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  

professional and  

community leadership  

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.

Individuals seeking  

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

speighb@odscompanies.com.