DES MOINES — The diagnosis for action by the Iowa Legislature on health care issues this session is inconclusive.
Iowa enters the week facing a mid-February deadline for submitting a blueprint on how state officials envision operating a health insurance exchange in partnership with the federal government. Exchanges are online sites where small businesses and people who aren’t insured at work will be able to shop for health insurance starting in 2014.
As envisioned under President Obama’s Patient Protection Affordable Care Act, individuals and small businesses would use the new framework to shop for health insurance among competing private plans and obtain federal subsidies to help defray the cost. States are to notify the federal government by Friday if they want to help with selected tasks, such as consumer assistance and the supervision of health plans, in partnership with the federal government.
Gov. Terry Branstad has notified federal officials that Iowa prefers a state-federal partnership and Michael Bousselot, Branstad’s policy adviser for health issues, said Iowa officials will submit a proposed blueprint — to be certified by March 1 — that will maintain and retain current state management and regulatory responsibilities of Iowa’s insurance market as well as control of the Medicaid eligibility system that connects with the federal government portal.
The federal government will handle the exchange website and information technology platform that interfaces with the federal portal and the Internal Revenue Service data base needed to provide users with real-time income and tax information and enroll them into a qualified health insurance plan or Medicaid program with access to eligible tax credits, he said.
“We’re going to maintain control of certain areas, and the federal government will run certain things,” Bousselot said. “We’re going to maintain and do the things that basically the state of Iowa has done for a long time: regulate insurance and regulate the eligibility and intake of new people into our Medicaid rolls. What the federal government is going to do is kind of the stuff that the state of Iowa would have a tough time having ready by Oct. 1.”
Open enrollment for exchange plans begins Oct. 1 for coverage starting on Jan. 1, 2014, when most Americans will be required to have insurance.
Last month, the U.S. Department of Health and Human Services announced it had given Iowa more than $6.8 million in federal money to help build its new health insurance exchange. This was to be used to conduct insurance market research and analysis. The state Department of Public Health can use the money to determine what financial resources are needed for individuals, small businesses, coverage appeals and complaints.
Sen. Jack Hatch, co-chairman of the House-Senate health and human services budget subcommittee, disagreed with Branstad’s decision to proceed with a partnership rather than a state-run exchange. Hatch, a Des Moines Democrat who is possibly the legislature’s top expert on health-care policy and is weighing a bid for governor in 2014, also has been critical of the governor for not providing state lawmakers with information on the proposed exchange.
House Speaker Kraig Paulsen, R-Hiawatha, said he believes the governor’s decision to pursue a federal-state partnership does not require any legislation, and he does not anticipate debating exchange legislation this session.
“The governor argues that the partnership gives us more flexibility and is cheaper for the state and that is just flat-out wrong. It doesn’t give us more flexibility. It restricts us,” said Hatch, who has introduced Senate File 72, which seeks to switch to a state-run exchange by 2015. “He’s trying to create an argument to defend his bad decisions on health care over and over again.”
Branstad spokesman Tim Albrecht disagreed, saying the partnership enables the state to run its health-care system more efficiently while maintaining the flexibility of expanding to a state-based exchange in the future or pulling back if need be.
“It’s going to be see as we go,” said Bousselot. “I think it’s going to be a challenge, but we shall see. It’s the brave new world of health-care reform implementation.”