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(Augusta) Consumers
for Affordable Health Care (CAHC), the largest consumer health care
advocacy organization in Maine, testified today before the Insurance
and Financial Services (IFS) Committee regarding the report issued in
September by the Exchange Advisory Committee. In August Governor LePage
chose the panel, which consisted of Dan
McCormack, Intermed; Steven Michaud, Maine Hospital Association;
Kristine Ossenfort, Anthem Blue Cross Blue Shield; Daniel Bernier,
Maine Insurance Agents Association; Joel Allumbaugh, Maine Heritage Policy Center;
Jamie Bissonette Lewey, chair of the
Maine Indian Tribal State Commission; Edward Kane, Maine Harvard
Pilgrim Health Care; and David Clough, the National Federation of
Independent Businesses in Maine. The Advisory Committee was chaired by
the Chair of the Dirigo Health Agency, Joe Bruno. Mitchell Stein, CAHC
Policy Director, delivered the testimony.
In
his testimony, Stein thanked the Advisory Committee for their hard work
and thoughtful deliberations. He focused on the four major areas CAHC
disagreed with the Advisory Committee's report: the structure,
governance, duties, and funding of the Exchange.
In
response to the Advisory Committee's recommendation that the Exchange
be located within the Department of Professional and Financial
Regulation, Stein suggested that the Exchange be created as an
independent public agency. "Doing so would ensure that the
operations of the Exchange were transparent and removed from the
administrative needs of an already large Department," said Stein
in his testimony.
Similar to the points CAHC
raised in its public comments on proposed federal regulations submitted
to HHS the day before, Stein also recommended that the Exchange should
have a governing board that includes consumers, small businesses and
insurance experts not employed by the health care industry.
Furthermore, those who would profit from enrollment should not govern
the Exchange. Exchange governance should exclude those with conflicts
of interest due to a direct financial stake in the health system. This
includes organizations and individuals representing hospitals,
physicians, insurers, and brokers. "While the input of these
constituencies will be important and may be obtained through advisory
groups they should not have decision making power as members of the
board," Stein added.
Stein offered a number of
recommendations on what duties the Exchange should have, including one
that can:
- give small
businesses and individuals the power to bargain in the market
similar to the way large employers currently operate. By banding
together to purchase health insurance through an Exchange it will
be possible to leverage their combined buying power in the market;
- allow the
Exchange to negotiate on price, benefits, and quality, and thus to
selectively contract with the most appropriate health plans;
- determine which
health plans should be accepted into the Exchange and which fail
to meet the standards necessary, so that there is a variety of
benefit options and pricing available; and
- provide
consumers with the best options available by rewarding plans with
payment incentives for providing strong benefits (such as
coordinated, high quality care), reductions of hospital
readmissions and reductions in health care
disparities.
Finally, Stein's testimony
concluded with how best to fund the Exchange. According to Stein, it
should be spread among all purchasers of health coverage in the state.
Furthermore, "If a fee is added on plans sold through the Exchange
only, then the same plan sold outside the Exchange would cost less.
This would inevitably lead to adverse selection, limiting who utilizes
the Exchange to only those who had no other option. A
robust healthy Exchange is in all of our interest - in order to
accomplish this it will be necessary to avoid adverse selection,"
concluded Stein.
The IFS Committee considered two
separate bills last session that would have created an Exchange,
however they agreed to table both bills until hearing the
recommendations of the Advisory Committee. It is likely that they will
consider both bills again this upcoming session, however they may be
amended versions from their last introduction to incorporate some of
the Advisory Committee's recommendations.
For Stein's complete
testimony, please click here.
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