Date: 06/05/2015

Final
Presentation - Colorado Health Institute about Connect for Health CO

HEALTH CARE EXCHANGE

Votes: View--> Action Taken:
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09:40 AM -- Presentation by Colorado Health Institute about Connect for Health Colorado

Jeff Bontrager, Director of Research on Coverage and Access, Colorado Health Institute (CHI), discussed how the exchange could be improved and how changes could be made to the exchange under a Section 1332 Innovative Waiver (waiver). Throughout his presentation Mr. Bontrager referred to a handout (Attachment E). He stated that improvements can be defined as operational improvements, financial improvements, and affordability and access improvements. He discussed strategies for sustainability of the exchange, as well as an exit strategy. Mr. Bontrager clarified that an exit strategy referred to making fundamental changes to the exchange not eliminating the exchange entirely.

150605 AttachE.pdf150605 AttachE.pdf

Mr. Bontrager discussed strategies for sustainability of the exchange which included utilizing access fees, diversifying the risk pool, diversifying offerings, leveraging partnership with Medicaid, leasing out infrastructure and permitting advertising. He also suggested ways to make fundamental changes to the exchange, such as contracting some functions to private entities, privatizing the marketplace, transitioning to the federal marketplace, doing away with the marketplace altogether, and considering other broad insurance market reforms. He further discussed that if the exchange is substantially changed, it would be important to make a plan to transition current enrollees to the new system, understand implication of the federal option, explore repurposing of the infrastructure, and assess the impact the change will have on competition and transparency.


09:51 AM

 Mr. Bontrager continued his presentation by discussing the application of waivers and the issues to be considered when deciding to move forward with utilizing the waiver option. He explained that some states have already begun discussing how an innovation waiver could help meet their goals around healthcare, and other states are certain to start the discussion. The few states that have begun conversations are still in the early stages. Mr. Bontrager explained that a waiver provides a means to make changes to the existing insurance requirements of the Affordable Care Act (ACA) by altering requirements for benefits, subsidies, tax credits, the individual mandate, the employer mandate, insurance marketplaces, and qualified health plan provisions. He stated that the General Assembly would need to pass legislation to permit the state to utilize the waiver option. He suggested that the first step in the waiver process should be to identify the problem with the current system and then build a waiver to solve this problem. Mr. Bontrager referenced an additional handout titled Section 1332 State Innovation Waiver A Vehicle for Change prepared by CHI (Attachment F).

150605 AttachF.pdf150605 AttachF.pdf

09:58 AM

Senator Roberts thanked Mr. Bontrager for his presentation and asked him to return to the next meeting to respond to questions from the committee once the committee has had time to consider his presentation. Committee discussion and questions followed about other states that have considered the waiver approach. Mr. Bontrager spoke about other states that have been exploring waiver options and the coordination of waivers and the 1115 Medicaid waivers. He explained that some waivers are Medicaid specific, but 1332 waivers address the rules regarding private insurance. Committee discussion continued about the advantages and disadvantages of seeking a waiver, as well as discussion about requirements for small businesses to qualify for tax credits. Committee members commented on Mr. Bontrager's presentation.