Seeking a say in design of exchange

Politics is the story of “who gets what, when and how,” as Yale political scientist Harold D. Lasswell once defined it. In that context, the creation of an ad hoc business advocacy group, the Coalition for Affordable Health Care Choices, to influence the design and operation of the R.I. Health Benefits Exchange is very much a “political” effort.
The spokesman for the coalition, Jim Borah, an insurance broker and president of trade association R.I. Business Health Care Advisors Council, defined the group’s goals within that framework. “We have a desire [for the health-insurance industry] to keep being able to offer a broad range of products for employers, employees and individuals, driven by those who are in the business,” in order to prevent “too much of that power being in the hands of government.”
The group has hired Cara Cromwell, a political consultant who managed John Loughlin’s failed 2010 Republican congressional campaign, to serve as its coordinator.
Borah could not say how much Cromwell is being paid.
At issue is the design and scope of the new R.I. Health Benefits Exchange, established in September 2011 by executive order by Gov. Lincoln D. Chafee, after a legislative effort to create such an exchange failed when it became mired in a political debate over abortion.
Nationally, such exchanges are a centerpiece of the Affordable Care Act, the federal health care reform law, with each state having the choice of designing their own exchange, or having the federal government run it. Under the law, states that choose to establish their own exchange can receive federal grants to help with implementation.
To date, Rhode Island has received about $100 million in federal grants to help establish the exchange.
In Rhode Island, the major responsibility of shepherding the exchange from design to operation belongs to Lt. Gov. Elizabeth H. Roberts. “The exchange is about providing Rhode Islanders easy access to affordable insurance from private insurers,” she said. “It is being built to be simple, to help Rhode Islanders easily understand their options, and to access tax credits to make their coverage more affordable.” Roberts said that the guiding principles of the new exchange, according to a strategic plan recently recommended by the exchange’s board of directors to Chafee, are “simplicity, affordability, flexibility and transparency.”
The origins of the new business coalition go back more than six months, when 10 of the current 16 coalition members signed a letter dated Sept. 8, 2011, addressed to Roberts and including corporate logos.
“Our organizations would like to recommend that the discussions regarding exchange development be focused on the functions the exchange is required to perform,” the letter read in part. “It is important to direct Rhode Island’s limited resources to meet these significant federal requirements in the short time that remains.”
The 10 members who signed the letter included: Tufts Health Plan of Rhode Island; the Greater Providence Chamber of Commerce; United Healthcare of New England; The Rhode Hospitality Association; The Oil Heat Institute of Rhode Island; Associated Builders and Contractors; Northern Rhode Island Chamber of Commerce; Rhode Island Business Healthcare Advisors Council; Independent Insurance Agents of Rhode Island; National Association of Insurance and Financial Advisors – Rhode Island; and Blue Cross & Blue Shield of Rhode Island.
Laurie White, president of the Greater Providence Chamber of Commerce, said that the coalition is still in its formative stages. “It’s starting an enterprise from ground zero,” she said. Among the concerns voiced by White was her opinion that the exchange’s operations should be kept small and focused.
Each of the three major commercial health insurers in Rhode Island – Blue Cross & Blue Shield of Rhode Island, UnitedHealthcare of New England, and Tufts Health Plan of Rhode Island – were members of both the initial working group and the “new” coalition. But each articulated its own reasoning for belonging to the group. For Blue Cross President and CEO Peter Andruszkiewicz, the coalition provides a way for the health insurer to work together with other insurers and businesses on “common interests.”
“There is no health-insurance association in Rhode Island,” Andruszkiewicz explained. In the coalition, he continued, “our interests are aligned. The coalition was created because there wasn’t a natural mechanism to work together on common interests.”
In terms of Blue Cross, he emphasized: “We have a good working relationship with Lt. Gov. Roberts, and we have a very productive relationship with our regulator [R.I. Health Insurance Commissioner Christopher F. Koller] as well.”
Moving forward, Andruszkiewicz said he believes that health care reform is essential. “I don’t think we’re going to be able to stop it, we’re going to have health care reform,” he said. “And, we are going to have it here faster in Rhode Island than in other states.”
The issue, according to Andruszkiewicz, “is how fast can we get to the tipping point on incentives [on payment reform]. It’s not just about what the health insurer wants; I think that’s what the business community wants, too.”
UnitedHealthcare, which has often provided a site to meet for the new coalition, positioned its participation as furthering its ability to listen and respond to the marketplace.
“UnitedHealthcare believes in listening closely to the Rhode Island marketplace and ensuring that we’re taking their interests into account,” said Stephen J. Farrell, president and CEO of UnitedHealthcare. “Our participation in the Coalition for Affordable Health Care Choices advances this commitment by creating the opportunity to engage in a positive dialogue with a broad-based coalition of Rhode Island employers, health-insurance brokers and providers.” Farrell called this a necessary process that “allows all of us to evolve, drive innovation and deliver results that respond to the needs of this market.” For Tufts, joining the coalition was not about creating a health-insurance association in Rhode Island, or about listening to the marketplace, but rather to be a participant in the ongoing conversation about how the exchange would work. “We do not see this as an opportunity to gain leverage, but a chance to participate in the conversation surrounding exchange implementation with a group of organizations with similar interests,” said Sonya Hagopian, vice president of corporate communications and public relations at Tufts.
Tufts did not feel that it had been left out of the process, but said it joined the group because, after participating in several meetings, “we felt that the members of the coalition shared many of the same positions that we have taken on exchange development,” she said. When asked to identify exactly what those “same positions” were, Hagopian did not respond.
Coalition spokesman Borah drew a bright line between the coalition’s efforts and those of the Rhode Island State Right To Life Committee, and its anti-abortion advocacy, which has filed a lawsuit to overturn the executive order creating the exchange, claiming that it usurped the authority of the General Assembly. “Our group is supportive of the exchange,” he said, adding that he felt it was unfortunate that the abortion issue had been entangled with the implementation of the exchange. “Ideally, we would like to see the exchange be created by the legislature and not an executive order.”
The development of the exchange in Rhode Island is happening at a rapid pace, according to Koller. Plans are still on schedule for it to be fully operational by October 2013. And, even if the U.S. Supreme Court rules against the Affordable Care Act, Roberts said it would not “prevent Rhode Island from continuing in the development of the exchange as a resource for Rhode Islanders to learn about and easily compare the quality and affordability of insurance options and enroll in coverage.” •

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