The Exchange Board Talks SHOP

The California Health Benefits Exchange Board met today in Sacramento. The Chairwoman, HHS Secretary Diana Dooley, called the meeting to order with a moment of silence for Rick Brown, the founding director of the UCLA Center for Health Policy Research, who recently and unexpectedly passed away last week.
Peter Lee began the substance of the meeting with his Executive Director’s update, which included an update on contracting and staffing.  The Exchange continues to hire in order to meet the high demands of the tremendous amount of work it must accomplish in a short amount of time.
The Board did not yet make a decision related to the selection of a CalHEERS vendor yet, but that decision is expected by the May 15th meeting. Lee also said that the Board would explore partnerships with the federal government, including the possibility of using federal information technology systems to get up and running for the first few years.
Another decision that will be made in a future meeting is the structure of the ongoing stakeholder process. Staff presented a memo outlining various options for engaging stakeholders: creating issue based groups, regional groups, or ad hoc groups.  More detailed descriptions of the options being considered can be found here.
Lee also provided a brief update on the work that Ogilvy and Heath have been doing related to outreach, including focus groups in Fresno and Los Angeles in English and in Spanish. One lesson of note was that the target population for the Exchange–uninsured working families from 133-400% of the poverty level live in a “culture of coping,” of worrying about health care and workarounds to get care. More detailed reports on this work, as well as Heath’s research about models for utilizing Assisters, will be presented in the May meeting.
The most substantive item on this meeting’s agenda, however, was the landscape discussion of the SHOP Exchange, or the Small Business Health Options Program.  The panelists each discussed their ideas for creating a successful SHOP Exchange from various perspectives.
Sandra Hunt of Price Waterhouse Cooper gave an overview of the SHOP planning process, including key policy considerations and decisions that needed to be made as well as the timeline by which each task needed to be accomplished.  The key design considerations she highlighted included:
  • Product Portfolio 
  • Qualified Health Plan Selection and Management
  • Employer Choices
  • Marketing Strategies
  • Benefits Administration
  • Operational Design

Many of these decisions must be made beginning in June.

John Grgurina, of San Francisco Health Plan, and formerly of PacAdvantage, California’s previous small business exchange, spoke both from the plan perspective, and from the PacAdvantage perspective.  He provided a number of “lessons learned”. He emphasized the importance of highlighting the benefits of the Exchange, including tax credits, to the three major participants: plans, brokers, and small employers.  He also warned of overestimating the leverage the Exchange would have with insurers.

John Arensmeyer, from Small Business Majority, presented the small employer perspective.  Based on research that Small Business Majority has conducted, Arensmeyer recommended that the SHOP emphasize choice, customer service, and conduct thorough outreach.

Reacting to the panelists were Roxanna Bautista from the Asian & Pacific Islander American Health Forum, who spoke of the challenges faced by individuals who were self-employed and mixed-status families; and a representative of brokers and agents, who emphasized their role in facilitating coverage for small businesses.

Clearly, a great deal of thinking and hard work is going to be required in order to create a SHOP exchange that will help the small businesses and small business employees of California gain access to quality and affordable health care.

The next meeting of the Exchange Board will be May 15, 2012. 
Health Access California promotes quality, affordable health care for all Californians.
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