Del. crafting partnership with feds on health exchange

Delaware is the only state in the region that agreed to work with the federal government in forming a health-care exchange under the Affordable Care Act.

Both Pennsylvania and New Jersey have both sent an official “No, thank you” to the Obama administration, saying they wanted no part in forming the exchanges that would serve their residents.

 

But Delaware has set out to create and run this online health insurance marketplace through a partnership with the feds.

Delaware officials say they will vet the insurance plans offered through the marketplace, whose goal is to enable the uninsured or underinsured to obtain adequate coverage.

Linda Nemes, assistant director of market regulation for the state’s Insurance Department, said Delaware will only accept companies that are solvent. And, state officials will make sure each health plan offers the standard benefits outlined by the federal government under the Affordable Care Act.

Delaware has also added its own requirements for something called “network adequacy.”

“That would prevent a carrier from having a network where all the physicians are 75, 100 miles away,” Nemes said. “We are insuring that the travel time will be kept to a minimum.

Consumers can also expect some in-state help when they have a complaint about an insurance company. But, Nemes said, initial calls will likely first be logged with federal call center.

“Then that would be trickled down to the Department of Insurance,” she said. “We feel we know the needs of the Delaware residents. Also it’s a regulatory issue, it helps us know what the carriers are doing and what the marketplace is doing.”

Delaware is leaving much of the complicated – and expensive – information-technology planning to federal officials. Experts say the government has to build a secure data hub that all states can access.

That central system will need to perform long list of tasks such as: verifying whether a person is a citizen or determining if a buyer qualifies for a subsidy under the Affordable Care Act.

Meanwhile, in New Jersey, which waited until the last minute Friday to make its position official, Gov. Chris Christie explained why he ceded authority to create the exchange to the Obama administration. He said that struck him as “the most effective and efficient” approach.

Christie’s decision displeased some advocates in the Garden State.

Diana Autin, co-director of the Statewide Parent Advocacy network, says the state has lost the opportunity to tailor its exchange.

“When states are running their own exchange, they will have more say in what the exchange looks like, how easy it is to use it, who gets to go on the exchange as an insurer,” she said. “If the federal government is running the exchange, those decisions are left to the federal government.”

Obama administration officials assured dubious U.S. senators at a hearing last week that the exchanges would, in fact, be ready to start enrolling customers by Oct. 1.

Pennsylvania Gov. Tom Corbett oped out of the exchange well before the deadline last week.

Details on the status of all 50 states’ health exchanges can be found on this interactive map published by the Kaiser Family Foundation.