Tag Archive for state

Some State Health Exchanges Won’t be Finished by Deadline

Obamacare’s health insurance marketplaces go live on Oct. 1, but some of them won’t quite be finished by then.

People should be able to start shopping for health insurance on Oct. 1, the date set for the online marketplaces (also known as exchanges) to open in the Affordable Care Act. But once they find a plan they like, they might have to wait a few more weeks before making any payments. That’s because several state-based marketplaces say they’ll be busy finalizing the payment functions of the exchange after the website launches.

It shouldn’t be a problem — plans sold on the exchanges start on Jan. 1, 2014, so insurers just need to receive payments by then to begin covering people — but it’s yet another reminder that exchange implementation is happening on an incredibly tight timeline with little room for error.

Officials in Oregon and Washington say they expect to still be finalizing their exchange’s payment functions after Oct. 1. Sue Doby, a senior consultant at Oracle, which is building Oregon’s health exchange, says several exchange features might not be ready until Jan. 1, and the payment process is probably the most important.

“A lot of testing still needs to be done,” she says. “We have to prioritize what pieces of product and code can be deferred.”

Likewise, at Washington state’s health exchange, officials said in an email that they expect to have their payment functions ready during December, which is when the first round of premiums would be due for coverage starting on Jan. 1, 2014.

At least six other states are expected to facilitate premium payments through the exchange, according to StateReforum, which tracks exchange implementation. All of the 30-plus federally run exchanges will have insurers bill their new customers directly. That is one less thing for the U.S. Department of Health and Human Services to worry about, after a recent Government Accountability Office report questioned the Obama administration’s readiness to open the exchanges on time.

But even in states like Rhode Island that plan to have their exchange’s payment features ready for the Oct. 1 launch, there is an acknowledgement that it could be delayed, and officials say the state has done some contingency planning in case that becomes necessary. For example, when the consumer purchases a health plan, they could receive a message notifying them that their coverage will be contingent on the insurer receiving payment and a bill will be sent at a later date.

“Our intent here in Rhode Island is to have the functionality for Oct. 1,” says Brian Keane, who is overseeing the exchange’s technical implementation for Deloitte Consulting. “But we do have a contingency plan, and we may go to one of those other options.”

A state’s inability to process payments on Oct. 1 might delay HHS’s decision to officially approve the exchange, but that doesn’t mean they won’t be allowed to open. All 18 state-based exchanges are currently conditionally approved and must receive final approval from HHS, but can be launched with only conditional approval, according to HHS.

“The secretary can allow states to operate their exchanges under conditional approval while they finalize components of their exchange,” an HHS aide said in an email.

This story was originally published by GOVERNING.com.

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Texas Groups Promote Health Exchange Without Help From State

Texas officials have declined to establish a state-based health insurance marketplace, a major provision of the federal Affordable Care Act. So private organizations are working to educate Texans about coverage options through the federal health insurance exchange, which opens on Oct. 1.

Of the more than 6.3 million uninsured Texans — the state has the country’s highest rate of uninsured residents — almost half will be eligible to buy insurance through the federal exchange, an online tool for coverage shopping.

But Texans suffer from a “general lack of knowledge” about the law, said Allison Brim, a director at the Texas Organizing Project, one of several groups working to reach uninsured families before the federal exchange’s rollout.

“Folks just don’t have a lot of information about the exchanges and what their options will be,” she said.

The Texas Department of Insurance has made no extra effort to publicize the federal exchange, said John Greeley, an agency spokesman. In 2010, it conducted a federally financed campaign about health insurance options but has done nothing comparable since, he said, adding that those with questions could use the department’s website or telephone service.

Brim criticized the state for not promoting the exchange, saying its help would make it possible to reach all eligible Texans by October.

“The state has, as far as we know, done nothing to spread the word to uninsured Texans about the exchanges or the Affordable Care Act,” she said. “It leaves a mountain of work for us.”

In response to questions about publicizing the exchange, Lucy Nashed, a spokeswoman for Gov. Rick Perry, wrote in an email that the state was “not interested in implementing Obamacare, including the exchange.”

On July 10, a division of the U.S. Department of Health and Human Services awarded about $9.9 million to Texas community health centers to make people aware of their options.

The department will also finance at least two “navigators” — organizations intended to guide people through the exchange — per state. Texas’ navigators will receive about $8 million.

But Jacob Cortes, the lead organizer of the group Austin Interfaith, said that might not be enough. “The private sector would have to step up,” he said.

Julie Bataille, a spokeswoman for the Centers for Medicare and Medicaid Services, said navigators were just one federal resource. The agency also dispatches officials from its Dallas office and Washington headquarters to speak with health workers and organizers in Texas.

And it collaborates with local initiatives, Bataille said, including groups like Blue Cross Blue Shield, which started a Be Covered campaign; the Texas Organizing Project; and Enroll America, which promotes the health care act.

Be Covered has joined with churches, museums and other organizations in every Texas county to distribute literature on obtaining insurance, said Michelle Riddell, a Blue Cross Blue Shield of Texas spokeswoman. 

The Texas Organizing Project and Enroll America are canvassing and organizing community meetings where Texans can get more information.

Reaching exchange-eligible people will not be easy, said Mimi Garcia, Enroll America’s Texas director. She added that groups like hers will have to work beyond January 2014, the deadline for Americans to obtain coverage.

“I would love it if we could get everybody enrolled in the first year and that would be it and we would be done,” she said. “But that’s not going to be the case.”

Cortes said ambiguity about the federal exchange — including yet-undetermined providers and premiums — make it difficult to spread a clear message.

Texas’ size poses another challenge, Brim said, because in rural areas “we just can’t reach as many people as fast.”

“There will be some folks,” she added, “who just don’t get the word.”

This story was originally published by The Texas Tribune, and was produced in partnership with Kaiser Health News.

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California’s Gregory Franklin to Retire from State Service

Gregory Franklin


Gregory Franklin, California’s assistant secretary of health information technology, will retire from state service in September. Jessica Mulholland


Gregory Franklin, the assistant secretary of health information technology in the California Technology Agency, will be retiring from state service in September.


Franklin has served in the California Technology Agency since June 2011, providing oversight in California’s health IT infrastructure.


Prior to the CTA, Franklin worked as the deputy director of health care operations for the California Department of Health Care Services from October 2009 to June 2011, in which he directed Medi-Cal program administration. He also worked as assistant executive officer in CalPERS from February 2007 to October 2009 as the executive of health care services purchases.


His first high-profile state government position was as the deputy director of health information and strategic planning in the California Department of Public Health from June 2002 to February 2007.


Franklin has long served as the senior health administrator for the United States Air Force Reserves, from January 1996 to the present day, where he ensures medical services for 3000 military personnel.


In 2012, Franklin told Government Technology that when California entered discussions on health-care reform in 2007, an electronic health records system also was being developed in the military, giving him valuable experience — even if the approach is different because of the setting.


“From purchasing health care to IT to project management, all of the political and administrative pieces are pretty much the same in the reserves, but [they’re] at a Department of Defense and federal level,” Franklin said. “A lot of the training and necessary skill sets that you need to be successful in both environments are the same.”


The majority of this story was originally published by Techwire.net. Photo of Gregory Franklin by Jessica Mulholland.


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Oregon Explores Treadmill Desks for State Workers

Anthony Behrens worries that the Affordable Care Act is going to kill him, but not for the usual reasons cited by opponents of the federal health care law.

Behrens is a senior policy analyst in the Oregon Department of Consumer and Business Services Insurance Division. The task of implementing the health law has kept him sitting at his desk 12 hours during the day followed by another few hours at home each night.

Behrens was so alarmed by research pointing to possible long-term health consequences from sitting for extended periods of time that he pitched a solution to his local state legislator: installing treadmill desks that would allow state workers to walk at slow speeds while they are working.

“Even if you get regular exercise at a gym, you’re still going to die sooner if you spend a certain amount of time sitting at a desk,” Behrens said. “I didn’t realize that if you sit for an hour, from that point on your body shuts down and almost goes into hibernation mode.”

A recent study of more than 200,000 adults 45 and older in the Archives of Internal Medicine found that adults who sat 11 or more hours per day had a 40 percent increased risk of dying in the next three years compared with those who sat for fewer than four hours a day.

That conversation resulted in a legislative proposal for a pilot project that would fund treadmill desks for some state workers and study the effects on health and productivity. Treadmill desks range in cost from $400 to $5,000, but the hope is that the state could recoup its expenses through lowered health-care costs over the long run.

At a recent hearing on the bill, Mayo Clinic endocrinologist James Levine testified about the potential health benefits via video-conference call while walking on a treadmill desk. “We’ve had extensive experience in deploying these types of programs and universally have seen either positive responses from employees’ improved health or improved productivity,” said Levine, who is widely credited with popularizing the concept. Legislators in the room could see the technology in action while they mulled its merits.

Levine told lawmakers they should act on mounting scientific evidence about the consequences of being sedentary. In 2012 alone, Levine said, 1,300 peer-reviewed studies were published linking sedentariness with heart disease, obesity, diabetes, high blood pressure and other negative health effects.

“Even if one does go to the gym three times a day, and if you make your (recommended) 10,000 steps at the gym, the long periods of sedentariness that we experience at work are not offset by those intermediary, scattered episodes of gym-going,” he said.

Use of treadmill desks has taken hold in a range of private companies, including BlueCross BlueShield and Marriott (see video), but is not common in the public sector, in part because of concerns about upfront costs.

Republican U.S. Sen. Orrin Hatch criticized the federal Center for Medicare and Medicaid Innovation for its use of treadmills. “In a post-sequester world, where White House tours are being canceled and Easter egg hunts are being threatened, you can imagine why American people would take a very cynical view about federal employees being furnished with thousand-dollar treadmill desks,” he said at a recent hearing.

But to Republican state Rep. Jim Thompson, the Oregon bill’s sponsor, the potential benefits of treadmill desks far outweigh the costs. “It’s not unbearably expensive; one of those units costs less than the desk I have in my office,” he said. Still, Thompson said, the bill will have a better chance of passing if they can find some support from private donors.

“We are not designed to sit,” he said. “We talk about all these things we need to do to get people healthier, but when are we actually going to try some of them?”

This story was originally published by Stateline.org. Stateline is a nonpartisan, nonprofit news service of the Pew Center on the States that provides daily reporting and analysis on trends in state policy.

Photo courtesy of Shutterstock

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Washington State Joins HIX Club

Washington state has been granted conditional approval to move forward with plans to roll out its health insurance exchange (HIX) program, according to the Puget Sound Business Journal. Washington, the sixth state to reach this milestone, will call its online health-care marketplace Washington Healthplanfinder. The website is scheduled to go online Oct. 1, 2013.

“This conditional approval is a significant validation of the work that we’ve done to get our state’s health insurance exchange up and running,” Washington Gov. Chris Gregoire said in a statement. “We are clearly ahead of the curve and well positioned to remain a national leader on health-care reform. Through our exchange, we will offer coverage to more than 200,000 uninsured Washingtonians and boost competition in the marketplace.”

Washington officials submitted their plans for establishing the HIX more than one month before the deadline. Oregon, Massachusetts, Maryland, Colorado and Connecticut have also received preliminary approval for their exchanges. By contrast, many states have either chosen to default to a federally run exchange or have not yet announced any plan for an exchange. According to the Henry J. Kaiser Family Foundation, Florida, Idaho, Indiana, Pennsylvania, Utah and Virginia have not announced an official course of action for an exchange.

By July 2013, Washington state will announce which Qualified Health Plans will be available to the public and by September 2013, a call center and toll-free phone number should be available for residents. Enrollees will receive coverage effective Jan. 1, 2014.

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