On Friday, Feburary 25, 2011 OK Governor Mary Fallin issued a press release announcing “Oklahoma Will Accept $54 M “Early Innovator Grant” to Support Oklahoma-Based Health Insurance Exchange.”
Noticably missing from the announcement is the fact that the “Early Innovators” grants are to fund implementation of the Information Technology (IT) infrastructure needed to operate Health Insurance Exchanges, a cornerstone of the Patient Protection and Affordable Care Act, aka “ObamaCare.”
The grant application, officially called the Cooperative Agreements to Support Innovative Exchange Information Technology Systems, is a 41-page document outlining the purpose, authority, and background of the funding “opportunity”, as well as eligibility requirements states must meet in order to qualify.
The application also notes the specific sections of the Patient Protection and Affordable Care Act (and the Health Care and Education Reconciliation Act, together referred to as the Affordable Care Act) authorizing the funding of the grant.
Oklahoma was one of seven initial grant awardees, with our state getting the largest dollar amount – $54,582,269. The grantee in Oklahoma is the Oklahoma Health Care Authority.
According to Grants.gov, the expected number of awards is 51 – all 50 states, plus the District of Columbia.
All of the exchanges are to be interoperable and usable by other states.
Exchanges – Cornerstone of the PPACA
The creation of Health Insurance Exchanges is a cornerstone of PPACA (ObamaCare), without which there would be no socialized health care plan. The plan requires an IT infrastructure to be in place in order to function. No Exchanges, no ObamaCare.
These insurance Exchanges are mentioned 278 times in the Act.
The specific section of PPACA (ObamaCare) noted in the grant application are:
Page 5 of the grant application cites Section 1311 of the PPACA.
On March 23, 2010, the President signed into law the Patient Protection and Affordable Care Act. On March 30, 2010, the Health Care and Education Reconciliation Act of 2010 was signed into law. The two laws are collectively referred to as the Affordable Care Act. The Affordable Care Act includes a wide variety of provisions designed to expand coverage, provide more health care choices, enhance the quality of health care for all Americans, hold insurance companies more accountable, and lower health care costs. Among its provisions, the law provides grant funding to assist States in implementing parts of the Affordable Care Act.
Section 1311 of the Affordable Care Act provides funding assistance to the States for the planning and establishment of Health Insurance Exchanges (“Exchanges”). The Affordable Care Act provides that each State may elect to establish an Exchange that would: 1) facilitate the purchase of qualified health plans (QHPs); 2) provide for the establishment of a Small Business Health Options Program (“SHOP Exchange”) designed to assist qualified employers in facilitating the enrollment of their employees in QHPs offered in the SHOP Exchange; and 3) meet other requirements specified in the Act.”
Pages 6 & 7 of the application cite Section 1323 of the PPACA:
“The products of this Cooperative Agreement will be available to all States and the District of Columbia for evaluation and adaptability throughout the process so that non-grantee-States will not have to wait until a complete product is finished to test for adaptability for its existing systems. As IT systems are developed, attention should be paid to assuring that information gathered will be accessible for evaluation purposes. U.S. Territories that establish Exchanges under Section 1323 will be eligible to participate in the evaluation and adaptability process and the products developed under this Cooperative Agreement will be available to them.”
Pages 7, 17, 21, 28, and 29 of the application cite Section 1561 of PPACA:
Key Principles of Exchange IT capabilities for Early Innovators
• The organization governing the design, development, and implementation of the core capabilities must follow standard industry Systems Development Life Cycle (SDLC) frameworks including the use of iterative and incremental development methodologies. The governing body must also be able to produce requirement specifications, analysis, design, code, and testing that can be easily shared with other interested and authorized stakeholders (i.e., other States, consortia of States, or any entity that is responsible for establishing an Exchange).
• The design must take advantage of a Web Services Architecture (using XML, SOAP and WSDL or REST) and Service Oriented Architecture approach for design and development leveraging the concepts of a shared pool of configurable computing resources (e.g., Cloud Computing).
• The services description/definition, services interfaces, policies and business rules, must be published in a web services registry to support both internal and external service requests that are public and private, and be able to manage role-based access to underlying data.
• Per Section 1561 of the Affordable Care Act, all designs must follow the standards thatare currently outlined in the recommendations published by the Office of the National Coordinator (ONC). For details on Section 1561 Standards, see: http://healthit.hhs.gov/portal/server.pt?open=512&mode=2&objID=3161.
• Per National Institute of Standards and Technology (NIST) publications, the design and implementation must take into account security standards and controls. (For details on NIST publications, see: http://csrc.nist.gov/publications/PubsSPs.html)
Health Insurance Exchange Legislation
Currently there are several live bills implementing the Health Insurance Exchange but two worth noting are SB 960 by Sen. Bill Brown, and HB 2130 by Rep. Kris Steele.
Health Insurance Exchange Impact on Independent Brokers
Several independent insurance brokers in Oklahoma are concerned about the impact the exchanges will have on their businesses. The exchanges operate contrary to the free enterprise system and most likely will put the independent insurance broker out of business. Click here to hear the 2/27/11 interview with Mark Croucher of WHY-Insurance.
To contact Governor Fallin about this issue:
To call Senate Pro-Temp Brian Bingman:
To call House Speaker Kris Steele:
More on this subject in the weeks ahead.