Posted by: gilleyellen | February 18, 2013

A Federally Operated Insurance Marketplace: What it Means for North Carolina

You’ve probably seen or heard it in the news (or on this blog) in the past few days: Governor McCrory has announced his decision to have the federal government (HHS) run North Carolina’s health insurance marketplace.  The other option was to implement a federal-partnership insurance marketplace, which former Governor Beth Perdue supported and for which North Carolina received a $74 million dollar grantearlier this year.

The basic difference between these two models is reflected in the names.  A partnership gives states responsibility to use their expertise to run parts of the exchange.  In North Carolina, Governor Perdue proposed to run both the consumer assistance and plan management sides of the marketplace.  Among other things, having a partnership in North Carolina would have allowed the state to create a consumer assistance program (In Person Assistors, or IPAs) to work with and fill in the gaps of the federal consumer assistance program, “Navigators.”  The federal marketplace, by contrast, is run completely by HHS, although HHS will still seek advice from state departments and agencies, and does not allow for IPAs.

Governor McCrory’s decision was not unexpected.  In 2012, the North Carolina Senate refused to pass a bill that would have enacted a state-based marketplace.  And just a few weeks ago, the Senate came out with Senate Bill 4,titled “No N.C. Exchange/No Medicaid Expansion,” which Governor McCrory has been pushing.  With only a technical change to be approved before it goes to McCrory’s desk, an important questions is raised: what are we losing with a federal marketplace?

According to Governor McCrory, next to nothing.  One of his main reasons for supporting Senate Bill 4 was “a lack of preparation within state government during the past year to build necessary and reliable systems to implement a state [marketplace].”  Put simply, Governor McCory does not believe that North Carolina has the infrastructure to carry out the consumer assistance and plan management needs of a marketplace.

On the contrary.  In November 2012, North Carolina proposed a partnership marketplace based on the combined plan management and consumer assistant model and received a federal grant of $74 million dollars to continue to implement it. North Carolina has a strong background in health insurance consumer assistance.  Through the North Carolina Department of Insurance (NCDOI), the state has over 25 years experience in providing consumer assistance in health care.  Specifically, the state’s SHIIP (Seniors Health Insurance Information Program) program provids health care counseling, training and education to counselors, enrollment efforts and statewide outreach in the area of seniors’ health care needs and plans.  SHIIP was to be the basis of the IPA program.  And that IPA program intended to develop health insurance counseling, education, and assistance for people who currently cannot obtain or afford health insurance. State agencies, community groups, and non-profit entities would all inform—and potentially form—IPAs to ensure that hard-to-reach populations had access to information about the marketplaces and were properly enrolled.  Though HHS intends to create a robust system of Navigators, Navigators are not empowered to perform the same level of consumer assistance, such as assisting individuals in appealing insurance claims.  Moreover, unlike IPAs, funding for Navigators is not yet available, delaying North Carolina’s ability to set up the consumer assistance program.

In addition, the North Carolina Department of Insurance created Smart NC in August 2011, funded from federal grants made available under the Affordable Care Act. Smart NC is the state’s primary source for health insurance information consumer assistance for anyone not receiving Medicare.  It acts as the first-stop for North Carolinians with any questions about health insurance.  For example, Smart NC assists individuals in finding health insurance, resolving disputes with an insurer, and understanding how the ACA impacts them. And as a tangible example, on August 27, 2012, Smart NC’s call center became operational from federal funds.  By October 2012, it had received 2774 calls, assisted 427 consumers who were enrolling in a health plan, explained the ACA to 74 concerned individuals, and collected data to identify future outreach in various geographic regions. Smart NC was planned to house the IPA program and build its structure. In sum, for about the past three years, North Carolina has begun to create an operational and successful framework for consumer assistance that was built on a long history of consumer assistance in health insurance.

So, again, what are we losing?  Perhaps most significantly, enacting a federal marketplace means that North Carolina will not have a program of IPAs, and though North Carolina Department of Insurance will continue to assist consumers in health insurance decisions, the future of Smart NC is unclear.  Consumer assistance will be performed primarily by federally-funded Navigators.  Wayne Goodwin, North Carolina’s Insurance Commissioner has said it best: “Having a federal exchange in North Carolina will no doubt limit our ability to resolve consumers’ health insurance issues at the state level. People who have questions, concerns or complaints about health insurance will have to seek out help from the federal government rather than from trusted regulators in our own state.”

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Responses

  1. [...] On the contrary.  In November 2012, North Carolina proposed a partnership marketplace based on the combined plan management and consumer assistant model and received a federal grant of $74 million dollars to continue to implement it. North Carolina has a strong background in health insurance consumer assistance.  Through the North Carolina Department of Insurance (NCDOI), the state has over 25 years experience in providing consumer assistance in health care.  Specifically, the state’s SHIIP (Seniors Health Insurance Information Program) program provids health care counseling, training and education to counselors, enrollment efforts and statewide outreach in the area of seniors’ health care needs and plans.  SHIIP was to be the basis of the IPA program.  And that IPA program intended to develop health insurance counseling, education, and assistance for people who currently cannot obtain or afford health insurance. State agencies, community groups, and non-profit entities would all inform—and potentially form—IPAs to ensure that hard-to-reach populations had access to information about the marketplaces and were properly enrolled.  Though HHS intends to create a robust system of Navigators, Navigators are not empowered to perform the same level of consumer assistance, such as assisting individuals in appealing insurance claims.  Moreover, unlike IPAs, funding for Navigators is not yet available, delaying North Carolina’s ability to set up the consumer assistance program.Source: dukeaidspolicyproject.com [...]


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