitively priced private health insurance options. The Blueprint
also sets forth the application process for states seeking to enter
into a Partnership Exchange. If a state chooses to operate its own Exchange
or a Partnership Exchange, HHS will review and potentially approve or
conditionally approve the Exchange no later than Jan. 1, 2013, so it
can begin offering coverage on Jan. 1, 2014. To see the state Exchange
Blueprint, visit
http://cciio.cms.gov/resources/other/index.html#hie
Exchanges in every state:
Consumers in every state will have access to coverage through an Affordable
Insurance Exchange on Jan. 1, 2014. If a state decides not to operate
an Exchange for its residents, HHS will operate a Federally-facilitated
Exchange (FFE). This guidance describes how HHS will consult with a
variety of stakeholders to implement an FFE, where necessary, how states
can partner with HHS to implement selected functions in an FFE, and
key policies organized by Exchange function. To see the guidance on
the FFEs, visit
http://cciio.cms.gov/resources/regulations/index.html#hie
The Department will conduct implementation forums in the coming months
to work with states and stakeholders on their questions and the work to
be done in building Exchanges. The Department will also engage in consultation
with Tribes, Tribal Governments, and Tribal Organizations on how Exchanges
can serve their populations.
March 9th, 2012 News release "Source Oregon.gov"
September 21st, 2012 News release "Source Oregon.gov"
Governor Kitzhaber applauds Senate confirmation
of Oregon Health Insurance Exchange Board
Liz Baxter to serve as its Chair
(Salem, OR.) - Governor Kitzhaber today applauded the Senate
for confirming his nominees to the Oregon Health Insurance Exchange Board.
"I am pleased the Senate confirmed this talented and diverse group
of Oregonians whose range of experience will serve the state well in our
efforts to improve the delivery of health care by ensuring that individuals
and small businesses have access to affordable, quality health insurance
in the private market," said Governor Kitzhaber.
The Board will oversee the development of Oregon's Health Insurance Exchange,
a central marketplace where individual Oregonians and small employers
can compare the quality and value of insurance plans on an apples-to-apples
basis and easily enroll in coverage that is affordable. The Board of Directors
will submit a formal business plan for the Exchange no later than February
1, 2012, for approval by the Legislature.
Health Insurance Exchange Board Members:
Chair: Liz Baxter, Executive Director of We Can Do Better, a
non-profit organization focused on improving health care and health outcomes
for Oregonians.
Vice Chair: Teri Andrews, of Corvallis, Owner of CG Industries,
a small business in Albany
Bruce Goldberg, M.D., Director of Oregon Health Authority
Teresa Miller, Administrator of the Insurance Division, Oregon
DCBS
Ken Allen, Executive Director of Oregon AFSCME Council 75
Aelea Christofferson, Owner of ATL Communications, a small business
in Bend
Jose Gonzales, Principal Broker of Tu Casa Real Estate Corporation,
a small business in Salem
Gretchen Peterson, Vice President of Human Resources of Hanna
Anderson in Portland
Dr. George Brown, Chief Executive Officer of Legacy Health System
2012 Health Benefits Solution, Inc -
Health Benefits Solution, Inc - Doug Ellsworth