|By Winthrop Quigley, Albuquerque Journal, N.M.|
|McClatchy-Tribune Information Services|
HSD expects up to 250,000 New Mexicans to be eligible to use the exchange between 2014 and 2020 and estimates that 55,000 uninsured will enroll in 2014.
Consumers who receive insurance from their employers, who receive federal or veterans health benefits, members of retirement health plans, and
The federal A ffordable Care Act, also known as Obamacare, requires that all consumers have access to a web-based health insurance marketplace. States have a choice of organizing their own exchange or having the federal government set one up.
Friday is the deadline for states to notify federal officials if they intend to set up their own exchanges.
"We've been moving forward on a state-based exchange to keep more f lexibility in the hands of the state," New Mexico HSD communications director
Kennicott said a federal exchange would let the federal government choose what health insurance is available to
A he a lt h i n su r a nc e exchange allows small businesses and consumers to shop for insurance policies via the Internet. The policies must meet minimum coverage requirements.
The ACA allows states to organize compacts that would allow consumers in one state to purchase insurance on the exchange that is available in another state. New Mex ico has not decided whe t her t o join a compact.
The idea of e x c h a n g e s is to create c omp et it ion among plans, give consumers enough information to make intelligent choices and put the plans and consumers "on a level playing field," said
Cal i for nia, M innesota,
Some states, like
What it will do
Ingram said that at a minimum, an exchange:
Gives qualified plans an electronic space to offer their products.
Administers government subsidies available to lowincome consumers who buy a policy.
Helps consumers compare and understand the products being offered.
Helps insurers and brokers market to consumers.
Determines if shoppers using the exchange are qualified for subsidies or for public programs like
"In this version they have a computer system that allows people to look at products," Ingram said. "They have an online application you can easily fill out to apply for products." It's rather like
States can also "do a little bit more," she said.
If as a matter of policy a state is trying to reduce obesity, for example, it might require plans to offer fitness and dietary programs. A state might require coverage for Oriental medicine or traditional healers. Plans might be required to include Indian health systems in their networks of providers. A state that is trying to improve health care quality might require compensation programs that reward medical providers for meeting quality standards.
The nation's first insurance exchanges were state-initiated efforts in
Kennicott said the
That structure bothers Health Action New Mexico, a policy advocacy organization.
Its executive director,
Webber doubts the alliance's role, which is defined in statute, can be changed without legislative action. She said the structure could be challenged in court, "and that's going to delay health reform in
She also worried that absent expansion of
"If we don't do a full
By far the biggest challenge facing the states is building the information technology that runs the exchanges, Ingram said.
"It has to be consumer friendly and easy to use," Ingram said. "You want to have something that is not complicated (for consumers). They'll be turned off it is too complicated."
At the same time, and with the utmost security, the system has to collect and verify personal income information to see if the consumer is eligible for a subsidy or
Ingram said many people bounce back and forth between
Consumers have to have enough information to make a good choice, and their choice has to be conveyed quickly and without error to the right company.
Kennicott said the state is hoping to buy a turnkey system that will allow it to begin enrolling people next October.
(c)2012 the Albuquerque Journal (Albuquerque, N.M.)
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