Printed on: September 25, 2013

Idaho health insurance marketplace to open on time

By DAN POPKEY
Idaho Statesman

BOISE -- With a little more than five months to complete a monumental job, the Idaho Health Exchange Board 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," board member Dr. John Livingston said. "There are so many moving parts."

Livingston also was a member of the 2012 task force that recommended the state-based exchange to Gov. C.L. "Butch" Otter and the Legislature.

Starting Oct. 1, YourHealthIdaho.org will offer 146 health plans to about 190,000 eligible uninsured Idahoans, as well as to those who want 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 call center and a crew of newly trained "navigators," who must be fingerprinted and pass state-mandated background checks.

Stephen Weeg of Pocatello, who has spent 40 years in health and human services, turned down an offer to serve as exchange executive director. But Weeg agreed to head 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 said. "Other than that, it was a piece of cake."

House Minority Leader John Rusche, D-Lewiston, is one of three legislators on the board.

"We're baking a multimillion-dollar business from scratch," he said. "You don't just add water and expect it to be completed."

In bed with the feds

Director and Board Treasurer Jeff Agenbroad lamented that the Legislature didn't act in 2012. It took Otter a year to finally convince reluctant lawmakers, who took final action on House Bill 242 on March 21.

"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," Agenbroad said.

The board hired Executive Director Amy Dowd on its second day, drawing criticism from the Idaho Freedom Foundation, the biggest foe of the exchange, for not doing a longer search, as well as 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, Ore. 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," said Director Kevin Settles of Boise, owner of Bardenay Restaurant and Distillery.

Dowd was on the phone for the board's next meeting May 9, when it 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," said 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," Director Margaret Henbest said. "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." Henbest, a Democrat who represented northwest Boise in the Idaho House from 1996 to 2008, is executive director of the Idaho Alliance of Leaders in Nursing.

Tasks completed in short order included creating six committees and leasing office space across from the Capitol; adopting bylaws and conforming to the state's 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. 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 said. "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, only 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.

Board Chairman Weeg said the federal government has been "very responsive" to the board's 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. Total start-up and operating costs for the first year are estimated 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.

Because the first grant wasn't immediately available, Health and Welfare Director Dick Armstrong loaned the exchange $385,000 from a federal bonus fund. The board voted Sept. 16 to pay the money back by month's end, addressing concerns about the Legislature's prohibition on state taxpayer support for the exchange.

A job worth doing?

A $5.7 million contract was awarded to Gallatin Public Affairs of Boise for outreach and education. 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, said 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," said Rice, also a board member. "We've done that."