Rhode Island can learn from Mass. reform effort

IDEAS EXCHANGE: Tufts Health Plan President and CEO James Roosevelt Jr., speaking, wearing glasses, says that the insurer is committed to the R.I. Health Benefits Exchange. / PBN PHOTO/RUPERT WHITELEY
IDEAS EXCHANGE: Tufts Health Plan President and CEO James Roosevelt Jr., speaking, wearing glasses, says that the insurer is committed to the R.I. Health Benefits Exchange. / PBN PHOTO/RUPERT WHITELEY

Many of the top supporters of health care reform in Rhode Island joined in a Providence Business News-sponsored panel discussion on “Health Care Reform and the Insurance Exchange,” held March 28 at the Crowne Plaza Providence-Warwick.
Christine Ferguson, executive director of what’s now called the R.I. Health Benefits Exchange, began the dialogue with a nuts-and-bolts overview of the exchange, promising that it will be “amazing and fantastic.” She called it a “once in multiple-generation” opportunity to change health care delivery for the better in Rhode Island – and the nation.
The exchange will be open for business on Oct. 1, Ferguson said, with a Web presence and comparison-shopping for the different health-insurance plans, as well as an informational contact center to help consumers with questions.
Actual enrollment through the exchange will begin on Jan. 1, 2014, Ferguson continued. There will be a six-month open-enrollment period for individuals, beginning in October, and small businesses with less than 50 employees will have a running enrollment period, depending on their renewal dates.
On April 2, the U.S. Department of Health and Human Services said that it was delaying employees from small businesses the choice to purchase health insurance in federally run exchanges for a year, until Jan. 1, 2015. However in Rhode Island, the plan remains to offer employees that choice beginning in Jan. 1, 2014.
“Our extensive outreach in the business community has shown that both small-business employers and employees clearly value choice in the exchange marketplace, and our intention is to build a program that will offer them full employee choice beginning in 2014,” said Ian Lang, associate direction of marketing and communications for the R.I. Health Benefits Exchange.
Testing of the exchange’s new IT system – which will include online Medicaid eligibility and enrollment for approximately 270,000 Rhode Islanders – will begin in April.
By Jan. 1, 2015, the exchange will need to become self-sustaining, without support from federal funds. Ferguson did not share any details of how that will be accomplished; fees consumers and insurers may be charged for the exchange’s services were not explained.
The biggest news Ferguson delivered in her opening remarks was that the exchange would have a new name. “The new name and branding of that name will be revealed as part of a marketing and outreach effort scheduled to begin in early summer. When asked about who is eligible to participate in the exchange, Ferguson suggested that those in attendance with questions go to the exchange’s Web site for specific details, adding: “The exchange is available for individuals who don’t have access to affordable health insurance.” Affordable, she continued, is defined as premiums that are less than 9.5 percent of income. The exchange is also open for small businesses with less than 50 employees, she said. It is not aligned with Medicare members.
James Roosevelt Jr., the president and CEO of Tufts Health Plan, spoke about what Rhode Island can learn from Massachusetts’ experience with its state health care reform law. Acknowledging that the state and federal laws are different, Roosevelt said that some general principles apply.
As a health insurer, he continued, Tufts is “very committed” to Rhode Island and its exchange. “The goal is to provide high-quality, affordable health care. This is going to require developing new products with different funding methods,” Roosevelt said. It will also require providers, payers and stakeholders working together, he continued, “something I think we are all doing now.”
Roosevelt also urged that the emphasis be on what works, rather than what may be held up as an ideal.
“One thing that Massachusetts did that was really important was the outreach effort and marketing campaign of its exchange, known as ‘The Connector,’ ” Roosevelt said, describing how the state partnered with the Boston Red Sox to get the message out to people. “This is a new concept for people, and you have to explain how it works and why it matters,” he said.
Like everything else in life, Roosevelt continued, “there are people who will try and game the system,” describing what he termed “jumpers and dumpers,” people who signed up for health insurance to deal with particular medical needs, and once they were met, dropped their insurance.
In Rhode Island, Roosevelt said that the rules were being configured to avoid this pitfall. “We have the opportunity to do this right from day one here,” he said. Roosevelt said that there would be a price to pay for the effort to deliver health care in a more affordable and more transparent manner. “There will be increases in premiums,” he said. “You don’t get anything … for nothing.”
Jumping into the conversation, R.I. Health Insurance Commissioner Christopher F. Koller warned the audience to be careful when they read stories predicting what increasing costs will be as a result of health care reform. “Nobody knows for sure about costs,” he said. Stories that attempt to predict the costs, Koller continued, “will be attempting to make a political point.”
Lt. Gov. Elizabeth H. Roberts attempted to reframe the discussion around costs, saying: “If we were to keep doing the same thing that we are now, the costs are going to go up,” she said. “We’re not really changing how we get health insurance, but how we get health care.”
Ferguson touted the accessibility and transparency of information on the new exchange, saying that consumers will be able to make apples to apples comparisons 365 days a year. The total costs of health insurance will be transparent, she promised. Further, she predicted that most employers in the state will not try to game the system, citing statistics that 98 percent of employers with more than 50 employees in Rhode Island offer employees health insurance. And about 50 percent of employers with under 50 employees also offer health insurance to employees.
“Employers will want to be engaged,” she said.
William E. O’Gara, a partner in the law firm of Pannone Lopes Devereaux and West, LLC who heads the firm’s litigation and employment teams, voiced optimism that the new exchange may provide some relief to businesses. “We’re in a state where the economy is so difficult,” he said. “Health costs suck all the oxygen out of the economy. The entire system stopped working several years ago.”
Ferguson said the new exchange system may provide employees with new freedom to choose jobs, because until now they have been shackled with what she termed the “golden handcuffs” of health-insurance benefits, unable to leave a position that they don’t like. “I would be really careful about how you think about health insurance,” she warned employers.
“A happy employee is a more productive employee,” Roosevelt chimed in. •

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