Jeff Agenbroad is one of four directors representing small-business employer interests and chairs the Finance Committee. A former TitleOne Corp. vice president, he founded Since 86 Inc., a Nampa holding company that owns a licensed debt buyer, gravel pit and farm property. Agenbroad recently joined the commercial banking division of Zions Bank in Boise.
“We have a broken health care system. It’s not a broken insurance system, hospital system, doctor system, consumer system or tack on anything else related to health care,” he says. “It’s the entire system that’s broken, and that’s what attracted me to help.
“I don’t think there are any magic bullets, but I have faith that a free-market exchange will help. There will be many, many bumps in the road, but I think with our Idaho resilience we’ll succeed.” firstname.lastname@example.org
Frank Chan, right, has a bachelor’s degree in computer science from Virginia Tech, owns Consistent Internet Income and co-owns Time2Tiki.com, a Virginia-based manufacturer of Dave & Anna’s Signature Blends. Mark Estess, Idaho state director for AARP, is at left. The website markets salad dressings, stir-fry sauce and Mai Tai Mix made famous in Alexandria, Va., by Chan’s parents’ Honolulu Restaurant, which closed after more than 25 years when it was condemned for a bridge project.
During the first week he worked to set up the Time2Tiki website, Chan said he slept about 16 hours. “That start-up process mirrored what we did here. It’s an impressive amount of progress in a short period of time.”
Chan says Idaho’s experience may set a national standard. “I suspect they’re watching how we implement because some of the other states may want to follow a similar path to ease into a state-based marketplace.” email@example.com
Hyatt Erstad has run his family’s Boise insurance agency, Erstad and Co., since his father’s untimely death at 51 in 1979. Representing insurance agents, Erstad says more change has happened in the business in the last two years than in the 32 that preceded them.
“We may not like the taste of the medicine, but we’d much rather be able to hold the spoon and deliver it ourselves instead of having it forced down,” he says. “That way we can keep the Idaho independence around it to where I think we’ll have a viable exchange.”
He says, however, that federal rules are a drag. “It’s like saying I’m going to show you how to crack an egg but now I’ve got the federal government in here and it takes a 12-page explanation on how we’re going to crack the egg.” firstname.lastname@example.org
Mark Estess, Idaho state director for AARP, was trained as a lawyer, represents consumers on the board and chairs the Outreach & Education Committee. “We’re staying focused on putting the consumer at the forefront of the investment we’re making to directly benefit Idahoans,” he says.
Estess says “managing expectations” is important as the exchange gets its sea legs.
“It’s essentially a new company and infinitely more complex than people can appreciate,” Estess says. “This is not going to happen overnight. We’ll be able to enroll folks Oct. 1, but the other transformational benefits will play out in ’15 and ’16 and years to come as we continue to build the partnerships to inform and create value in the state-based exchange.” email@example.com
Margaret Henbest, a nurse, represents health care providers and chairs the Small Business Health Options Committee.
She said many providers regret not self-correcting when skyrocketing costs made the system unsustainable. “In my world, there are a lot of people kicking and screaming about reform, but they also are embracing the cost and quality initiatives.”
Margaret Henbest said she was “stunned” at how the board “pulled together for the greater good” despite competitive pressures over politics and business interests. “People are seeing past potential disagreements early on. I think that will surface over time — the stronger disagreements and political issues.”
But for those who speak of repeal, Henbest says, “I don’t know what the options are if this falls apart. I wish people were asking that question and pushing for answers.” firstname.lastname@example.org
Scott Kreiling is president of Regence Blue Shield of Idaho and represents health insurance carriers on the board. Regence’s BridgeSpan affiliate is offering policies on the exchange.
“We know the challenges of Idaho better than the federal government does,” says Kreiling. “It’s something built by Idahoans for Idaho. That makes sense.”
A member of the boards of the Boise Metro Chamber of Commerce, Idaho Association of Commerce and Industry, Treasure Valley YMCA and Leukemia and Lymphoma Society, Kreiling says the most important measure of success will be how many people sign up.
“The subsidy is making it more affordable, so people can access preventive care rather than go to the emergency room.” email@example.com
Dr. John Livingston served 14 years active duty in the Navy as an internist and surgeon and continues to teach trauma surgery at Fort Sam Houston in Texas. He represents providers on the board and chairs the Operations Committee.
He calls himself a “Barry Goldwater-Ronald Reagan Republican” who opposed the Affordable Care Act and “firmly believes in the marketplace and its ability to set pricing.” But he also backs the state exchange.
Livingston resists calls from some stakeholders to focus on specific medical problems such as neonatal morbidity or breast cancer. “That isn’t what the exchange is. It’s a place where you buy health care insurance and take the burden of responsibility off your shoulders. Nothing more, nothing less. And I think we’re doing a good job of marketing it as that — not as a cure for obesity or anything else.” firstname.lastname@example.org
Rep. Kelley Packer, R-McCammon, cast her “no” vote in July, objecting to the Department of Health and Welfare supplying the technical infrastructure for the call center. The center will be staffed by 10 exchange contract employees. Your Health Idaho will pay Health and Welfare for technical support. Packer noted that lawmakers wanted a clear divide between state government and the quasi-public exchange.
“Most of my questions have been answered, but it still just doesn’t set well with me to have a state agency as our call center,” says Packer, who has worked in advertising, broadcasting, human resources and as a country singer.
Still, she says she has no regrets for helping pass the exchange and is committed to making it work. “If I’m going to vote for something then I better be willing to support it long term.”
Rep. Kelley Packer says she expects a challenger in the 2014 GOP primary over the exchange. Rice, R-Caldwell, says he, too, is ready to explain his support.
“I think people in my district understand why I voted that way and agree,” says Rice, a lawyer who chairs the Governance Committee. “I don’t think my district really wants the Affordable Care Act, but they understand why we should do a state exchange.
“If I can explain logically and reasonably why we need to do something, that’s what I’m there for. I’m not there just to worry about the next election.” email@example.com
Rep. John Rusche, the House Democratic Leader from Lewiston, is a retired pediatrician who also worked for Regence Blue Shield. He says delaying a decision on the exchange from 2012 to 2013 will likely cost more money because of the rush.
After federal grants run out, Idaho will rely on premium fees to operate the exchange.
“The exchange has to provide value for the customer,” Rusche says. “My expectation is that not only individuals will want to use it, but small groups and even brokers and agents will use it to help their customers out.
“Without changes in the system, the cost of employee health insurance is going to become prohibitive. Business will not be able to compete internationally, they will not be able to pay employees well — unless there’s a way to get control of the acceleration of health care costs.” firstname.lastname@example.org
Dave Self is senior vice president of marketing and regional director of Idaho and Washington for PacificSource, an insurer offering policies on the exchange.
Self says low-income Idaho subsidies of $500 to $700 a month for a family should tempt the most firm opponents of the Affordable Care Act.
“I think a lot of people, once they figure out what the amount is, are going to have to make a decision: Do I accept the premium tax credit, regardless of my politics? I think it’s an economic-driven decision for most households. It’s pretty tough to walk away from 5, 6, 7 percent of your total income.” email@example.com
Kevin Settles, president and CEO of Bardenay Restaurant and Distillery in Boise, says he’s no fan of the new law “but I want to see how I can turn this thing to make it work to my advantage.”
Settles, who represents small employers on the board, this month expanded his company’s health insurance coverage from 15 salaried employees to an additional 45 full-time hourly workers.
“I just shake my head when I see how we are going to spend a lot more money on this exchange, and it’s extremely confusing and complex, and we’ve created a bigger bureaucracy,” he says. “But it looks like it actually might moderate health insurance rates.”
Shores, a Boise insurance agent, told a Senate committee in March that his mother would have washed his mouth out with soap had he spoken frankly about his views of the Affordable Care Act. But Shores says now that it’s the law of the land, he wants to make sure salespeople can survive reform.
“We have to do the best we can,” Shores says. He remains frustrated with federal authorities who “think we can set this up like Expedia. It’s a lot more complicated than that.”
Shores firmly believes many consumers need agents to find the best policy. “Maybe I’m being a little pain-in-the-rear-end or paranoid, but my feeling is if I don’t stand up for these guys, no one else is going to do it.” firstname.lastname@example.org
Karen Vauk, president and CEO of the Idaho Foodbank, says she was puzzled when she was asked to serve on the board as a consumer advocate when she had little insurance expertise.
“It became clear that it was not only an opportunity for me to represent all consumers, but to represent the population we’re close to at the Foodbank,” she says. “That’s when I was hooked.”
Schooling herself in the subject, Vauk says, “I had no idea how big and complex this really was.”
Vauk expects problems but says access to care will improve. “This opens the door. It’s highly unlikely the system will be perfect from the start. But where does that happen?”
Veloz is chief financial officer of M S Administrative Services in Meridian, a third-party administrator of employee benefit plans. He also chairs the Employers Health Coalition of Idaho and testified on behalf of the state exchange at the Legislature.
After he spoke, Veloz said, he was confronted by opponents. “They said, ‘Hitler was a dictator and you’re a dictator, so you’re a Nazi!’
“I was just trying to get a message across that the state-based exchange is in the best interests of the whole state, both for the insured and uninsured population. I want to see this thing through from start to finish.” email@example.com
Stephen Weeg, the board chairman, ran a community health center in Pocatello, worked at Idaho State University’s Institute of Rural Health, was a private consultant, ran State Hospital South in Blackfoot and was a regional director at the Idaho Department of Health and Welfare.
“I’ve spent 40-plus years in health and human services. I’ve seen the impact of what happens to people without health insurance. I saw this as a vehicle that could make a difference in the lives of a lot of people getting access to health care and living a healthier life. That’s what drives me.” firstname.lastname@example.org
Zelda Geyer-Sylvia, president of Blue Cross of Idaho, was the only voting member to decline comment. Blue Cross is selling insurance on the exchange, and Geyer-Sylvia represents carriers on the board.