Dolores Voorhees, Who Should An Exchange Be Built For?

On December 21, I attended a meeting of the Health Insurance Exchange Advisory Task Force in St. Cloud.  The agenda consisted of reports from the Financing, Long-Term Governance and Navigators/Brokers working groups, followed by a brief time for public comment.

The Health Exchange and must be implemented by January, 2014.  Federal funding is available through the end of 2014, but after that, the Exchange must be self-sustaining.  The funding mechanism chosen needs to be fair and equitable — to consumers, not just the insurance companies offering their products on the exchange.  The Financing work group presented pros and cons of various options — see their presentation here.  One point that drew attention was the idea of financing the Exchange by selling naming rights or allowing ads on the website. Both these ideas received some raised eyebrows, and drew concern from TakeAction Minnesota Health Care Program Manager Sarah Greenfield during the public comment period.

The Governance work group was up next — presenting guidelines on how The Exchange should be governed and different governance possibilities.  For example, Minnesota’s Exchange could be a state government agency, or an independent non-profit, or a hybrid of the two.  See the full presentation here.  The committee appeared to lean toward a hybrid model, often called a “quasi-governmental organization.”

Finally, the Navigator/Broker work group is charged with defining the role, training, and certification/compensation structure for people to help us consumers use the Exchange effectively.  See their full presentation here.  Navigators are people or organizations who will help people (like my family, see below) find and enroll in the best health coverage for them, especially people that are new to insurance or have language, income, or other barriers. However Bob Paulsen of the Minnesota Department of Commerce proposed allowing insurance agents or “brokers” who are paid by insurance companies, to also operate as Navigators inside the Exchange. Navigators themselves are not allowed to be compensated by insurance companies so that they don’t have an incentive to enroll people in a plan that might not be the best for them. This proposal raised concerns from TakeAction and others that Brokers would have an incentive to steer people to plans outside of the Exchange in order to be better compensated.

During the public comment period, I shared my concern for those in my life who have struggled to remain insured.

My son-in-law is a farmer and has seasonal income and my daughter is setting up a new acupuncture process.  They are on MN Care and their kids are on M.A.  Every six months there is a flurry of activity to document their income and assets, and the anxiety of wondering if they will continue to receive insurance benefits.  They would not be able to purchase unsubsidized insurance.

I have another young man in my life who is a Type I Diabetic.  He works 60 hours/week at $8/hour with NO health insurance right now.

My niece lost her coverage for two months because her M.S. has affected her cognitive abilities and she lost track of the re-certification process.

These are some of the people for whom the Exchange should be built and whose needs must be met by the Exchange.  All decisions made need to be evaluated against the needs of real people.

Dolores Voorhees

Dolores is a leader in TakeAction Minnesota’s Together For Health Campaign.  She lives in Oak Grove.