Current Status in Establishing Exchange:
Declared state-based exchange, called Cover Oregon.
Regular legislative process.
- Oregon has received the Exchange Planning grant of $1 million, the Early Innovator grant of $48 million to build a modular and reusable IT system, a Level One Establishment grant of $9 million to support the final design and implementation of the Exchange’s business and operations plans through August 2012, and a second Level One Establishment grant of $6.9 million to continue to support the planning process through May 2013.
- Cover Oregon estimates annual start-up costs between 2011 and 2013 to total approximately $27 million, excluding the development of the IT infrastructure and website which will be funded with the Early Innovator Grant.
- The exchange plans to submit a Level Two Establishment grant application for $47 million, which will pay for implementation through 2013 and operating expenses for 2014.
- In addition, Oregon, along with nine other states, is receiving technical assistance from the Robert Wood Johnson Foundation through the State Health Reform Assistance Network; this assistance includes help with setting up health insurance exchanges, expanding Medicaid to newly eligible populations, streamlining eligibility and enrollment systems, instituting insurance market reforms and using data to drive decisions.
- Once the Exchange is operational, the Board will impose and collect administrative charges from all insurers and state programs participating in the Exchange to cover costs and expenses. Insurers will be charged based on the number of individuals enrolled in health plans offered through the Exchange, excluding individuals enrolled in state programs. The legislation defined the maximum charge to be 5% of the premium for each enrollee through the Exchange where the total enrollment is less than or equal to 175,000, 4% for between 175,000 and 300,000 enrollees, or 3% for more than 300,000 enrollees. After examining the estimated operating expenses and enrollment projections, the Exchange calculated possible carrier administrative fees for the first two years of operations. The example calculation resulted in fees of 2.52% in 2014 and 2.73% in 2015, which were estimated to be sufficient to accumulate a reserve of half of the operating costs for the next year of operation.
· Small Group Plan
· EHB Benchmark Plan: Pacific Source Preferred CoDeduct small group plan.
- Cover Oregon is governed by a nine-member board. The Oregon Senate confirmed the Governor’s nominees to the Health Insurance Exchange Board on September 23, 2011.They are:
o Liz Baxter (Chair), We Can Do Better
o Teri Andrews (Vice-Chair), CG Industries
o Ken Allen, Oregon American Federation of State and County Municipal Employees
o Dr. George Brown, Legacy Health Systems
o Alea Christofferson, ATL Communications
o Jose Gonzales, Tu Casa Real Estate Corporation
o Gretchen Peterson, Hanna Anderson
- Oregon has received conditional approval from the Department of Health and Human Services to establish a state-based exchange, as long as Oregon demonstrates all necessary functionality and complies with current and future guidelines.
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