Connector needs more participants

Only a handful of days remain to be peeled off the calendar before the national launch of the health insurance exchanges under the Affordable Care Act. Although the first open enrollment period will last six months, it’s nerve-wracking that Hawaii’s exchange seems a bit behind the eight ball this close to the Oct. 1 start date.

That exchange, the Hawaii Health Connector, was constituted by state law but is run as a private nonprofit organization. Hawaii’s two dominant insurance carriers, Hawaii Medical Service Association and Kaiser Permanente, are the only two to have votes on the governing board. By design or not, these companies are also the only two to be offering plans on the exchange so far, with most of the marketing at this stage further bolstering their position.

Considering that the informational campaign is underwritten by federal funds, this is distressing. Consumers need good information about their options but have not yet received more than glossy advertising. The grassroots educational program involving contracts with 34 nonprofits, a crucial person-to-person component of outreach, is also behind schedule.

This is certainly not the ideal outcome for consumers, who will benefit most from the widest array of choices. Connector officials are still actively wooing additional competitors, and they should try to streamline the process of approvals required to sell on the exchange.

For their part, key lawmakers say they’re monitoring how the Connector functions. State Sen. Josh Green, who chairs the Senate Health Committee, said he will have a bill vehicle ready to move in the upcoming session, once it’s clear where the important tweaks to the law need to be.

Here’s a start: The Legislature should consider restructuring the Connector board to avoid conflicts of interests, as Green and other lawmakers, as well as community advocates, would have preferred from the outset. Insurance carriers should be ex-officio members of the board, and the roster should include more of them.

"Insurer input should definitely be solicited by the exchange but they should not have a vote on the board," said Rosemarie Day, an independent industry consultant who addressed lawmakers during the 2012 session. Unfortunately, they didn’t listen.

Most of the smaller players in the Hawaii insurance market have held off joining the exchange for their own reasons, including the costs of meeting regulatory requirements and plugging into the Connector database. Reg Baker, executive vice president of the Hawaii Medical Assurance Association, also said HMAA deals in business-provided insurance plans, not individual insurance, but said he now hopes to have some presence in the exchange before the end of the enrollment period on March 31.

Baker said there were efforts to keep them involved in the process of setting up the Connector. Still, a more inclusive board may have encouraged greater participation in the exchange, which remains the ultimate goal.

There should be moves to clear confusion about how the exchange functions, and to clarify consumer choices. Individuals now uninsured should be helped to find plans that best suit their needs, on or off the exchange. Of course, only the exchange can offer the individual subsidies to help with premiums and the tax credits to give small businesses an assist, which is why competition and consumer rates need to be the measuring stick.

"This entire exercise should be as favorable to the consumer as possible, from my perspective," Green said. "That’s the whole reason for the Connector in the first place."

We agree. And the 2014 legislative session will provide the occasion for a hard look at how well, or poorly, Hawaii has done.