Here comes the exchange UPDATED
Months and months after Rhode Island hoped to start designing the state’s online marketplace for health insurance, Governor Chafee has finally signed an executive order putting the process into motion.
Here’s the brief explanation- the General Assembly was going to create a quasi-public agency to design the health insurance exchange. The legislation had broad support until a last minute amendment essentially banned plans on the exchange from covering abortions. The bill never made it to a vote in the House.
Rhode Island was supposed to have this exchange planning committee established by the end of September to qualify for 10s of millions of dollars in federal planning grants. There wasn’t enough time for lawmakers to meet and work on a new bill, so state officials resorted to using an executive order to do this same thing *almost.*
The General Assembly has the power to create a quasi public agency in charge of figuring out how this website should work, but Chafee can’t do that with an executive order. Instead, all of the thinking about the exchange will have to happen inside state government, technically as an office within the “executive department.”
Why does that matter? Folks were hoping that the quasi-public agency would be a bit more nimble, less weighed down by bureaucracy. But Lieutenant Governor Elizabeth Roberts assures me that this “executive department” office will be flexible too.
This will not be a big bureaucracy inside government. This is going to be a relatively small office. It’s supposed to run like a business, so we want it to be as little like traditional government programs as possible.
Where this “small office” will physically exist is still unclear. Roberts says it will be in some state owned property that has some vacant space to spare. The executive director who sitting in that office hasn’t been hired yet, but his/her salary will be paid with federal funds.
Chafee not only created the governing board for the exchange today, he also appointed some of its members-
- Margaret “Meg” Curran, Former United States Attorney for RI
- Michael C. Gerhardt, Former Health Insurance Executive, Interim Executive Director for RI agencies in transition
- James Grace, President & CEO, InsureMyTrip.com
- Linda Katz, Policy Director & Co-Founder, The Poverty Institute
- Peter Lee, President & CEO, John Hope Settlement House
- Pamela McKnight, MD (not currently practicing)
- Donald Nokes, President & Co-Founder, NetCenergy
- Tim Melia, UFCW New England Council
- Minerva Quiroz, Case Manager, AIDS Project RI
These “public members” will serve alongside Secretary of Health and Human Services Steve Costantino, Health Insurance Commissioner Chris Koller, Director of Administration Richard Licht, and Department of Health Director Michael Fine. Former U.S. Attorney “Meg” Curran will serve as chair.
So what’s next? Rhode Island is now finishing its application for millions of dollars in federal dollars to help design the exchange. That application is due September 30th. The board hasn’t scheduled its first meeting, but Roberts says that “the group will be up and meeting… as quickly as that is possible to do.”
There’s also the possibility Rhode Island Right to Life will file a lawsuit challenging the constitutionality of the executive order. Earlier this year, executive director Barth Bracy accused Chafee of “hi-jacking health reform” and by-passing the General Assembly with the executive order. At the time, Barcy believed he had a legal case against the executive order.
So far he hasn’t returned my calls for comment. UPDATE: Here’s a statement from Bracy’s lawyer Joseph S. Larisa, Jr. about the executive order.
It is a fundamental principle of both American and Rhode Island constitutional law that the legislature enacts the laws, the Governor executes the laws and the courts interpret the laws. The General Assembly considered and refused to adopt a health benefits exchange in June — and its own bill correctly declared that legislation is required to create the exchange to meet federal requirements. Until today, no other state has attempted to bypass the legislature and create an entire health care exchange.
That last sentence actually isn’t true. The Governor of Georgia used an executive order to establish his state’s health insurance exchange. So did the governor of Alabama and the governor of Indiana. Go here to read Rhode Island Right to Life’s complete statement. Barcy says Larisa is preparing a lawsuit to challenge the order and will file it soon.
Want to know how other states are progressing on this effort to create websites for selling health insurance? Check out this map. It was made in August, so it doesn’t reflect Rhodes Island’s most recent progress.