Gov. Dave Heineman voiced concern about whether a state-based health insurance exchange would be a wise course for Nebraska during a day-long public hearing on the issue.
Heineman presided over the public hearing held at the Holiday Inn in downtown Lincoln, often engaging speakers after they gave a brief presentation.
AARP’s Mark Intermill advocated a consumer-centered exchange with its cost levied as broadly as possible. He told the governor the exchange should be as state-based as possible.
“I think insurance regulation is something that should stay with the state,” Intermill stated.
“We think insurance regulation will stay with the state, probably no matter what,” Heineman replied. “But, I have yet to figure out other than what tax we’re going to implement and who we’re going to put it on, what decisions we get to make at the state level.”
Under the federal healthcare law, Nebraska can create a state-run exchange, allow the federal government to run the exchange or partner with the federal government to operate an exchange.
Michael Cannon with the Cato Institute said the state’s approach to establishing a health insurance exchange should be simple.
“And, I think, this issue is really a slam dunk, that Nebraska should not establish its own health insurance exchange,” Cannon stated.
Cannon argued that the federal government will not give the states enough power to control their own exchange.
Others disagreed, arguing that Nebraska should create its own exchange to better control how it operates.
Kimberly Russel with Bryan LGH of Lincoln said the state should take control.
“We also strongly support the concept of a health insurance exchange that’s headquartered in Nebraska, governed in Nebraska and operated and managed by Nebraskans,” Russel said. “We believe that our state should not delegate this responsibility to the federal government.”
The governor asked Aubree Mancuso to explain her support of a state-based exchange which would minimize the impact on consumers.
“You say minimize the impact on consumers, and yet you say a fee on health plans,” Heineman said. “Well, that’s going to be passed on to the consumer, right?”
“I believe some portion of it would be passed on to consumers,” Mancuso answered. “I think there’s also been significant evidence that most people are paying for the uninsured now through their premiums, so I think it would be something similar where they’re paying a fee, but also receiving a benefit from it.”
Who would govern the exchange became a secondary focus of the hearing.
Jon Bailey with the Center for Rural Affairs suggested there were pros and cons to establishing a strong, independent governing board to oversee operation of an exchange.
“I think that’s the way we want it, though,” Bailey said.
“OK, but the problem is, they’re not elected,” Heineman responded. “Once they serve their five-year term, during that entire five years, you can’t get rid of them if you don’t like their decision.”
“I understand that, but we have a lot of experience in this state, as you just pointed out, and you have a lot of experience appointing governing boards that I think do a very good job,” Bailey countered.
Jennifer Carter of Nebraska Appleseed said that no matter who runs it, it must keep the consumer in mind.
“Our focus is also on creating a broad-based exchange that has consumers as its priority and at its heart and improves access and affordability to health care and provides meaningful opportunity for consumer participation in the governance and the decision-making in the exchange,” Carter stated.
The governor initially endorsed establishing a state-based health insurance exchange under provisions of the federal healthcare law, but Heineman now believes the federal government will give the state little control over such an exchange.
“Again, I’ll just repeat, I can’t think of a single decision we get to make at the local level here, other than who we’re going to tax and how much,” Heineman stated.
And, so the long public hearing wouldn’t be devoid of some humor, Chairman Chris Shaffer of the Nebraska Pharmacists Association answered concerns Heineman expressed about the law.
“It’s going to be unbelievable what’s happens on January 1st, 2014 when this goes into effect,” Heineman said. “Total chaos.”
“To make a shameless plug for my profession, we can treat that,” Shaffer replied to laughter in the room.
AUDIO: Brent Martin reports [:50]