Coral Andrews, the retired Navy captain, is sailing into what can be described as uncharted waters, at least for Hawaii. In physical terms, this translates into folding chairs, card tables and other elements of the temporary offices the new Hawaii Health Connector now occupies. What’s more, as the Connector’s executive director, Andrews is overseeing the construction of an online service that has never existed here before.
But, she said, describing it as "a Travelocity concept" may help people to envision it. Just like the Internet travel booking portal, the Connector will be a site that pulls together health insurance plans into a database that "shoppers" will be able to find through a fairly basic search. These shoppers are people not covered by their employer, small businesses seeking coverage for employees and potential Medicaid beneficiaries.
The Connector was created as part of health care reform, what’s known for short as the Affordable Care Act (ACA). Andrews, her staff (now under construction, too) and the board are pressing ahead with current federal deadlines, rather than waiting for the pending U.S. Supreme Court decision on the law’s constitutionality.
Andrews, 50, has had a career as a Navy nurse and various health administrative roles before her most recent civilian post, vice president of the Healthcare Association of Hawaii. Her husband was a pilot for the now-defunct Aloha Airlines; they and their two teenage sons were unsure whether they could remain in Hawaii until he got picked up by Hawaiian Airlines.
She said friends have asked her why she took a job with such built-in challenges.The entire project was caught in a legislative firestorm this past session, when consumer groups and others raised a protest. They centered on concerns that the Connector, a nonprofit corporation, is not subject to the state’s Sunshine Law on open government, and that the voting board will include members from the health insurance industry itself. Andrews maintained that federal regulations address these issues.
"There’s a lot of passion around us," she acknowledged. "There are markets that are being affected by the insurance exchange coming in. So as a result of that, there’s a survivor instinct that emerges.
"But if we can bring access to affordable coverage, rather than being on the bench and complaining about it, I want to be out there helping to shape it."
QUESTION: How do you answer people who are concerned that the exchange won’t be covered by the Sunshine Law, and that voting members of the board have a financial interest in what the Health Connector is doing?
ANSWER: I think that there’s a misunderstanding of the role that the federal government actually plays in overseeing and regulating our activities. … Within the ACA, there is a section pertaining to the insurance exchanges. There’s an agency called CCIIO (Center for Consumer Information and Insurance Oversight), who are actually calling into our board meeting on Friday. …
The final guidance is actually very specific, under governance of insurance exchanges, describing their responsibilities of conducting their meetings in public, to establish conflict of interest policy, to maintain transparency. And also it speaks to the composition of the board. It says you must have at least one consumer representative, and that health plans, while not precluded by the federal government from participating, … the regulations just specify that they cannot comprise a majority of the board.
Again, helping the public to understand that we’re not just operating under state statute: While the focus during the (legislative) session was around the state statute, there are already regulatory requirements we have to meet that address some of those same concerns that surfaced during our legislative session.
Q: So how will they be addressed?
A: We have actually a conflict of interest policy that is coming back before the stakeholders and board this week. We have until May 26 to incorporate those federal regulatory requirements into that. We have always conducted our meetings in the public. …
Q: Who is the consumer representative on the board?
A: The final exchange regulations do not offer a definition of "consumer." … This came out of the FAQs (frequently asked questions) from the final regulations, that "consumer" is interpreted to be anyone that is a user or receives health insurance coverage.
Q: That could be just about anyone.
A: It could be anybody, right. … Small businesses are a critical stakeholder in the establishment of the insurance exchanges. We want to make every effort to outreach to the small business community, and start to bring their voice forward as well.
Q: Who represents them?
A: Sherry Menor-McNamara is our chair, and she’s the COO (chief operating officer) for the Chamber of Commerce.
Q: You’re not bound by the Sunshine Law, but would you be adopting any protocols on public notification on meetings?
A: We already do that. … We have a policy in place that says we will conduct our meetings in public, and notice will be delivered seven days in advance of our board meetings. The final regulations require that we conduct our meetings in public. …
Q: Do the regulations ban private discussions of business, apart from the meetings, as the Sunshine Law does?
A: I believe what the regulations require is that there be stakeholder engagement in the course of the development of the insurance exchange … but it does not mirror Sunshine (Law) with respect to, for example, three board members (meeting together). No, there’s not that degree of specificity. …
We have from now to January 2014, that we need to get our IT (information technology) systems in place. We actually have to get an RFP (request for proposals) out to a vendor in June. By Jan. 1, 2013, it’s our understanding the state’s desire, and our board members’ desire, is to be a state-certified exchange. In order to do that, we have to hit these milestones, or it does default to a federally facilitated exchange.
And so there’s a balance there, in us needing to be able to conduct our business and hit the aggressive milestones, while at the same time balancing that with stakeholder input. …
I’ve been in health care for 26 years. I certainly understand the discussions that are out there. I do acknowledge that health insurance and health care is a very personal thing, and as such it causes anxiety when there are changes being made to it.
But what I do ask for is that we be given an opportunity to get this company off the ground, to be able to work through a process to demonstrate that we are going to follow through with the things that we have said we are going to, with respect to establishing those policies and hopefully bring together a group of stakeholders to help us make this successful for Hawaii.
Q: There aren’t that many health insurance options out there for many people. How, in theory, does an exchange help?
A: The concept behind insurance exchanges is to expand the market. … All plans that apply through the (state) Insurance Division and meet the federal requirements … to be able to participate on the insurance exchange will be allowed to sell insurance on the exchange. …
It’s an aggregated site where, rather than individuals having to go to four different places to shop for an insurance plan, it’s giving them accessibility to the information, it rounds up information. … We’re in the process of working to develop the blueprint behind the exchange.
So, let me walk you through a consumer experience. … You have a family of four. And maybe you have the mom who receives health insurance through the individual side of the exchange, but you have the children who could receive services through Medicaid. Rather than having that family have to go to three different places, they can initiate a query through our web portal.
The federal hub for IRS (Internal Revenue Service), as an example, is attached to the exchange. So they do an income assets assessment at the time. They provide information to the exchange to let us know if that individual qualifies for premium tax subsidies to help cover the cost of insurance. At the same time it may say for the children, they appear to be eligible for services through a Medicaid program.
So for that family we’re able to provide a service, in a single encounter, even though the coverage is coming from different places. …
Q: Separate carriers would be accessible through the exchange in a single inquiry?
A: Right. We’re still working on the blueprint. … We have to work through the financial management aspects of the exchange, because we have an obligation to inform the feds, under our grant, how all that’s going to work. But there will be multiple plans available on there. …
If you live on a neighbor island, and you have a chronic disease, and you have a physician you don’t want to lose, as you’re shopping that’s your preeminent value: Which plan has that in the network? … We hold as a vision that we want it to be a seamless encounter for the consumer, as much as is possible.
There’s going to be stakeholders involved in that. It’s not just going to be us as the Connector staff. … The Consumer Outreach Committee meeting, they’re going to be tapped to assist us with call centers: How do you set up a call center so that it supports the multilingual needs of our population? Where are those arteries that go out to the communities, where information is transacted from individual to individual? How do we get information out to inform the public of how to access the insurance exchange?
