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Stakeholder Engagement Report to Commission April 7, 2011.

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Presentation on theme: "Stakeholder Engagement Report to Commission April 7, 2011."— Presentation transcript:

1 Stakeholder Engagement Report to Commission April 7, 2011

2 STAKEHOLDER ENGAGEMENT WHY –Required in grant –Fundamental change of Exchange in purchasing insurance PROCESS –Reviewed Exchange concept –Outline required and optional functions –Reviewed pro’s & con’s of choices DESIRED OUTCOME: Understand –Question, worries, opinions

3 Results Pass information to PCG Incorporate into planning process Combined with data & actuarial analysis, submit recommendations to Governor and General Assembly

4 EXCHANGE REVIEW Place to shop for insurance –Individuals –Small businesses & employees Tool to comply with coverage mandate Subsidies for individuals <400% FPL ($88,000 family 4) Tax credits business < 25 employees, low wages

5 EXCHANGES MUST Certify qualified health plans Toll free telephone number Website – standardized info on plan options Electronic calculator Information on public programs Assign ratings to plans – quality & price Establish Navigator program

6 KEY DECISIONS FOR DELAWARE Whether to establish Exchange 1 or 2 Exchanges? Merge/separate small and non group markets Where resides & how governed Sustainability & scope Definition of small group Products in & out of Exchange Brokers and Navigators Number of plans in Exchange

7 ESTABLISH AN EXCHANGE StateRegionalFederalNotes Brokers#1 Brokers #2 See regional problems Brokers #3 Small Business #1 ? Exchange and cost Small Business #2?? Exchange and cost Small Business #3?Concern over DE small numbers DE State Chamber of Commerce Health Plan See regional problems Consumers – non- profits ??Too many unknowns Physicians See regional problems; concern DE small numbers Hospitals?? Unsure of wisdom of DE Exchange

8 How Many ExchangesMerge MarketsComments Brokers #1?No definitive opinion Brokers #22 ExchangesNOAfter discussion agreed management by one board ok Brokers #31 Exchange; two avenuesNo Small Business #1?? Small Business #2?? Small Business #3?? DE State Chamber of Commerce ?? Health Plan1 Consumers – non-profits1Divided – see benefits of merging Physicians1No opinionConcern about small numbers HospitalsConcern about small numbers and sustainability

9 INSIDE/OUTSIDE MARKET NUMBER OF PLANS IN EXCHANGE INSIDE/OUTSIDE MARKET INSIDE/OUTSIDE # OF PLANSCOMMENTS Brokers #1Same rating rules; Potential for adverse selection ?Outside market could have richer benefit plans Brokers #2Want outside market; rules the same Increase choice; allow CDHP in Exchange Impact on NCCCC Benefits Connection Brokers #3Prefer outside market?Each tier have same benefits Small Business #1?Increase competition; attract more plans Small Business #2? Suggest pooling w/outside market if there is one ? but want choice Small Business #3Stressed simplicityWant choice; See trade-off number of plans & market share of each plan Delaware State Chamber of Commerce No outside market; adverse selection Health PlanNo outside market; DE too small; adverse selection Limit number of plans More plans  lower costs Consumers – non-profits?Limit number of plans PhysiciansNo outside market; adverse selection Limit number of plans HospitalsSmall may be better

10 SMALL BUSINESS DEFINITION NAVIGATOR/BROKER ROLES Increase to 100Navigator/BrokerComments Brokers#1 Navigators do not enrollUse brokers in Exchange Brokers#2 200 if possibleUse brokers in ExchangeConsider NCCCC Benefits Connection Brokers#3neutralNavigators helpful, but do not enroll Use brokers in Exchange Small Business#1 up to 500Employers rely on brokers Small Business#2Employers rely on brokers; navigators also needed Small Business #3 Employers rely on brokers Delaware State Chamber of Commerce Employers rely on brokersHigher level training for broker in Exchange Health Plan Navigators for social services Consumers – non-profitsNo opinionUse both – separate servicesFlat broker fees Physicians Small businesses rely on brokers HospitalsNo opinion

11 GOVERNANCE State Agency Quasi-GovernmentPrivate non-profitComments Brokers#1No comment Brokers#2 Independent Board Brokers#3 Nat’l org wants private, but recognize benefits of quasi Small Business#1No comment Small Business #2No Comment Small Business#3 Delaware State Chamber of Commerce No Comment Health Plan Consumers – non- profits Some felt more discussion needed Physicians HospitalsConsider “what” is being governed first

12 Other Issues Raised Definition of full time, part-time, seasonal employee Treatment of employees across state lines Concern about “gaming” – pay penalty cheaper than providing insurance Create “beta” site to allow consumers to “test drive” the Exchange If regional Exchange not feasible consider sharing “back-room” operations

13 Consensus and Unresolved CONSENSUS State Exchange Quasi-state entity Use brokers and navigators – separate roles and functions Expand small group definition to Pay attention to DE small numbers UNRESOLVED Sustainability Inside/outside market Merged or separate small and non-group markets # plans in Exchange – trade-off competition & choice and market share to make Exchange attractive Scope of Exchange functions (tied to sustainability)


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