{"id":3711,"date":"2012-01-13T07:30:58","date_gmt":"2012-01-13T14:30:58","guid":{"rendered":"http:\/\/stateimpact.npr.org\/idaho\/?p=3711"},"modified":"2013-05-13T15:39:42","modified_gmt":"2013-05-13T21:39:42","slug":"state-health-exchange-advocates-say-jobs-hang-in-the-balance","status":"publish","type":"post","link":"https:\/\/stateimpact.npr.org\/idaho\/2012\/01\/13\/state-health-exchange-advocates-say-jobs-hang-in-the-balance\/","title":{"rendered":"State Health Exchange Advocates Say Jobs Hang In The Balance"},"content":{"rendered":"
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Molly Messick \/ StateImpact Idaho<\/p>

Rep. John Rusche (D-Lewiston) wants to see Idaho establish its own health insurance exchange.<\/p><\/div>\n

Under the federal health care law, states are charged with deciding whether to establish their own health insurance exchanges.\u00a0 Those exchanges are often described as transparent marketplaces where people will be able to purchase health insurance.\u00a0 States including Utah and Nevada have already established their own exchanges.\u00a0 In Idaho, lawmakers will come to a verdict this session.\u00a0 As they prepare for the debate, advocates of a state-based exchange say local jobs are at stake.<\/p>\n

<\/param><\/param><\/embed><\/object>State Health Exchange Advocates Say Jobs Hang In The Balance<\/a>
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In the Idaho Legislature, there\u2019s no shortage of fighting words about President Obama\u2019s health care law.\u00a0 Rep. Vito Barbieri (R-Dalton Gardens) had this to say at a legislative preview event last week.\u00a0 “This healthcare mandate is not good for the nation.\u00a0 It\u2019s socialism.\u00a0 A socialist America is a broken America.”<\/p>\n

<\/em>On principle, Barbieri would have state lawmakers refuse the more than $20 million dollars in federal grant funding set aside for the creation of a state-based health insurance exchange.\u00a0 That\u2019s one view.\u00a0 At the other end of the spectrum are those who believe that establishing an Idaho-based exchange is the only sensible route.\u00a0 House Minority Leader John Rusche (D-Lewiston) falls into that camp.\u00a0 For Rushe, a medical doctor who spent half his career as a health insurance executive, the real story of what\u2019s at risk can be found amid the tidy cubicles of a Blue Cross of Idaho call center near Boise.<\/p>\n

It’s a place that brings together two things that Rusche thinks could be endangered, if Idaho chooses not to build its own exchange, and instead defaults to a federal model.\u00a0 Those two things are local jobs, and local customer service.<\/p>\n

In Idaho, the individual and small group health insurance market is mostly served by two, Idaho-based, not-for-profit insurers — Blue Cross of Idaho and Regence BlueShield of Idaho — as well as regional insurer PacificSource. \u00a0Together, those companies employ just under 2,000 people in the state.\u00a0 When Idahoans insured by one of those companies have questions about their benefits, their calls are answered by someone in Idaho.\u00a0 Rusche fears that under a national exchange, that system that employs local people and provides local accountability might not hold up.\u00a0 To understand why, think about what Rusche believes a national health insurance exchange could look like.\u00a0 “What I expect will be happening is there will be five, six, seven, eight carriers in the national exchange,” he said.\u00a0 “I think they will have kind of a restricted exchange, and they may actually make them bid for their position in the exchange.\u00a0 Our local companies, our domestic companies just can\u2019t compete in that world.”<\/p>\n

In other words, Rusche believes a national exchange will favor larger insurers.\u00a0 What\u2019s the result for Idaho\u2019s existing companies? “I think it will be significant, significant reductions in the size of the companies,” Rusche said.\u00a0 “I think there will be job loss.”<\/p>\n

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Molly Messick \/ StateImpact Idaho<\/p>

Shad Priest is a former deputy director of the Idaho Department of Insurance.<\/p><\/div>\n

It’s a worry that isn’t hard to find, among those who want the state to create its own exchange.\u00a0 Department of Insurance Director Bill Deal has expressed it.\u00a0\u00a0 And Regence BlueShield\u2019s Shad Priest also doesn\u2019t think Idaho\u2019s insurers can expect to compete in a national exchange.\u00a0 “The federal government is operating under the same time constraints that Idaho is,” he said.\u00a0 “They have to have this up and running by 2014.\u00a0 That\u2019s a really short time to put something this complex into place.”<\/p>\n

Given that, Priest believes he knows what a national exchange will look like.\u00a0 “In my view, they\u2019re going to have to come up with a one-size-fits-all approach, and I don\u2019t think an exchange that\u2019s designed to work in Florida, that\u2019s designed to work in Louisiana, is necessarily going to be the best solution for the people of Idaho,” he said.
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Alan Weil, Executive Director of the nonpartisan National Academy for State Health Policy, says predictions like this are hard to check.\u00a0 The federal government has said little about how it will structure a national exchange.\u00a0 “Really, all we know is that under the law, the federal government will establish and operate an exchange in any state that chooses not to build one,” Weil said.<\/p>\n

That means we don\u2019t know key things about the national exchange, like what its approach will be to selecting the plans that can participate.\u00a0 Still, Weil says he doesn\u2019t believe a national exchange will exclude local insurers.\u00a0 After all, health insurance exchanges are supposed to be marketplaces.\u00a0 Weil says it wouldn’t make sense for those creating the national exchange to build the kind of one-size-fits-all model that Rusche and Priest fear.\u00a0\u00a0 “They\u2019re not going to pick a plan that doesn\u2019t do business in the state and hand them everyone\u2019s business in the state,” Weil said. “That\u2019s not what the exchange does.\u00a0 What I do think is that they\u2019re likely to establish conditions of participation that are based on national norms and maybe not Idaho norms.”<\/p>\n

And that, Weil says, could make the competition tougher for Idaho\u2019s existing insurers.\u00a0 Given these divergent views about the composition and effects of a national exchange, it’s a small wonder that Idaho insurers want the relative predictability of a state exchange.\u00a0 Steve Tobiason, General Counsel of Blue Cross of Idaho, says controlling the exchange locally is the best way to minimize all of the uncertainties.\u00a0 “If you had a state exchange, we know we would participate,” he said.\u00a0 “If you had a federal exchange, we may not be able to participate.\u00a0 We don\u2019t know.\u00a0 And if we want to eliminate that risk, it\u2019s a state exchange.\u00a0 In one sense, it\u2019s that simple.”<\/p>\n

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Molly Messick \/ StateImpact Idaho<\/p>

Blue Cross of Idaho General Counsel Steve Tobiason says a state insurance exchange is the least risky option for Idaho insurers and residents.<\/p><\/div>\n

But how about the best interests of Idaho residents?\u00a0 Do they dovetail with the best interests of Idaho insurers?\u00a0 Tobiason says yes.\u00a0 “Idaho typically wants to solve their own problems and not have somebody else solve it for them.\u00a0 If the various players \u2013 legislature, industry, business, consumers \u2013 can sit down and say, ‘This is how we think it ought to look,’ then you\u2019ve got something that\u2019s going to work for this marketplace, and there\u2019s no guarantee that that\u2019s how it will look under a federal exchange.”<\/p>\n

A local exchange, he says, will be more accountable to local people.\u00a0 Whether the legislature at large will be persuaded by this argument \u2013 that story will be told by the session ahead.<\/p>\n","protected":false},"excerpt":{"rendered":"

Under the federal health care law, states are charged with deciding whether to establish their own health insurance exchanges.\u00a0 Those exchanges are often described as transparent marketplaces where people will be able to purchase health insurance.\u00a0 States including Utah and Nevada have already established their own exchanges.\u00a0 In Idaho, lawmakers will come to a verdict […]<\/p>\n","protected":false},"author":46,"featured_media":3727,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[15],"tags":[235,119],"acf":[],"_links":{"self":[{"href":"https:\/\/stateimpact.npr.org\/idaho\/wp-json\/wp\/v2\/posts\/3711"}],"collection":[{"href":"https:\/\/stateimpact.npr.org\/idaho\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stateimpact.npr.org\/idaho\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stateimpact.npr.org\/idaho\/wp-json\/wp\/v2\/users\/46"}],"replies":[{"embeddable":true,"href":"https:\/\/stateimpact.npr.org\/idaho\/wp-json\/wp\/v2\/comments?post=3711"}],"version-history":[{"count":1,"href":"https:\/\/stateimpact.npr.org\/idaho\/wp-json\/wp\/v2\/posts\/3711\/revisions"}],"predecessor-version":[{"id":3738,"href":"https:\/\/stateimpact.npr.org\/idaho\/wp-json\/wp\/v2\/posts\/3711\/revisions\/3738"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/stateimpact.npr.org\/idaho\/wp-json\/wp\/v2\/media\/3727"}],"wp:attachment":[{"href":"https:\/\/stateimpact.npr.org\/idaho\/wp-json\/wp\/v2\/media?parent=3711"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stateimpact.npr.org\/idaho\/wp-json\/wp\/v2\/categories?post=3711"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stateimpact.npr.org\/idaho\/wp-json\/wp\/v2\/tags?post=3711"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}