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Maine Health Care Exchange Plan Sparks Criticism
11/01/2011   Reported By: A.J. Higgins

A legislative committee charged with developing a plan for setting up a nonprofit health care exchange heard criticism today from some members of the public. A number of consumer advocates are objecting to Gov. Paul LePage's plan to place oversight of the exchange within a state department, where they fear politics will play too much of a role.

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The health care exchanges are envisioned as a necessary requirement under the federal health insurance overhaul known as the Affordable Care Act. The exhange would be a sort of marketplace or clearing house for consumers who can shop for insurance coverage within a framework that is supposed to encourage competition and, in the process, reduce costs.

The Affordable Care Act--derided by Republicans as "Obamacare"--requires that Maine and other states establish the exchanges, and make them self-sustaining by 2015.

Members of the Legislature's Insurance and Financial Services heard from a number of health care advocates who liked many aspects of the plan to create a health care exchange that was crafted by a special nine-member panel advisory panel appointed by the governor. But there was one element that many didn't like, and it involved how oversight and governance of an exchange would be maintained and structured.

"While the exchange advisory committee recommended the exchange be housed within the Department of Professional and Financial Regulation, we think the exchange should be created as an independent public agency," said Mitchell Stein, the policy director for Consumers for Affordable Health Care.

Stein is concerned about the potential for the exchange to fall victim to political influence if it is absorbed into an existing state department, rather than be established as a quasi state agency with its own board of directors. Stein says the plan seems contrary to goals for transparency that were envisioned at the federal level.

"Having the exchange as an independent agency would allow the governance of the exchange to be through an independent board," said Stein. "Having a board run the exchange would remove day-to-day political considerations from factoring into the exchange's decisions and ensure that the exchange was directly accountable to the people of Maine through the board."

State Rep. Sharon Treat, a member of the legislative committee, says that for a time, the governor's panel appeared to be favoring an exchange that was to be governed through a independent structure.

"And then the governor really inserted his desires and said, 'No, I want it to be within this department'-- and pretty far below in the department," Treat says. "It raises concerns because, basically, there's the opportunity for political meddling, but almost as important or equally important is the fact that it makes it very difficult to have an independent board that truly respresents consumers and is truly transparent. And that's a real concern with the way the final recommendations came out."

"I do believe that it is very important that the exchange be housed within the Department of Professional and Financial Regulation," said Dan Bernier, who is among those supporting the governor's decision. Bernier represents the Maine Association of Health Underwriters and works as a lobbyist for insurance company associations.

Bernier said locating the exchange within a state department provides the best playing field for all of those involved--particularly when it comes to resolving disputes. "There are going to be turf issues between the exchange and the Bureau of Insurance. How do you get those resolved?" Bernier said. "The simplest way is for both the Bureau of Insurance and the exchange to have the same boss, being the commissioner."

Members of the committee are scheduled to meet again on Dec. 13th to work on an exchange recommendation to the full Legislature in January.



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