LITTLE ROCK — Arkansas Advocates for Children and Family issued a report Tuesday that urges the state Insurance Department to keep consumer interests front and center as it implements a federally run health-insurance exchange for Arkansas.
The federal health-care law, the Patient Protection and Affordable Care Act, requires that by Jan. 1, 2014, every state set up an online exchange where people can shop for private insurance plans.
The fate of that law is unclear — the U.S. Supreme Court is expected to rule soon whether to strike down all of it, part of it, or to uphold it.
The state is going ahead with planning. Last month, the Arkansas Legislative Council gave the Insurance Department the authority to spend a $7.7 million grant to plan its portion of the exchange.
The exchange will be run by the federal government, but the state can determine which health insurance plans will qualify for the exchange and can develop programs to guide consumers through the process.
The exchange is an opportunity to extend insurance coverage to thousands of people who have not previously had it, said Anna Strong, director of health-care policy for Arkansas Advocates for Children and Families. The state should design it so that consumers can make good choices, she said.
“We want to make sure that as we develop something that meets those consumers’ needs, that they are part of that conversation, and they are part of the decisions that are made,” she said.
“We want to make sure that with the federally facilitated exchange, that Arkansas has a say in what goes on in this.”
The Insurance Department projects that 211,000 Arkansans will enroll in plans through the exchange in 2014, with 170,000 more participating in a newly expanded Medicaid program, according to the report. The department estimates that there are currently 572,000 people in Arkansas without health insurance.
In the report, Strong and co-author April Moore urge the department to ensure that the majority of the exchange’s advisory body be composed of exchange users, small businesses and organizations that serve the interests of low-income and minority-group consumers.
The report also recommends a limited role on the advisory board for doctors, hospitals, insurers and brokers.
“Some stakeholders stand to benefit financially from the exchange, posing a conflict of interest and jeopardizing the effectiveness of the exchange advisory group in protecting consumer interests,” they wrote.
Jay Bradford, the state insurance commissioner, noted that federal rules dictate that industry not dominate the advisory boards — the rules require that the majority of the board membership “is not made up of a majority of voting representatives with a conflict of interest.”
The report’s recommendations are appropriate, Bradford said.
“Those issues will be addressed through various committees,” he said.
A plan-management committee is evaluating what benefits will be required for plans that will be sold on the exchange. Former Supreme Court Justice Annabelle Imber Tuck is a co-chairman of that group, which includes representatives of insurance companies, medical providers and business groups.
“Private plans have been developed with working adults in mind, so they may not meet the unique needs of children,” the report states. The report recommends that the plans be affordable and that plans just for children should be made available to Medicare-eligible grandparents who have custody of grandchildren.
Another committee is working on the “navigator” program that will help guide consumers through the process of using the exchange to select an insurance plan. That committee includes Arkansas Advocates, Arkansas Children’s Hospital, AARP and several others. Strong is a co-chairman of that committee, along with representatives from the Fay W. Boozman College of Public Health and Regions Insurance.
Both committees report to a steering committee that will advise the commissioner.
The Arkansas Advocates report recommends that the navigators be able to reach underserved populations, including those with “unique cultural, language, or literacy needs.”
The report also recommends that the exchange be integrated with Medicaid so that parents with children who qualify for Medicaid or ARKids First can use it easily.
State Rep. Bruce Westerman, R-Hot Springs, emphasized that Republican lawmakers would not have allowed the state to start spending the $7.7 million federal grant. The state should not assume the exchange is a done deal and the question of whether to spend time and money on planning will be more clear in the coming weeks.
“The report reads as if the Supreme Court decision’s not even at play,” he said. “I think that’s still a huge issue.”
Arkansas, Pages 9 on 06/13/2012