Following word Thursday that Minnesota state officials have received another $42.5 million to help plan the state health insurance exchange, Republican state Rep. Steve Gottwalt, chair of the House Health and Human Services Reform Committee, has lots of questions.
In a letter on Sept. 18 (not Friday, as earlier reported) to Mike Rothman, state Commerce commissioner, Gottwalt says he wants answers. Lots of answers.
[The Commerce Department points out that it responded to Gottwalt on Sept. 21 that those questions should go to state Management and Budget Commissioner James Schowalter, not the Commerce department.]
Gottwalt has more than 70 specific questions about where the exchange is headed, and says he wants the answers by Oct. 1, “so Minnesotans have some time to review and understand them before the November 16th federal deadline to file for preliminary approval.”
(Coincidentally, that would also give time for Minnesotans to review and understand them before the Nov. 6 statewide election.)
Gottwalt wrote: “I am deeply concerned you have resisted sharing details with Minnesotans about this exchange and how it will impact them.”
Here’s the list of his questions:
1. What kind of governance is planned for the Exchange?
2. What body will govern the exchange (i.e. a private nonprofit, a quasi public-private entity, or a state agency?)
3. Who will serve on the governance body?
4. By whom will members be appointed and to whom will they be accountable?
1. What is the projected annual budget for the exchange, in detail?
2. How will the exchange costs be funded? Specifically, what are the revenue sources?
3. How much will the exchange cost Minnesotans to operate each year, including salaries and benefits?
4. On what operational and/or other expenses are those cost projections based?
5. Are the functions on which you are basing the total cost obligatory under federal law, or discretionary per state judgment?
6. How will the state pay for the exchange in the near and long-term?
7. How are you planning to build an exchange without adding more cost to the system?
8. Initial financial calculations suggest the exchange may cost as much as $28 pmpm (per member, per month). The state of Utah just said the cost of their exchange will be $6 pmpm. Why can’t Minnesota’s costs be closer to Utah’s costs?
9. What are you building that will require such high costs? In detail, share precisely how you are spending the $73 million in federal grant dollars (granular spreadsheet).
10. How many employees have you already hired for the exchange?
11. How many more do you plan to hire in the next few years?
12. What are their respective job descriptions, salaries and benefits?
13. What consultants have you hired to help build the exchange, how much are you paying them, and what are their backgrounds?
14. Will you inform legislators and the general public in an open, transparent manner about how these dollars are being spent? Exactly how do you plan to do that? Will you do so ahead of the Nov. 6th elections? If not, why not?
1. Who will own and operate the IT infrastructure?
2. How will the state operate the exchange in 2014 if it potentially lacks clear legal authority to create a governance body?
3. What agency or agencies is/are the appropriate home and/or conduit for exchange communications?
4. Will the IT infrastructure and call center be functional by 2014, and how will it coordinate with private entities, including plans, providers, brokers, agents, and small businesses, to ensure smooth operations?
5. Will the exchange systems and infrastructure you are building support a single-payer government-controlled system of health care coverage? Is that your objective?
6. Will there be a private market, much like today’s, allowed to operate freely outside the exchange?
7. Beyond health care coverage, are you building the exchange to accommodate other government programs and benefits?
8. In detail, what government programs and benefits do you intend to provide through the exchange?
9. How will eligibility for programs and subsidies be determined within the exchange?
10. Will eligibility remain a state function, or will it default to a central federal system and master database?
11. How will the exchange you are building address concerns about data privacy and security?
1. How will brokers work with the exchange?
2. What will be the scope of licensure, practice, respective roles, and compensation structure of Navigators versus brokers?
3. How are you handling “navigators”?
4. Will they be held to the same high standards of training, licensure, CE, ethics and regulation as licensed insurance producers?
5. Will there be a distinction between “licensed insurance producers” and “navigators”?
6. How will commissions and/or reimbursement be handled for producers or navigators?
7. Will the state set these, or will producers be free to negotiate with carriers as happens now?
Regulation and Functions
1. What functions will the exchange perform?
2. What regulatory power, if any, will the exchange governance body have?
3. Will markets outside the exchange be free and robust, subject only to minimum state and federal standards, to protect product diversity and consumer choice?
4. Will the exchange act as a market facilitator, or does the state prefer that the exchange assume the role of an active purchaser?
1. What are you doing to ensure there is a competitive marketplace that provides plenty of choice for employers and individuals?
2. How will the exchange provide quality information on products and providers to empower consumers to make informed purchasing decisions?
3. How will small businesses work with their brokers and agents to participate in an exchange if they choose to do so?
4. How will small businesses communicate with the exchange regarding tax credits?
5. How will larger businesses communicate with the exchange regarding potential penalties incurred by employees’ utilization of subsidies?
6. How can small businesses work with brokers to determine potential whether alternate insurance, such as defined contributions, meet federal requirements and whether their employees are better directed to a state exchange or elsewhere?
7. What products and services will an exchange offer?
8. Will you inform the public, in detail, how the exchange you are building will change what they have now?
9. Will consumers be able to keep their current coverage?
10. What options will the public have for health care coverage, and how will those differ from what they have now?
11. Will they be more expensive?
12. Exactly how will Minnesotans access health care coverage through the exchange you are building?
13. Will they be able to continue accessing coverage through their employer?
14. Will they be able to continue accessing coverage through their agent or health plan?
15. Will employers who face extraordinary cost burdens associated with “play or pay” have options? If so, what options will they have?
16. How many jobs do you estimate employers will have to cut when the exchange is imposed?
1. How will the state legally establish its exchange?
2. Will you seek legislative authorization before committing Minnesota to the exchange you are building? Will you introduce 2013 legislation? If so, when?
3. If not, will you issue an executive order?
4. If not, what legal authority does the state have under current law to implement an exchange, and how will it utilize any such authority?
5. Do you need legislative authorization to expend federal tax dollars to build an exchange for Minnesota?
6. What are the priorities and basic requirements for exchange readiness moving forward, and how will the state and Task Force elevate and address those issues?
7. Does the Commerce Department intend to follow what was done in Massachusetts and create an Exchange using an “active purchaser” model? Is that a primary consideration in what you are building?