Two Health Care Reform bills signed by governor
Governor John Kitzhaber recently signed Senate Bill 99 and Senate Bill 91, which will shape Oregon's health insurance market beginning in 2014.
SB 99: Creating the Oregon Health Insurance Exchange Corporation
The Oregon Health Insurance Exchange Corporation will provide access to individuals seeking non-group coverage (on a guaranteed issue basis) and employers with no more than 50 employees, beginning Jan. 1, 2014. On Jan. 1, 2016, employers with 51 to 100 employees will also be eligible.
- The Exchange will be a public corporation governed by a board of directors consisting of nine members.
- The directors of the Oregon Health Authority and Department of Consumer and Business Services will serve as ex officio members.
- No more than two members may be affiliated with the healthcare sector (insurers, third- party administrators, producers, providers, trade or professional associations).
- At least two members must be consumers, including one individual and one small employer purchasing coverage through the Exchange.
All members must be
U.S. citizens and Oregon residents and have demonstrated
skills and experience.
Oregon will maintain dual individual and small group markets. Qualified health plans will be available through the Exchange
while the traditional marketplace will continue
as an option for
individuals and small
groups. Health insurer participation in the
Exchange is voluntary,
but if an insurer uses the Exchange, it must offer
the same products outside the Exchange as within,
and at the same price.
The insurer must also maintain common risk
pools for individual and
small group products, respectively.
premium tax credits and reduced cost-sharing
based on household
income, and employers who want to receive small employer health insurance credits must purchase coverage through the Exchange.
Any insurer licensed by the state of Oregon and meeting applicable federal requirements for participation may offer products in the Exchange. The Exchange, however,
will adopt uniform requirements that all qualified health plans must meet, and may limit the number of plans available
as long as the limit applies uniformly to all insurers.
While the planning, development and implementation of
Oregon's Exchange will commence in earnest, the actual operation of the Exchange is conditioned
upon legislative approval
of a formal business plan submitted by the Exchange Board no later than
February 2012. In addition, the Exchange is required
to report regularly to
interim legislative committees on the implementation of the information technology
system that will support Exchange operations.
On June 23, Governor Kitzhaber named Howard "Rocky" King the interim director of the Oregon
Health Insurance Exchange Corporation. Rocky served for more than 20 years
as the administrator of the Office of Private Health Partnerships and the
Oregon Medical Insurance Pool; both programs work closely with Oregon health insurers to improve access to health insurance coverage through various premium subsidy mechanisms.
The following activities
are anticipated over the next 90 days:
- The initial management team of the Exchange will be assembled.
- The governor will solicit nominations for the Exchange Board, with names forwarded for Senate confirmation in late September.
- A federal establishment
grant will be approved with funding for about one year.
- Federal policy guidance on several key operational issues will be published.
A PDF of SB 99 is
available at: SB99
SB 91: Bronze and silver plans in reformed market
This legislation requires
all health insurers
operating in Oregon to offer bronze and silver health benefit plans approved by
the Department of
Consumer and Business Services in both the individual and small group markets, either through
the Oregon Health Insurance Exchange or outside the Exchange.
- Bronze plans are actuarially equivalent to 60 percent of the full actuarial value of the essential benefit package as defined by the federal Affordable Care Act.
- Silver plans are equivalent to 70 percent of the full actuarial value.
The purpose of this legislation is to assure the most level playing field possible between the Exchange and the outside market. Requiring all
carriers to offer
benchmark bronze and
silver plans will help consumers compare
insurers operating inside
and outside the Exchange. In addition, it provides the Oregon Insurance Division with a tool for reviewing
the appropriateness of an insurer's rating
methodology across its product portfolio.
A PDF of SB 91 is
available at: SB91
If you have questions
about SB 99 or SB 91,
contact Barney Speight at ODS at