Ted Simons: Good evening and welcome to "Horizon." I'm Ted Simons. More than 40 community groups are calling for the creation of an Arizona health insurance exchange. They've endorsed several key ingredients for a successful program that would keep costs down while providing a marketplace where individuals and small businesses can shop for health plans and receive subsidies. Joining us to talk about all this is Dana Wolfe Naimark, president and CEO of children's action alliance. And Jack Beveridge, president and CEO of Empowerment Systems. He's also a board member for the Arizona Rural Health Association. Thanks for joining us.
Jack Beveridge: Thank you.
Dana Wolfe Naimark: Thank you.
Ted Simons: A state health insurance exchange. What are we talking about here?
Dana Wolfe Naimark: This is a part of our future of healthcare in our country, and in Arizona. Healthcare exchange will be the new marketplace where people can go get health insurance, if you don't have it through your employer and so it will be a new place for small businesses and individuals and it’s actually projected that about a million Arizonans will be getting their healthcare through the exchange so it's vital we get involved in how we want to design that exchange.
Ted Simons: How would this exchange work? Give us the machinations here.
Jack Beveridge: Well, this exchange is aimed really at low to moderate income folks and small businesses that have a hard time finding health insurance and health coverage. It's especially important for the low income groups who are -- tend to be on AHCCCS now or not qualified enough for AHCCCS because they make a little bit too much money or not enough or don't have coverage with their employer. We operate a wellness center in Apache Junction, serving mostly Pinal County and we’re finding that people do need a lot of help to find insurance and this would really fit the bill for them.
Ted Simons: Talk about the relationship between this kind of exchange and AHCCCS. What's the dynamic there?
Dana Wolfe Naimark: Well, the relationship ideally will be a seamless transition- the exchange will be a one-stop, a grand efficient website where people can go and compare healthcare options given their own circumstances and AHCCCS will be one of those opposites and it will be designed so that if you no longer qualify for AHCCCS you can easily transition to another type of coverage through the exchange.
Ted Simons: So who would -- I guess you find out if you qualify -- does anyone qualify, does anyone not qualify for such a thing?
Jack Beveridge: There will be criteria for qualifications but what we're looking at is an electronic kind of shopping cart, if you will, that gives a good comparison of the different plans in a standardized fashion and people -- well, we help people right now, go into the internet and look for low income -- I mean, affordable insurance and AHCCCS and they can sign up, actually enroll with AHCCCS over the internet.
Ted Simons: You are dealing with folks who are applying to a similar sort of thing, correct?
Jack Beveridge: Yes, we are.
Ted Simons: What are you seeing as far as challenges there?
Jack Beveridge: It's not real simple to navigate systems of care and you do need assistance and so we have coaches on board that actually help people go on the websites and shop and help them enroll.
Ted Simons: You need assistance and healthy people to make sure that the thing pays for itself, I would think. How do you ensure that happens?
Dana Wolfe Naimark: A variety of ways. We're focused on keeping this simple for consumers and keeping it affordable like you said. You want to avoid only having people with medical conditions in the exchange. Part of it is how you design it and what rules. A couple of things we're suggesting with the 40 organizations is to make sure that the same rules for insurance companies and health plans apply inside the exchange and outside the exchange. You don't want them have disincentives to be in the exchange or incentives to be only outside of the exchange. You want it to be extremely broad so that there are healthy people and people with health conditions in the exchange.
Ted Simons: Does that make for something that is too broad? How do you get that to work?
Dana Wolfe Naimark: No, I don't think there's such a thing as too broad. I think it will be more successful the broader it is, and not everyone who goes to the exchange will qualify for a reduction in their premiums but everyone can go to the exchange and look for the options available.
Ted Simons: So standardized plans, standardized ideas, as much as possible here, to keep too many bumps in the road?
Jack Beveridge: To make them comparable so that it's easy for people to look at the plans, put them side by side and then make the right choice.
Ted Simons: Can there be too many options, especially for folks who don't feel that well or are getting up in age. Sometimes, dealing with health insurances in general can be a labyrinth, can you have too many options out there?
Jack Beveridge: Isn't it in Utah, I think, Dana, they just opened it up to everyone and they have something like 143 plans. Think about how that would be to figure out what’s best for you.
Ted Simons: How do you decide what's in and out?
Dana Wolfe Naimark: We're suggesting that the board of exchange be allowed to limit the number of plans. Doesn't mean they have to limit it but if it's getting to the point where there are too many options they can look at ways to make it doable for consumers. In Utah, they found when they survived small businesses, many small businesses went on the exchange to look and left without buying anything because they could not figure out what the choices were because there were too many choices.
Ted Simons: You mentioned the governing board, who’s on the board, how do you get there and who decides who gets there?
Dana Wolfe Naimark: That's up to Arizona, that's one of the exciting and challenging things about where we're at right now. We have a lot of choices to make in Arizona about how we want our exchange to look. And again, with this community perspective, from these 40 organizations, we are suggesting that the board be appointed by a combination of the governor, of the attorney general, and the majority and minority leadership in the legislature so it can be a diverse group and have majority consumer representation on the board.
Ted Simons: Who pays for all of this? Will legislative appropriations be necessary?
Jack Beveridge: It's -- that's possible, but not likely, right now. It's a tax credit program where actually the premium is reduced for based on sliding fee scale according to the income of the individual. And then it’s reduced to make it affordable. So it is subsidized by the federal government.
Dana Wolfe Naimark: Arizona will have to figure out how to finance our portion over time and one of our suggestions, however we finance it, it's broad base so we're not only charging people in the exchange. Again, that could be a disincentive. It's a part of our overall healthcare system so we’re looking for broad base financing.
Ted Simons: It seems like something similar came up in the last legislative session. I could be wrong here, but it just rings a little bit of a bell.
Dana Wolfe Naimark: You're right.
Ted Simons: But the bell didn’t ring very long and hard.
Dana Wolfe Naimark: It was a very quiet bell.
Ted Simons: A quiet bell. What's different this time? What’s happening here?
Dana Wolfe Naimark: We don't know yet what's different. There were two bills proposed last year neither got very far as you recalled. Since then, the planning has been centered in the governor's office and actually the governor’s office received a million dollar federal planning grant so they’ve been moving forward looking at some of the operational issues, the website issues- how do we get a website up and running? And now we’re looking at this as the beginning of a community conversation to bring up some of these other design issues and see where we go from here.
Ted Simons: Other states doing this right now?
Jack Beveridge: A number of other states are involved. Dana, you --
Dana Wolfe Naimark: Ten states, yeah, ten have passed legislation. One state has passed an executive order and many states are like us, in the process of figuring out what they want to do and how they want to do it.
Ted Simons: You deal a lot with rural health issues. What are you seeing out there? Obviously, this would affect a lot of people in a variety of ways. But specifically, folks out in rural Arizona.
Jack Beveridge: Absolutely, I'm glad you asked me that, because active outreach is a part of this plan. It's a part of -- and that means getting out into the community, and not waiting for them to come to us and we have different sites that our staff goes to, that our coaches go to and help people enroll for the benefits and that's the outreach. We don't -- we don't -- we're a multidisciplinary program. We don't just deal with health. We help people apply for unemployment and jobs and things like that.
Ted Simons: But as far as health issues right now and health insurance issues, pretty tough in rural Arizona?
Jack Beveridge: Absolutely, very tough. And that's why this program would provide coverage for some of the people where there just is none.
Ted Simons: What is next and what needs to be done to get this started, to get this off the ground?
Dana Wolfe Naimark: Well, we need conversations with state legislators and with the governor's office. And keep talking about some of these key design components.
Ted Simons: Have you had -- what is the response of late? We know what it was last session. Are you sensing a shift? Are you some folks listening maybe a little longer and a little harder?
Dana Wolfe Naimark: I think there is a lot of interest and a lot of disagreement and a lot of perspectives at the state legislature. I think our group of community organizations and a lot of folks in the business community feel very strongly that we are much better off if we do it our way in Arizona and not leave it to the feds to run. But not every legislator agrees with that, so that will be a part of the upcoming discussion.
Ted Simons: And if someone wants some more information from this, if they didn’t get quite enough information from this interview, where do they go?
Dana Wolfe Naimark: You can visit our website at azchildren.org. And we have a variety of briefing materials and a list of other resources to look at about the exchange.
Ted Simons: Alright very good. Good to have you both here. Thanks for joining us. We appreciate it.
Dana Wolfe Naimark: Thank you.
Jack Beveridge: Thank you.