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The Hill Exclusive: States quietly consider ObamaCare exchange mergers

Exclusive: States quietly consider ObamaCare exchange mergers

By Sarah Ferris – 05/22/15 06:00 AM EDT

A number of states are quietly considering merging their healthcare exchanges under ObamaCare amid big questions about their cost and viability.

Many of the 13 state-run ObamaCare exchanges are worried about how they’ll survive once federal dollars supporting them run dry next year.

Others are contemplating creating multi-state exchanges as a contingency plan for a looming Supreme Court ruling expected next month that could prevent people from getting subsidies to buy ObamaCare on the federal exchange.

The idea is still only in the infancy stage. It’s unclear whether a California-Oregon or New York-Connecticut health exchange is on the horizon.

But a shared marketplace — an option buried in a little-known clause of the Affordable Care Act — has become an increasingly attractive option for states desperate to slash costs. If state exchanges are not financially self-sufficient by 2016, they will be forced to join the federal system, HealthCare.gov.

“What is happening is states are figuring out the money is running out,” said Jim Wadleigh, the director of Connecticut’s exchange, hailed as one of the most successful in the country. “At the end of 2016, everyone has to be self sustaining.”

Other states are being driven to consider the idea by the King v. Burwell case, in which the Supreme Court will decide whether subsidies are allowed in states that didn’t set up their own health exchanges.

If the court rules against the Obama administration, millions of people in states across the country will lose subsidies.

Some of those states could be interested in joining with other states that have their own ObamaCare exchanges.

“It’s absolutely being driven by the court case,” said Joel Ario, the former director of the federal government’s Office of Health Insurance Exchanges.

Most Republican state leaders have avoided talking about how they would respond to a decision against the use of subsidies on the federal exchange. Behind the scenes, however, many are anxiously contacting states that run their own exchanges.

“In the last seven business days, I’ve probably had seven to 10 states contact me about contingency plans,” Wadleigh said, though he declined to disclose the names of states he’s been talking to. “You can imagine the political backlash that would be if the names got out.”

Wadleigh, who became the CEO of Connecticut’s exchange last fall, said he has been in conversations with many states — some using the federal exchange and some running their own exchanges — about possible partnerships.

“Clearly, we can’t sell the code, which was paid for by federal dollars, but what we can do is have collaborations like joining exchanges, if that’s feasible,” Wadleigh said.

His office met recently with officials from Vermont and Rhode Island to talk about ways to collaborate. A few weeks earlier, the directors of all state marketplaces met in Denver to discuss ways to share services.

That same group will come together again in late July at a conference hosted by the Centers for Medicare and Medicaid Services (CMS).

By most accounts, creating a multi-state marketplace would be a logistical nightmare.

It’s unlikely that states could ever merge the full responsibilities of a marketplace — such as regulating plans and managing risk pools.

But even with a simpler model, like a shared call center or website platform, there are big questions about how states could share those costs and duties.

Jennifer Tolbert, a state health expert with the Kaiser Family Foundation, said “one of the trickiest issues” would be determining a governing structure for multi-state exchanges.

“I don’t know how that would be resolved,” she said.

These hurdles have been big enough to thwart multiple states from moving forward with their plans. Delaware, Maryland and West Virginia — which commissioned a study on the option in June 2013 — have all dropped the idea.

What is more feasible, experts believe, is a technology-sharing system, where multiple states all hire the same private contractor. States could also create a regional call center or outreach team.

"There’s lot of states that are trying to crack this sustainability problem, and there have been times when they’ve talked about regional solutions, but it’s really been very early on in those discussions," said Pat Kelly, the director of Idaho’s health exchange, Your Health Idaho.

He said sharing some services, particularly technology, could bring big benefits to states, though his own state couldn’t do so because it used federal dollars for the contract.

“Is it possible and is it a good idea? Absolutely,” he said. “Every time you can share the costs, it’s going to be more efficient.”

Eventually, it could also involve states that are already on the federal exchange, though that kind of transition would likely take years, said Ario, who has served as the state insurance commissioner for both Oregon and Pennsylvania.

“I think if King goes against the government, there will be a flurry of activity,” added Ario, who is now the managing director at Mannatt Health Solutions. “Otherwise, it will be more of a gradual transition.”

He said it could be possible for states in some regions — like the Great Plains, where the politics and populations are similar — to leave HealthCare.gov in favor of their own, more autonomous system.

“You can imagine an SEC exchange,” he said, referring to states participating in the Southeastern Conference college football league. “Maybe they could run an exchange really well.”

The idea is becoming more attractive as more and more states are facing dwindling budgets.

Already, Oregon and Nevada have been forced to scrap their own systems and move to the federal exchange. Hawaii is now nearing a shutdown of its program after lawmakers rejected a last-ditch $10 million funding request.

The costs of running Vermont’s ObamaCare exchange are expected to rise to $200 million this year, while California has made major cutbacks after seeing less-than-expected enrollment figures. Its latest budget, released last week, scales down the budget for advertising, outreach budget and technology services.

For all states, technology is the biggest cost item and the biggest barrier for states to set up their own exchanges.

The Obama administration, which has given $5 billion in grants to help launch exchanges, has already pushed back the deadline for state marketplaces. Exchanges were initially told to be self-sufficient by 2015.

Still, while forming larger exchanges could make financial sense for the states, it could risk a political backlash.

The state-based exchanges were included in the Affordable Care Act to calm fears that the law would lead to a new, national system for obtaining insurance similar to a “public option.”

Kevin Counihan, the CEO of HealthCare.gov, said earlier this month that he has been encouraging to share “best practices” among state marketplaces that are struggling.

“Our role is to do everything we can … to help those states succeed,” Counihan told a group at the Health Insurance Exchange Summit earlier this month.

Wadleigh, who will speak at the CMS-sponsored July conference, said officials have been “very supportive” about his discussions with other states, including multi-state partnerships.

A spokesperson from CMS declined to answer questions about the exchanges.

DISB Press Release: Insurers File Proposed Rates for 2016 Health Plan Offerings on DC Health Link

These filings mark the beginning of the department’s rate review process.
DISB Press Release
For Immediate Release
May 15, 2015
Contact: Kate Hartig, (202) 442-7753
kathryn.hartig

Insurers File Proposed Rates for 2016 Health Plan Offerings on DC Health Link

Washington, D.C. – The D.C. Department of Insurance, Securities and Banking received 162 proposed health insurance plan rates for review from four major insurance companies in advance of the third year of open enrollment on DC Health Link, the District of Columbia’s health insurance marketplace.

These filings mark the beginning of the department’s rate review process where department actuaries engage with the insurers to determine if the rates are reasonable by law and should be approved for sale on DC Health Link.

The same four major insurance companies as last year – Aetna, CareFirst BlueCross BlueShield, Kaiser Permanente and UnitedHealthcare – have proposed rates for individuals, families and small businesses for the 2016 plan year.

The proposed rates are generally higher than last year and increases vary among the insurers; however insurers may submit revised rates during the department’s rate review process. Last year, three of the four insurance companies (Aetna, CareFirst and United) lowered their rates from what was initially filed.

“Prior to the Affordable Care Act, health insurance pricing was not transparent and consumers didn’t always know what they were going to pay for health insurance prior to enrollment,” said Acting Commissioner Chester A. McPherson. “Insurers also didn’t know the prices of their competitors. By publicly releasing the rate information as part of the rate review, insurers compete for District insurance business and consumers can plan for health care costs.”

As insurers enter the third year of DC Health Link, they have refined their plan offerings based on market experience – from 301 plans in 2014, 227 in 2015 and a proposed 162 for 2016. For individuals, 26 plans were proposed: Kaiser (11) and CareFirst (15). In the small business market, 136 plans were proposed: CareFirst (53), United (41), Kaiser (24) and Aetna (18). Aetna is no longer offering plans in the individual market.

McPherson added that additional safeguards are in place to protect consumers from unfair rate increases. The Affordable Care Act requires insurance companies to spend at least 80 percent of the premium dollars they collect on medical care and “improvement qualities,” or reductions in medical errors. These percentages are known as “Medical Loss Ratios” or MLR. “If an insurer does not meet this requirement, it must provide a rebate on the portion of the premium dollars that exceeded this limit,” said McPherson. “This is part of what we look at in our rate review process.”

To view the proposed rates and additional information, follow this link. The department will announce any new proposed rate filings and maintain rate information at disb.dc.gov/2016rates.

In early power struggle with council, D.C. mayor could win battle, lose war

D.C. Politics

In early power struggle with council, D.C. mayor could win battle, lose war

By Aaron C. Davis, Washington Post, May 16

In her first budget — and her first major test of wills with the D.C. Council — Mayor Muriel E. Bowser has sought to invest heavily in affordable housing and to expand the power of her office.

And as council members gear up for final negotiations this week, their actions have made clear that she is almost certain to get the former but not the latter.

In a spending plan that Bowser said would set the tone for her four-year term, the mayor declared a mandate to focus on the city’s widening income gap. And council members have said they support that goal. From increasing spending on social services and education to replacing dilapidated shelters for the homeless, the two sides agree on more than 90 percent of the District’s $13 billion spending plan.

But in the last week, council members have also clearly signaled that they are unwilling to give Bowser more power, as she has requested, to rewrite the rules for how she can tackle her priorities.

Bowser entered office with the momentum and purpose of an overwhelming win at the polls — and with an ambitious agenda to tackle anew the vexing issues that haunted her predecessors. But early in her term, Bowser is facing a council willing to define the boundaries of her agenda more assertively than she had hoped.

The council’s Judiciary Committee last week struck down Bowser’s request to consolidate power in her office — and away from the District’s first elected attorney general — to review contracts, legislation and land deals signed by her administration to build new housing and other projects.

The Finance Committee rejected a quarter-cent sales tax increase that she proposed. With city revenue rising almost 3.5 percent, members said, Bowser’s rationale for needing the money for homeless services seemed flimsy.

The council also took a first step to nix Bowser’s request to hire and fire at will several top city bureaucrats, saying it could create a perception that legal and scientific decisions were subject to political influence from the mayor.

And Judiciary Committee Chairman Kenyan R. McDuffie (D-Ward 5) pressed pause on the mayor’s budget request for $5 million to outfit every patrol officer with a body camera. He said that he couldn’t go along with Bowser’s demand to shield the footage from release under public records laws.

Disputes ‘on the margins’

Council Chairman Phil Mendelson (D), who has broad power to shape the final $13 billion budget plan, said the mayor would get the overwhelming majority of funding she requested.

But on controversial issues, including those involving mayoral authority, there “would be disagreements on the margins,” Mendelson said “We can go to the mat on those.” The chairman said he was girding for a battle with Bowser before the May 27 vote because “every indication is that the mayor is going to resist any change” to her proposed budget.

Indeed, the Bowser administration is forcefully lobbying council members to move closer to her original proposals — and not to undercut others.

Bowser’s city administrator, Rashad M. Young, said he is worried about how Mendelson and the council will close a roughly $30 million gap between the mayor’s proposals and the council’s if the sales tax increase and other revenue generators are off the table.

In addition to rejecting the sales tax increase, Finance Committee Chairman Jack Evans (D-Ward 2) last week cut Bowser’s proposed tax increases on parking and on vapor cigarettes.

“I’m quite concerned,” Young said. “It’s not clear yet how that revenue gets replaced or what other reductions are going to be made to offset those,” he said.

The council is on board, however, with Bowser’s proposal to put $100 million toward affordable housing projects next year and to direct $40 million to begin constructing replacements for the troubled family homeless shelter at the former D.C. General Hospital campus.

The administration is also closely guarding money to continue long-term welfare payments to about 6,000 families for one more year, a major concern of advocates for the poor. Bowser is also adamant that the council retain $7 million she has proposed to allocate for students to ride free to and from school not just on Metro buses, but also on Metro trains.

‘Creating real problems’

Bowser’s administration has made exceedingly clear that it’s not done pushing for its priorities.

Young and other aides pointed to cuts Mendelson proposed late last week as reason to be concerned that he may further whittle down the mayor’s initiatives. Mendelson’s committee shaved a million dollars or more from each of several redevelopment projects, including a few dear to voters in Bowser’s home Ward 4: the rehabilitation of the former Walter Reed Army base and the new town center planned for the site of McMillan sand filtration site.

“I don’t quite understand the thinking or the logic of what that will accomplish,” Young said. “It’s creating real problems for us in terms of what we had planned and . . . isn’t going to help get those projects off the ground.”

One area that seems settled for now is continued autonomy for Karl A. Racine, the district’s first elected attorney general. Bowser had proposed making her in-house attorneys her prime counsel for land deals and other high-stakes city contracts.

After a backlash, the mayor’s office proposed tabling the issue. The council last week also backed Racine in his request to revive a consumer protection fund in his office, to direct $15 million to the effort, and to give him subpoena power to conduct investigations on that front.

Young said the administration supports the idea, just not the funding source, which would come from money earmarked for Metro, he said.

Young said the administration will also keep pressuring the administration to go further on body cameras.

McDuffie, the judiciary chairman, proposed halving Bowser’s request for 2,400 cameras. His plan, which now goes before the full council, would require the administration to work with civil liberties advocates, the police union and others toward a plan to share the footage with the public.

In a news conference outside the U.S. Capitol, Bowser last week called McDuffie’s move “two steps backwards” from her “bold” proposal to increase police accountability. She also urged the full council to reject McDuffie’s proposal. On the mayor’s official Twitter account, a Bowser spokeswoman last week urged voters to “hold Councilmembers accountable” on backing the mayor’s plan on body cameras.

In an interview, McDuffie dismissed the criticism and the tough talk from Bowser. “The whole idea is to enhance transparency and promote accountability within law enforcement,” said McDuffie, a former federal prosecutor. “You don’t do that when you say, essentially, that MPD [Metropolitan Police Department] and the executive are the only ones to decide who gets the footage.”

Abigail Hauslohner and Jonathan O’Connell contributed to this report.

Aaron Davis covers D.C. government and politics for The Post and wants to hear your story about how D.C. works — or how it doesn’t.

Inova’s cancer center receives major gift from prominent homebuilder

Inova’s cancer center receives major gift from prominent homebuilder

May 18, 2015, 12:01am EDT

Courtesy

Dr. Donald "Skip" Trump was hired to lead Inova’s cancer center in December. On Monday, Trump will formally be named chief of the Inova Dwight and Martha Schar Cancer Institute, following a gift from the founder of NVR Inc. and his wife.

Tina Reed

Staff Reporter- Washington Business Journal

Inova Health System’s cancer center will receive a $50 million boost toward its personalized medicine ambitions in a major donation from home construction mogul Dwight Schar and his wife, Martha Schar, officials plan to announce today.

Inova will use the gift from Schar, the founder of Reston homebuilder NVR Inc. (NYSE: NVR), to create endowments to recruit top research talent. The $200 million cancer center — to be located by 2018 at the former Exxon Mobil campus across the street from Inova’s flagship Fairfax hospital — will be named the Inova Dwight and Martha Schar Cancer Institute.

"This is obviously a tremendous gift not just for Inova but for the people of Northern Virginia and an opportunity to bring them a first-class cancer program and the science and genomics that go with it," said Dr. John Niederhuber, CEO of Inova’s Translational Medicine Institute, which is now part of the cancer center.

The health system also plans to formally name Dr. Donald "Skip" Trump, hired from the Roswell Park Cancer Institute in December, as the first director of the Schar Cancer Institute.

The institute is a major part of Inova’s effort to establish the Inova Center for Personalized Health at the Exxon Mobil site. The project stands to have a catalytic impact on the commonwealth’s floundering efforts to embrace life sciences, an industry mostly rooted in Maryland in this region. The new center would set the stage for Inova to partner with both universities and medical colleges as well with private companies to commercialize the research generated there.

Inova has been working to create the cancer effort for the last several years and is fast expanding its daily use of genomics for different clinical applications, such as in treating lung cancer patients. But the funding will allow the center to be competitive in building a team of researchers well in advance of opening at the Exxon Mobil site.

"These are resources that can be used immediately,” Trump said. “This funding will jump-start this program."

Cancer immunotherapy — or the harnessing of the body’s immune system to help fight cancer — as well the study of how genetics impact patients’ response to drugs are expected to be key components of work at the center, Trump said.

Trump anticipates the center will ultimately employ between 1,000 and 1,200 new people, including 300 to 350 clinical scientists and additional support jobs, such as laboratory technicians, required to run a cancer center of the size Inova is creating. "I am confident this will be an international center of importance," he said.

Gerry Gordon, president and CEO of the Fairfax County Economic Development Authority, said Schar’s gift makes a statement about what’s happening at Inova.

"It’s such a large gift,” he said. “It really attracts attention. So much of what we do is not only based on reality, but on perception that this project really has legs."

Tina Reed covers health care.

Hogan signs ‘Uber’ bill

Hogan signs ‘Uber’ bill

By Luz Lazo May 12 at 1:48 PM

It’s official. Gov. Larry Hogan (R) has signed into law a bill legalizing rideshare operations in Maryland.

The Uber bill authorizes the Maryland Public Service Commission to regulate Uber, Lyft and other app-based ride services operating in the state. Hogan’s signature makes Maryland the latest jurisdiction in the region to set regulations for the growing industry, ending months of uncertainty about its future in the state.

Hogan signed this and nine other “economic development and job creation” bills. The law will go into effect July 1.

Erin Montgomery, a spokeswoman for Hogan, said the governor commends the bill’s sponsor and other lawmakers for bringing together stakeholders “to develop a bill that creates a forward-thinking framework for bringing transportation network services and more jobs to our state. The Governor will proudly sign this bill into law.”

Uber, which is now operating in 57 countries, has been actively pushing cities to pass new laws that will get the car-sharing service out of the legal gray area in which it still operates in many places. So far, more than 40 jurisdictions have adopted rideshare regulations, according to Uber. The Maryland law brings the industry into compliance with permanent rules that classify the app-based car services in a different category than traditional taxis.

“We applaud Governor Hogan for following in the footsteps of 18 other states and moving ridesharing legislation across the finish line, permanently securing more jobs and transportation choices for all Marylanders,” Uber spokesman Taylor Bennett said. “We look forward to continuing to provide safe rides and the economic opportunities they create for many years to come.”

Rideshare and traditional taxi and sedan companies support the legislation. They say it provides a comprehensive regulatory framework that ensures reliable insurance protections and safety for the public.

Under the law, the public service commission will regulate the new transportation industry, and issue licenses to the companies and their drivers. The companies must prove they have a stringent background check system that requires fingerprinting of all drivers. Additionally, they would need to have insurance policies that protect consumers and other drivers.

Although taxi companies had opposed an earlier version of the bill, they voiced support after several changes were incorporated. Yellow & Checker Cab of Baltimore said the legislation closes many insurance gaps not addressed under existing Maryland law and reforms existing taxi and sedan statutes to promote “fair competition” and “a more level playing field.”

Bowser ally LaRuby May victorious in Ward 8 council race by a 1.09% margin

D.C. Politics

Bowser ally LaRuby May victorious in Ward 8 council race by a 1.09% margin

By Abigail Hauslohner, Washington Post, May 8

LaRuby May, a former campaign staffer to D.C. Mayor Muriel E. Bowser, has won the Ward 8 seat on the D.C. Council, according to an unofficial final tally the D.C. Board of Elections released Friday night.

May’s win marks a fresh victory for Bowser, who campaigned actively for fellow Democrats May and another former aide, Brandon Todd, who won in Ward 4. With them, Bowser gains two new allies on the 13-member council as she pushes forward with her agenda and a proposed $12.9 billion budget for fiscal 2016.

May won in Ward 8 with 1,955 votes and a 1.09 percent margin, according to Denise Tolliver, a spokeswoman for the elections board. A margin slimmer than one percent would have automatically generated a recount, she said.

May’s chief opponent, Trayon White, said he will ask for a recount.

The elections board will hold a public audit of the votes Monday and will certify the votes May 14. May and Todd could be sworn in the same day.

Tolliver said a recount would have to wait until the results are certified, and that even then, the new council members could start work.

“It’s up to the council when they swear the people in, but they can be sworn in on the 14th, whether they request a recount or not,” Tolliver said.

When polls closed April 28, May and White — who is a self-described protege of Marion Barry’s — were just 152 votes apart in the race to fill Barry’s vacant seat on the council.

The elections board had until 5 p.m. Friday to tally more than a thousand outstanding provisional ballots, pending proof of residency from some voters who had registered the same day as the special election.

The board also accepted absentee ballots, postmarked no later than April 28, until 5 p.m. Friday.

White, who emerged from a large field of candidates, said he believed that many of the provisional ballots would go to him, tipping the race.

In the end, May won by just 80 ballots.

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