|By Colleen Heild, Albuquerque Journal, N.M.|
|McClatchy-Tribune Information Services|
After securing a
An estimated 73,000 New Mexicans were predicted to sign up for a state exchange in 2014. About 250,000 could be eligible to use the exchange from 2014 to 2020.
But time is running out and now the process has been bogged down in a political dispute over how the exchange should work.
As of Monday, no contracts had been awarded and the state never applied for the
And a Democratic legislative effort to quickly approve a state-run exchange with a different focus than proposed by the administration has stalled on the House floor.
Three weeks of private negotiations earlier in the legislative session between the administration and health care advocates on a compromise bill "basically broke down," Rep.
The Martinez administration favors an exchange that "would be more of an Amazon. com style approach to shopping for insurance ... purchase, click and buy," according to a legislative analysis.
But health care advocates and many Democrats back an exchange that would act on behalf of enrollees in selecting eligible insurance plans and offer more consumer outreach.
"It comes down to a free market exchange versus an active purchaser exchange,"
With the more minimalist approach favored by the administration, he said, "People would be buying policies they're unhappy with and the subsidies will be wasted."
The negotiations did lead to a compromise on the makeup of a governing board for an exchange.
Advocates sought to eliminate the influence of private insurance companies in the entity proposed by the Martinez administration to oversee the exchange.
They were backed by the office of Attorney General
King's office in a December opinion said the dominance of the insurance industry on the proposed exchange board of directors violated the Affordable Care Act's provisions on conflict of interest.
The Martinez administration had turned over responsibility for operating the exchange to a little-known entity called the
Members of the Alliance are by law "all insurance companies authorized to transact health insurance business in the state," according to the AG's opinion. State law establishes its governing board as a combination of insurance company representatives, small employers and their employees.
The makeup is such that the insurance industry could exercise majority control if some vacancies occur in the non-insurance-related seats, according to the AG opinion. That would violate the Affordable Care Act, it concluded.
If no exchange legislation is passed and signed by Martinez, the federal government would likely set up an exchange by default.
Ortiz y Pino said that while no one "wants a federally run exchange, there are groups who would prefer that to what they consider to be a poorly designed
In both camps, nearly everyone seems to realize what's at stake.
"Of all the things we do this session, this might be the most important," said state Rep.
Gentry was among the six Republicans on the
Republican committee members voiced support for a competing bill sponsored by Rep.
Neither Taylor's bill or proposed exchange legislation sponsored by
"It is a once-in-our lifetime opportunity to get coverage for almost one in two New Mexicans who either have no coverage or marginal coverage," said
The AG's opinion said
And some advocates say they will file a lawsuit if Martinez tries to move ahead on her own.
A total of 33 states have rejected state exchanges so far, according to the Center on Budget and Policy Priorities.
Of those intending to create state-based exchanges, 10 states and the
Meanwhile, the Alliance since last November has been gearing up to select a project manager and a firm for the sizeable information technology portion of the exchange project.
One of the finalists has hired former state Insurance Superintendent
Vendors for the information technology portion and project management were supposed to be selected by
There have been mixed messages as to how quickly the state must act.
Stewart told the Judiciary Committee an exchange bill needed to be passed and signed by Martinez "in the first or second week of March."
All exchanges must be ready to begin enrolling consumers
"These deadlines are not negotiable," a legislative analysis stated, adding that it will take up to six weeks for any new exchange to get approved to receive federal funding for implementation.
Yet, Kennicott of HSD wasn't sounding any alarms.
"I would say we're well ahead of where other states are at this point. The federal government has actually said that they would be flexible on meeting some of these deadlines. Part of it is we honestly don't think the feds are going to be ready on their end."
Exchanges, also described as "marketplaces," are where individuals and small businesses will be able to shop for coverage.
Kennicott said a state excha nge, wh ich wou ld require no state tax subsidy, is the administration's preferred pathway.
"In a federal exchange you have health plans that are basically one size fits all. If you have your own state-based exchange, you have health plans that are basically here in the state and they're run by companies in the state and run by people who understand the needs of New Mexicans," Kennicott said.
But the foundation in a report last year said the exchange implementation in
Last November, however, Martinez's administration conf irmed it would proceed with a state exchange. This came after she vetoed exchange legislation in 2011 and
Martinez's administration recruited Dr.
Derksen was about to apply for another
At the time, Derksen said only that the administration decided to move in a different direction. Now working at the
He said he admired her "courage to cover uninsured New Mexicans through expansion of
Kennicott said the administration opted against seeking the additional federal money after Derksen left, preferring to take a "closer look" on how to proceed.
He said last week there are now plans to apply for an additional
"We wanted to make sure we were doing this in the right way. It's good to go and get money but at the same time you need to make sure you are getting it for the right purposes and it will be expended in the right way."
Ortiz y Pino lamented Derksen's departure, saying his work "would have put us months ahead of schedule, and he's a Republican."
Stewart's bill would set up a new exchange entity, with a 13-member governing board, but allow any exchange-related contracts enacted by the Alliance to transfer over.
Such an exchange wouldn't be required to account for its expenditures to
The operation will involve substantial revenue and expenditures that will occur outside of the oversight of the executive branch and
Some other states have opted to operate exchanges within the executive branch or set up independent state agencies, the analysis added, "presumably with greater oversight and accountability by
(c)2013 the Albuquerque Journal (Albuquerque, N.M.)
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