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We don’t have a trillion-dollar debt because we haven’t taxed enough; we have a trillion-dollar debt because we spend too much” - President Ronald Reagan
What do you get when the audience knows more about a bill than the presenters? Answer: Just another day dealing with bureaucrats. Blogger (and nurse) Sarah Drye visited one of those Healthcare Townhalls being run by the state government last week. Not surprisingly she knew more than Insurance Department head Jay Bradford and most of the other speakers about all this healthcare exchange rigamarole. Then again - she knows more about most of this government healthcare scheme than most government officials. Maybe they should invite her to fix the mess they’re making. Here’s her run-down of the event….
HBE Community Disaster/Meeting
The Arkansas Health Benefits Exchange Planning Division’s website gives a list of community meetings taking place across the state throughout June to mid-July. The site states that the forums are being held by Partners for Inclusive Communities and UAMS College of Public Health to “share information and get your ideas to help in this planning for Arkansans.” The meeting I attended Wednesday in Little Rock was less an exchange of ideas and more an exchange of unanswered questions.
The segment I attended was for “Healthcare Providers and Health Insurance Professionals.” The majority of attendees were Health Insurance brokers, there were a few nurses, maybe a doctor or two, and a couple of nice ladies from the Arkansas Legislative Council. Arkansas Insurance Commissioner Jay Bradford, who has been appointed to head planning the state’s Exchange system, was kind enough to grace the meeting with his presence. Bradford, along with the presidents of Delta Dental and QualChoice, and a couple of other insurance big wigs involved in the planning process, introduced themselves, though none seemed to want to share their ideas on the process or share any info with the room as to what has been planned and what they are planning to do in the Exchange.
The two gentlemen heading the meeting offered to answer any questions and encouraged us to give them our ideas. The crowd was inquisitive from the get-go; most questions dealt with the healthcare law’s implications for the state-based exchange, as well as certain aspects of the Law that will affect the private market and healthcare providers. The presenters could not answer most questions, and even had to ask us a few. Before long it became those of us attending answering one another’s questions.
When questions regarding Medicaid and the Exchange were brought up, the speakers admitted they had little or no knowledge of how it would work. They did say, however, that there is discussion to integrate Medicaid into the exchanges.
When asked if the insurance companies who choose to not participate in the exchange (noting that Arkansas already has only a few carriers) would be driven out of the state due to inability to compete and there being a reduced market, and what the private market will look like with the exchanges, the speaker admitted he did not know the answer to that question, but there would still be a private insurance market. We were informed that Blue Cross Blue Shield is currently the only carrier signed up to participate in the Exchange, and the State is hoping for more.
The State exchange will be able to add the minimal benefits found in the Law, and can add any extra benefits it wishes to these, but must cover the cost of the “extras” without federal assistance. It was brought to our attention that Gov. Beebe has already said Arkansas cannot afford to finance any extra benefits. The State must be able to solely fund the Exchange without assistance from the government by January ’15. If the state finds by that time that it does not have the money to fund the system then either taxes will be increased or benefits would be decreased (in other words: rationed). The speakers admitted they have not read the law, and one even told us, “You all know more about the exchanges than I do.” When asked where the money will come from, the answer was “That is above my pay grade; you’ll have to ask your Legislators about that.” The point some attendees were getting at is that the money is coming from tax-payer dollars, even those tax-payers who will not participate in the Exchange. One speaker argued that no, it would be “state money” (um, yeah - taxpayer dollars).
Some in the audience did try to offer ideas, some of which involved scope of practice for nurses and other healthcare professionals, and for a private sector market. After roughly two hours of not being able to answer our questions, the presenters acknowledged that they didn’t know where this all was headed, and that it would have to be set up and implemented before any of us knew how it was really going to work.
The HBE website has links to meetings of a “steering committee” and plans for creation of an Independent Advisory Committee (based on the Law’s model of an Independent Payment Advisory Board), which runs the exchange by regulating healthcare spending. No mention of either committee was made, and when I asked a speaker what their role, along with the Secretaries of the Department of Health and the Department of Human Services, would be in the exchanges, he could only tell me that he wasn’t sure and it hadn’t yet been decided who would be in charge of the exchange system. Whenever and however the decision is made of who will make up this committee will be based on the decision of who will be appointed to head the exchange system – it could be the Department of Health, the Department of Human Services, the state Insurance Department, or even the Department of Finance and Administration.
At the conclusion of the forum, the speakers asked Mr. Bradford to say a few words. Bradford thanked us all for being there and said that the opinions and ideas of Arkansans are very important in this planning process. He also made mention of people who were trying to “disrupt the process” of the meetings, some even filming them – “those tea partiers” he said (and then laughed….but he was the only one). Not a very gracious man at all, it seems. There were no disruptions in the meeting I attended, though there was plenty of disappointment in the way it was presented.
Myself and others walked away from the meeting uncomfortable with what we had just learned; which, essentially, was that those in charge of planning the exchange don’t know any more than we do. The Law itself doesn’t give any definite rules or parameters about what an exchange must look like. But it does make clear that if a state is unable to set up a working exchange and a plan to fund it by January ’14, the federal government will step in and design one for us.
I would like to note that I asked one of the speakers why the public hasn’t heard about these meetings until the last couple of weeks, and why so many meetings are being held in such a short time frame. I was told that they had only two weeks to plan the meetings and schedule them, and are currently contacting media sources across the state to spread the word. (They sure are in a rush, aren’t they?)
I would love to know what others attending these meetings have learned. Please share!