Oregon Leads Way on Heath Insurance Exchange

Oregon received good news this week when the U.S. Department of Health and Human Services (HHS) announced “Early Innovator” grant awards to seven states that will lead the way in developing pilot health insurance exchanges, as part of the major health care reform legislation approved by Congress last year.

President Obama will be in the Portland area Friday to tour Intel and can be expected to say more about the grant while here.

The Oregon Health Authority will receive $48 million to design and implement the information technology (IT) infrastructure to operate an exchange. Consumer-friendly and efficient IT infrastructure will be a key component to ensure exchanges are a place where individuals and small employers can shop for, select and enroll in high-quality, affordable private health plans.

The Affordable Care Act, signed into law March 23, 2010, requires states to create “American Health Benefit Exchanges” by 2014. These exchanges will offer different health insurance plans for individuals and small businesses. According to the law, the exchanges can be administered by either a governmental agency or a nonprofit entity established by the state. Federal funding will initially be provided to ease the financial burden of creating the exchanges, which must become self-sustaining by 2015.

For the project, Oregon Health Authority is using commercially available, off-the-shelf software to create its exchange. Oregon will create a modular, reusable IT solution that will provide individuals and small businesses with seamless access to information, financial assistance and easy health insurance enrollment.

Using the exchange, individuals up to 400 percent of the federal poverty level are guaranteed assistance without gaps in their coverage. About 516,000 Medicaid beneficiaries and 277,000 commercial insurance consumers are expected to use the Oregon exchange.

During a time of economic shortfalls, Early Innovator Grants give states across the country a chance to invent exchanges that can be duplicated once the exchange requirements goes into 2014.

In addition to Oregon, Kansas, Maryland, New York, Oklahoma, Wisconsin and a consortium of New England states received funding. Grantees represent different regions of the country, as well as different exchange governance structures and Information systems. Obama administration officials hope this diversity will yield a range of IT models that fit different circumstances in various states.

However, Oregon could be proceeding at its own peril. With much uncertainty surrounding the future of national health care reform, Oregon could be getting a head of a game with shifting ground rules. Challenges to the constitutionality of the law are gaining steam and ultimately will be decided by the U.S. Supreme Court. There is a very real possibility that the court could not only strike down the individual mandate, which has come under fire, but the entire health care law.