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HIX Digest for the week of November 5, 2012

With 20 percent of the state uninsured, Nevada's state exchange is aiming to offer affordable coverage and be financially self-sustaining, while neighboring California takes bids for its HIX, and insurers and state officials await a post-election rule-making flood from Washington.

Nevada's state exchange aiming for hands-off approach, with no state funding 

Nevada's budding Silver State Exchange is being designed to run like a business and has been developed somewhat quietly, as Capital Public Radio noted, in one of the states that originally sued the federal government over the Affordable Care Act

Amid opposition to other parts of the ACA, Republican Governor Brian Sandoval and the legislature approved the creation of a state exchange. It's being run by an independent agency, with a staff of 8 and led by John Hager, a former Navy pilot and previously the CFO at Nevada's Public Employees' Benefits Program. 

The aim, exchange officials say, is to reduce Nevada's uninsurance rate from 20 percent to 8 percent, while running the HIX like a business, without state funding. The Silver State Exchange has received $124 million in federal grants, with about $72 million going to a contract with Xerox for its cloud-based HIX system, online portal and customer call center. 

Exchange spokesperson CJ Bawden told Capital Public Radio that regulators will be pretty hands-off with plans and rates, with the aim of offering both affordable and more comprehensive insurance choices. Silver State Exchange officials have also been pushing for clarity from Health and Human Services on a number of regulatory questions. 

"We've been able to get out in front, and push the edges. They're actually kind of looking at us for some information on different programs," Bawden said. "Right now, we're at a point where we're going to be ready to have a state-based exchange and avoid federal intervention, whereas a lot of the other states that just went along the lawsuit path are scrambling to try to figure out what they can do."

Post-election regulatory forecast: cloudy with a chance of flooding

Federal agencies are expected to go on a post-election regulatory and promulgation spree, and the healthcare industry in particular has been waiting for HHS directives in a number of areas.

In addition to uncertainty over the federally-facilitated exchange, HHS still has to issue rules for state HIX minimum coverage requirements, administration of the individual mandate and definitions of full- and part-time employment.

There's also a temporary void of sorts at the Centers for Medicaid & Medicare Services' CCIIO, the Center for Consumer Information and Insurance Oversight, after some internal reshuffling, as JDSupra noted. Tim Hill, the CCIIO's deputy director overseeing HIX, is leaving after the office after more than a year for another CMS post.

Amid some concerns of opaqueness with the federal exchange and other aspects of the ACA, the Congressional Quarterly Roll Call reported that a team of CMS officials are leading implementation efforts in a somewhat leaderless collaboration.

California state exchange beckons 33 insurers

Covered California, the newly branded state exchange, is taking applications from insurers to sell plans next fall, and so far, 33 have said they're interested in bidding to sell plans in the HIX's 19 regional markets.

California health officials, as the LA Times put it, are "eager to flex their purchasing power under the federal healthcare law by selecting only certain individual and small business health plans" in certain markets.

Cover California executive director Peter Lee, a former director of delivery system reform at HHS, told the LA Times that competition for the slots "will enable the exchange to be an active purchaser in every region and pick the best five or six plans."

Kaiser Permanente, Anthem Blue Cross, Blue Shield of California and Health Net Inc, California's four largest insurers in the individual market, have expressed interest in bidding, and the winning health plans are expected to be announced by June.

Patrick Johnston, from the California Association of Health Plans, told the LA Times that the trade group is emphasizing "that affordability matters most"  in talks with state exchange regulators.

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