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THEIR OPINION: Opt for N.D. state health insurance plan, but hold out

BISMARCK -- In principle, North Dakotans would be better off with the state creating health insurance exchanges than if the federal government does that work.

BISMARCK -- In principle, North Dakotans would be better off with the state creating health insurance exchanges than if the federal government does that work.

However, the practical questions become: Who pays? How much? What will people get in return? And will those reforms actually be put into place?

The Legislature, in its special session next week, will consider a bill that weaves major provisions of federal health care reform into state law. In particular, it would set up health insurance exchanges and expand eligibility and benefits.

Because the state will be required to pay for and operate the exchanges after 2015, we believe North Dakota can create a more practical and efficient framework for implementing the federal law. We agree with Rep. George Keiser, R-Bismarck, chairman of the committee writing the legislation, who said, "If we go with a state-based plan, it does require an awful lot of effort, time, resources (and) money. But I believe that we will operate the program more economically than allowing the federal government to operate the program for North Dakota and then send us the bill."

The cost would be $83 million through June 30, 2013, based on committee work by lawmakers and members of the state Insurance Department. The legislation contemplates hiring 50 people to set up and operate the exchange and to tweak the technology related to changing eligibility for Medicaid and the Children's Health Insurance Program. At least 10 of those hires would be eliminated after the exchange became operational.

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The Legislature should not rubber-stamp the proposed legislation. Is $83 million the right level of funding? Are 50 new state employees necessary? If the state spends the initial $83 million, how much will be reimbursed by the federal government?

There are a lot of questions that must be asked. Lawmakers should give no one a blank check.

While there is an expectation for federal funding (also, our money), relying on Washington to set up insurance exchanges could cost North Dakotans a great deal more than $83 million. Legislators and health care officials here best understand the state and its needs. North Dakota should, if it can, avoid being stuck with a one-size-fits-all template for health insurance exchanges created in Washington.

There are, however, additional issues for lawmakers to consider:

- U.S. Health and Human Services has the authority to pay states dollar-for-dollar for setting up their own health insurance exchanges. HHS isn't required to pay the states, nor does it indicate when it would pay. With $83 million in play, the state should know what its financial risk might be.

- Only a dozen states have set up exchanges and, in every case, Democrats controlled the Legislature. No state with a Republican-controlled Legislature has set up an exchange. The GOP has a tight grip on the North Dakota Legislature. But this throws uncertainty into the recipe.

- The Republican candidates for president say they will repeal the health care reform law. Saying and doing are two different things. It depends upon who's in control of Congress -- if anyone.

- Deadlines set by HHS have been tweaked and tweaked again. At worst, the state has 14 months to have health insurance exchanges up and operating. That marks the Oct. 1, 2013, beginning open-enrollment period.

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- HHS has waffled on whether states can opt in and out of running health insurance exchanges. If HHS is flexible in working with the states, North Dakota could have more time to craft a state response.

- HHS has not determined what will be in the mandatory, essential health benefit plan. Will it be more or less than North Dakota mandates for its insurance carriers? What will it do to price?

- The unintended consequence of the federal health care reform could be huge, given the complicated nature of insurance and the need to make it apply in all 50 states.

In other words, it's a mess -- politically and administratively.

Health care reform last year was a hard sell in North Dakota. But it's what we have. By making the health care exchanges North Dakota friendly, the state could save taxpayers money and offer better and more responsive services.

The devil will be in the details and, of course, in Washington.

The work done to develop the proposed legislation will not go to waste, no matter the decision in November.

North Dakota lawmakers, who hold regular sessions every two years, will have tough choices on health care reform. It would be prudent to hold off making a decision as long as possible without giving up the option for locally set up and operated exchanges.

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Figuring those time frames out will be tricky.

-- Bismarck Tribune

Related Topics: HEALTHCARE
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