It's probably fair to say that no one would consider a medical emergency a vacation, but that is how Gov. Earl Ray Tomblin's staff has been describing the state's options for a health insurance exchange.
"You can look at it a couple of different ways," Gov. Earl Ray Tomblin's Chief of Staff Rob Alsop told lawmakers from five different subcommittees during an interim committee meeting Dec. 10. "Like if I'm taking a trip to Disney World, I have a couple of different options other than calling myself."
Alsop, and Tomblin himself last week, have compared the many options related to a health insurance exchange to the different ways a family could book all the options for travel, activities and accommodations.
Alsop said under the Affordable Care Act, an insurance exchange will be set up in West Virginia by Oct. 1, 2013, but the state has the choice to decide whether or not to take part.
"There will be an exchange, but the only question is how it will be set up," he said.
Lawmakers had many questions even after the hour-long briefing from Alsop and Jeremiah Samples of the West Virginia Insurance Commissioner's office.
Alsop said the state has three options. The first is to let the federal government do everything, but Alsop said the governor's office is "a little concerned about turning everything over," to offices in other cities and states. The second option is for the state to do everything related to the insurance exchange itself, which Alsop said could be problematic for the small Mountain State, especially if few people sign up for the exchange at the beginning. If that happened it could make health insurance "more expensive than it needs to be."
Alsop said the third option, a middle approach, would be a partnership so West Virginia could maintain some of its regulatory authority but still take advantage of some economies of scale that would come from allowing the federal government to run things, such as IT functions.
A 25-page handout and slideshow for lawmakers provided brief explanations of everything from how the individual mandate and employer coverage will work to the pros and cons of all three options related to the exchange.
Samples said West Virginia has already done work with multiple state agencies and engaged other states, as well as analyzed the feasibility of the exchange.
He said the health benefit exchange will not operate a health insurance plan, carry risk or process claims, eliminating the role of insurance agents or set premiums.
He said exchange-eligible individuals will be lawful state residents of all incomes who are younger than age 64 and are not incarcerated.
Delegate Harry Keith White, D-Mingo, and chairman of the meeting, said it was the first of many informational meetings to let lawmakers, the public and the media know what work the state has already done on the issue.
Samples said state's tentative plan for 2014 is to proceed with the partnership plan, because a state-based exchange would put too much of a fiscal burden on consumers, industry and the state, while a full federal exchange would put too much of a regulatory burden on consumers and the industry.
Alsop said about 35 states are in the same boat as West Virginia — trying to decide how to negotiate a balanced plan with a little help from the federal government.
Samples said state officials will continue to meet with stakeholders and continue analyzing some economic models as well as look at ways to lower the cost and increase the quality of care.