N.J. officially hands running of health exchange over to feds
February 18, 2013By Carolyn Beeler and Taunya English
N.J. Gov. Chris Christie has officially asked the federal government to run the state's online insurance marketplace.
Christie had vetoed legislation that would allow the state to create its own health insurance exchange, so the final decision Friday was no surprise.
Pennsylvania had previously ceded the job to the feds, while Delaware is fashioning and running its exchange in partnership with the Obama administration.
The goal of the exchanges is to create an understandable online marketplace where the uninsured and underinsured can find adequate options.
Christie, a Republican, wrote in a letter to Kathleen Sebelius, U.S. secretary of health and human services, that the Garden State is committed to complying with the federal health law, "but only in a manner that is the most efficient and effective for the residents of New Jersey."
Diana Autin, co-director of the Statewide Parent Advocacy network, said the state has lost the opportunity to tailor its exchange to the needs of New Jersey residents.
"When states are running their own exchange, they will have more say in what the exchange looks like, how easy it is to use it, who gets to go on the exchange as an insurer, etc.," Autin said. "If the federal government is running the exchange, those decisions are left to the federal government."
A coalition that includes Autin's group has already met with federal representatives to relay stakeholder input into what a New Jersey exchange should look like.
New Jersey Policy Perspective's Ray Castro said now that Friday's deadline for proposing a state-based exchange or asking the feds to step in has passed, the hard work of getting people signed up must begin.
"It's going to be a challenge," Castro said. "We have over a million people who are uninsured in the state, so it's going to be difficult to really reach all of them."
Individuals and families with incomes up to 400 percent of the federal poverty level will be eligible for help paying their premiums.
People at income level will be able to compare prices for standardized insurance policies online.
The insurance exchange will also serve as a portal to Medicaid and the state children's health insurance program for those who qualify. Insurance companies will be required to submit insurance plans to the federal government in April for approval.
Members of the Obama administration assured dubious United States senators at a hearing last week that the exchanges would, in fact, be ready to start enrolling customers by Oct. 1 as planned.
The federal government will be wholly running 25 exchanges, New Jersey and Pennsylvania included. Seven states, including Delaware, plan to work with the federal government in partnership. Details on the status of all 50 states' health exchanges can be found on this interactive map published by the Kaiser Family Foundation.
In Delaware, state officials say they will leave some of the heavy lifting to Sibelius and her staff, but will vet any plans offered through the exchange.
Regulator Linda Nemes said Delaware will only accept companies that are solvent. And, state officials will make sure each health plan offers the standard benefits outlined by the federal government under the Affordable Care Act.
Delaware has also added its own requirements for something called "network adequacy."
"That would prevent a carrier from having a network where all the physicians are 75, 100 miles away," Nemes said. "We are insuring that the travel time will be kept to a minimum."
Consumers can also expect some in-state help when they have a complaint about an insurance company. But, Nemes said, initial calls will likely first be logged with federal call center.
"Then that would be trickled down to the Department of Insurance," Nemes said. "We feel we know the needs of the Delaware residents. Also it's a regulatory issue, it helps us know what the carriers are doing and what the marketplace is doing.
Delaware is leaving much of the complicated - and expensive - information-technology planning to federal officials. Experts say the government has to build a secure data hub that all states can access.
That central system will need to perform long list of tasks such as: verifying whether a person is a citizen or determining if a buyer qualifies for a subsidy under the Affordable Care Act.