State authority preps for Obamacare rollout

The timeline is laid out, and the state’s health care connector authority hopes to start offering Affordable Care Act-compliant plans one year from now.

The exact makeup of those plans is unclear, though Health Insurance Connector Authority Director Glen Shor said he expects all of the connector’s current insurers to continue to be part of the program.

“We have eight to nine commercial insurers today, all the major Massachusetts carriers, and we expect them to continue to participate in 2014,” Shor told the News Service after a board meeting last Thursday.

Another conversation at the meeting revolved around how state regulations of mandated health insurance will match up with the new federal regulations. That conversation began with a briefing on the “minimum standards” the state needs to meet.

“It’s important stuff, but I feel like it’s more like putting a foot in the water. And the whole body’s going to jump in the water in November and December,” Shor told the board, referring to the more immersive talks planned for future meetings.

Though they share core similarities, the state’s 2006 health reform law and the 2010 federal law differ in the requirements for employers, health insurance companies, and individuals who are mandated to have insurance.

“Is it possible for them to make this any more complicated?” board member and Group Insurance Commission Executive Director Dolores Mitchell asked at one point during an explanation of how self-insured companies are excluded from some of the federal requirements.

The ACA, also known as Obamacare, requires all small-group and non-group plans to cover a variety of medical treatments, including maternity care, behavioral health, and prescription drugs, according to a presentation by Kaitlyn Kenney, national health reform coordinator.

Other aspects of the Obamacare rollout are uncertain. The connector is required to offer qualified health plans to individuals and businesses, but “specific guidelines are still not available” for determining the quality of those plans, chief financial officer Jean Yang told the board.

“There’s a lot of pushing and pulling in Washington on that very subject,” Mitchell said.

The Center for Consumer Information and Insurance Oversight is the body deliberating on that subject.

In January, the state will issue a request for proposals to insurance companies seeking to offer plans through the connector. In October 2013, the connector hopes to have those plans “on the shelf” for consumers, and the coverage through those plans would begin in 2014.

Other concerns abound about the new federal law and how it might overlap with or supersede the existing state law.

Kenney said, “…it is important to make sure there are no double penalties” for people who might violate the so called “individual mandate” for state and federal health insurance.

Others were concerned that more companies might seek to become self-insured to avoid some of the regulations.

“The regulations don’t apply to large firms and self-insured firms. They can do whatever the hell they want,” said John Gruber, an MIT professor and board member. He continued, “There’s these sort of quasi self-insurance plans where small firms can sort of pretend they’re self-insured when they’re not really.”

Ian Duncan, a health care consultant, said he was concerned about the precedent of Massachusetts health insurance regulations overlapping with federal regulations and worried about other states following suit so that the country becomes a patchwork of state regulations on top of the ACA regulations.

“If there’s one thing that will drive large employers out of providing insurance for their employees in the future, it is having to administer a different set of rules in every locality around the country,” Duncan said.

Administration and Finance Secretary Jay Gonzalez, who is chairman of the board, said moving forward, state officials should speak with large employers, list the differences between the state and federal regulations, and provide the board with some recommendations.