LINCOLN — The slow release of information and regulations from the federal government has hampered progress toward a Nebraska health insurance exchange, the state’s insurance director said Friday.
Bruce Ramge said his agency is waiting for several key regulations.
Among the most critical are final rules about choosing the minimum benefits for health plans sold in the state. The state has a Sept. 30 deadline to decide on those minimum benefits.
Ramge said the federal government doesn’t expect to issue final rules until November, although it has issued detailed guidance.
“No formal recommendation is possible at the present time,” Ramge told members of the Legislature’s Banking, Commerce and Insurance Committee.
However, State Sen. Jeremy Nordquist of Omaha said the federal government has provided enough information that Nebraska should be further along in its planning process.
He expressed frustration that state officials have not produced a more specific and detailed proposal about how Nebraska should implement the federal health care law.
Time is running short for the state to make key decisions, Nordquist said.
The state must notify the federal government by Nov. 16 whether it intends to set up a state-run exchange, leave the job to the federal government or opt for a joint effort.
Insurance exchanges are the centerpiece of the federal health care overhaul. They are to be places where people can compare and buy health insurance policies. Federal subsidies will be available only through the exchanges.
Under the law, a set of minimum benefits, called “essential health benefits,” are to apply to all health insurance plans, whether sold through the new insurance exchanges or not.
The federal law sets out 10 broad categories of benefits that must be included in the minimum coverage, such as maternity and newborn care, hospitalizations, prescription drugs and behavioral health care.
States can determine much of the specific coverage based on a benchmark plan of their choosing.
They can choose from among four types of plans for that benchmark, including the federal or state employee health plans, the state’s largest health maintenance organization or the most popular small group health plan offered in the state.
Based on what’s known now, Ramge said, the Insurance Department would recommend the most popular small group plan — the Blue Cross Blue Shield Blue Pride Option 5 — as the benchmark.
He said that plan offers the best balance of benefits and affordability.
That also would be the plan federal officials have said they would choose if state officials do not make a choice, Ramge said.
Other unknowns surround the U.S. Supreme Court ruling that states cannot be forced to expand Medicaid as envisioned in the 2010 health care law.
Gov. Dave Heineman has said he opposes the expansion, which would extend coverage to all adults with incomes of less than 138 percent of the federal poverty level.
Ramge said the federal government has not provided details about how the exchanges are to interact with Medicaid.
For example, he does not know if the “no wrong door” requirement still applies after the ruling. The requirement was that people should be able to go one place to either buy insurance or apply for Medicaid.
Ramge also reported on meetings held across the state to gather opinions about the state’s insurance exchange options.
He said people had mixed views about whether the exchange should be run by the state, the federal government or be a joint effort.
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