Idaho’s health exchange down to the deadline

This board has been working since April to make Idaho one of three states led by Republican governors operating their own health insurance exchanges. Business Insider spoke with 16 of the Idaho Insurance Exchange board’s 17 voting members.

dpopkey@idahostatesman.comSeptember 24, 2013 

With just over five months to complete a monumental job, the Idaho Health Exchange Board says it will meet its deadline and open an online insurance marketplace next week.

“A year ago, I would have said it was impossible to get where we are,” says Dr. John Livingston, a member of the unpaid board and the 2012 task force that recommended the state-based exchange to Gov. Butch Otter and the Legislature. “There are so many moving parts.”

After a year to build support, Otter finally convinced reluctant lawmakers, who took final action on House Bill 242 on March 21.

On Oct. 1, YourHealthIdaho.org will offer 146 health plans to about 190,000 eligible uninsured Idahoans, as well as to those who wish to one-stop comparison shop. Enrollment will continue through March. The first policies take effect in January.

Consumers can get advice from Idaho insurance agents, a crew of newly trained “assistors” or “navigators” who must be fingerprinted and pass state-mandated background checks, and a call center.

Stephen Weeg of Pocatello, who has spent 40 years in health and human services, turned down an offer to serve as the executive director of the exchange. But Weeg agreed to Otter’s entreaty to chair the 19-member board of directors, which first met April 22.

“We started with no staff, no office, no funding, a prohibition against using any state money and the challenge of doing something in five months that other states and the federal government had over two years to work on,” Weeg says. “Other than that, it was a piece of cake.”

House Minority Leader John Rusche, D-Lewiston, is one of three legislators on the board. He likens the last five months to a belated birthday cake. “We’re baking a multimillion-dollar business from scratch. You don’t just add water and expect it to be completed.”

“These people are doing a big, big job,” says House Speaker Scott Bedke, R-Oakley, Otter’s single-most-important ally on the exchange. “We are in many ways ahead of other states that have had much more time. I’m no fan of the Affordable Care Act, but we’re making this the lesser of two evils.”

IN BED WITH THE FEDS

Director Jeff Agenbroad laments that the Legislature didn’t act in 2012. “I think it’s kind of sad the Legislature’s put us in this position with a short time frame to do such a huge job,” says Agenbroad, board treasurer.

Moving quickly, the board hired Executive Director Amy Dowd on its second day, drawing criticism from the Idaho Freedom Foundation, the exchange’s biggest foe, for not doing a longer search and for paying her $175,000 a year. Dowd helped develop Idaho’s exchange blueprint in 2010-11 and was working as a health care consultant with Ernst & Young in Portland. From 1993 to 2000, she was an IT project manager at Idaho Power Co.

“Amy was the one person who had her finger on the pulse long enough to know how to do this,” says Director Kevin Settles of Boise, owner of Bardenay Restaurant and Distillery.

Dowd was on the phone for the board’s next meeting on May 9, when the board voted for something it knew would draw blood: using the federal IT platform to support the Your Health Idaho website in the first year.

“There was just too much work to do,” says IT Committee Chairman Frank Chan, owner of Applied Computing in Boise. “Though it may not be too popular, we had to make a decision and get something up for the citizens of Idaho.”

“That was a huge deal from a political standpoint,” says Director Margaret Henbest, a Democrat who represented Northwest Boise in the Idaho House from 1996 to 2008 and who is executive director of the Idaho Alliance of Leaders in Nursing. “It was really the most pragmatic and wisest decision we could have made, given the time frame. The board pulled together for the greater good to get the job done quickly and without rancor.”

Among the tasks completed in short order were creating six committees and leasing office space across from the Capitol; adopting bylaws and conforming to the state fiscal year; establishing procurement, travel, HR, finance and public record policies; hiring a bookkeeper, attorney and consultant; and opening a bank account and establishing credit without any cash.

The only “no” vote cast during 10 board meetings between April and August came from Rep. Kelley Packer, R-McCammon, part of a gang of 14 freshmen that pushed the exchange through the House.

But Packer seconded the motion to use the federal IT platform for the first year. This week, the board will solicit vendors to operate a state-run IT system by Oct. 1, 2014.

“When you’re moving as fast as we’re having to move, there’s not a lot of time for dissension,” Packer says. “We have plenty of diversity. It’s not stacked as much as we don’t have the luxury of going back to the drawing board.”

EYE ON IDAHO

Of the 16 states and the District of Columbia operating their own exchanges, just three have Republican chief executives: Idaho, Nevada and New Mexico. Twenty-seven states have defaulted to a federally operated system and seven states are using a state-federal partnership.

Otter joined other GOP governors fighting to overturn the law, but argued that once the Supreme Court upheld Obamacare, a state exchange would better serve Idaho consumers and business. Unveiling the Your Health Idaho logo and website last month, Otter thanked Democrats and Republicans “for their recognition that this is a responsibility that the rule of law puts on us, and we are going to be handling it to the best of our ability.”

Director Tom Shores of Shores Insurance in Boise is president of the Idaho Association of Health Underwriters. He says he’s focused on advocating for agents like himself whose business model has been turned upside down. About 10 percent of Idaho’s 6,000 agents have taken the certification course to sell on Your Health Idaho, and more are expected to sign up.

“The state has done an incredible job of making sure that everything is set up and geared to make sure the agent is part of the process,” Shores says.

Weeg, the board chairman, says the federal government has been “very responsive to our needs,” including waiving a 3.5 percent premium fee for the IT platform. “It’s been very obvious that they are very eager to see us succeed as a state-based exchange.”

The board has asked for another $50 million federal grant on top of $20.3 million already awarded. The board estimates total start-up and operating costs for the first year at $70 million. Most of the money will pay for IT infrastructure to allow Idaho to operate its own platform, which must start by Oct. 1, 2014, Weeg says.

Because the first grant wasn’t immediately available, Health and Welfare Director Dick Armstrong loaned the exchange $385,000 from a federal bonus fund, which warranted a dry notation in the board’s June 5 minutes: “The exchange now has money in the bank, and bills can be paid.”

The board voted Sept. 16 to pay the money back by month’s end, addressing concerns about the Legislature’s prohibition on the use of state taxpayer support for the exchange.

A JOB WORTH DOING?

A $5.7 million contract has been awarded to Gallatin Public Affairs of Boise for outreach and education between August and April. Of that, $3.55 million is for advertising. To satisfy the law’s requirement for those who want in-person assistance, $1.7 million has been budgeted for face-to-face customer service.

The state’s premium fee is set at 1.5 percent, less than half the federal rate, a figure that Sen. Jim Rice, R-Caldwell, says proves the worth of the state effort.

“We told the people of Idaho it would cost them less, that there would be differences between the state and federal exchange and that we’d be able to control some things,” says Rice, also a board member. “We’ve done that.”

Idaho Freedom Foundation Executive Director Wayne Hoffman says he’s “done plenty of foot-stomping” about pay for five full-time employees, the rush to hire Dowd and the use of the federal IT platform. But he credits the board for working to protect personal information.

“The fault for the fact they’re implementing Obamacare rests with the Legislature and Governor Otter,” Hoffman says. “The board was appointed to do a job, and they’re doing that job.”

But days before the exchange opens for business, Hoffman’s feet are still pounding. “It’s quite possible on Oct. 1 that there will be some states with no health exchange whatsoever and Idaho will have one. Those other states will be better positioned to fight Obamacare.”

Chairman Weeg says a board that some feared would prove unwieldy — with 17 voting members, plus Health and Welfare Director Armstrong and Insurance Director Bill Deal as nonvoting members — has proved its mettle. (Click here to meet the 17 board members)

“Most people roll their eyes and say, ‘You should never have a 19-person board,’” Weeg says. “But the truth is what’s been amazing to me is people have come to the board with different agendas, different political perspectives and different orientations and the board has been incredibly cohesive. It has pulled together and worked hard to make an Idaho exchange a success.”

Dan Popkey: 377-6438, Twitter: @IDS_politics

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