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State insurance officials assured lawmakers they are on track with planning for a Nebraska-based insurance exchange required under Obamacare, while two lawmakers questioned whether the governor has the authority to decide what kind of exchange to create.
Insurance department officials briefed a legislative committee today on their progress implementing President Obama’s health care law, saying Nebraska is on par with many other states in the planning and design of health care exchanges, which will provide insurance to uninsured people. States must decide whether to have state-based, regional or federal exchanges by Nov. 16, although there’s some indication that deadline could be extended.
Bruce Ramge, director of the state Insurance Department, said Gov. Dave Heineman intends to make that decision by executive order. But Columbus Sen. Paul Schumacher questioned whether it’s the governor’s right to make such decisions since the Legislature is the policy-making branch of government. However, the next legislative session doesn’t begin until January, so a special session would have to be called to make such decisions.
“Where do responsibilities for decisions lie: at your office or the Legislature?” Schumacher asked, pressing insurance department heads to show him where the state constitution gives them that authority.
The governor’s spokeswoman, Jen Rae Hein, said the state constitution gives the governor the authority.
“The governor has executive authority to proceed and protect the state’s interests in having the option of a state-based exchange program,” she said after the briefing.
Martin Swanson, chief policy counsel for the insurance department, said numerous governors have made such decisions by executive order since the 1970s, and the federal government has said it would be acceptable.
Ramge said his office was asked by the governor to handle the planning process.
“We are being diligent, doing a thoughtful process, trying to obtain as much information as we can to make the right decision for Nebraska,” Ramge said.
Swanson also said the feds have told Nebraska officials they’re doing a “great job” of planning, which is contrary to public perception. Ramge said part of the reason the process has moved slowly is a lack of answers from the feds to many questions. Ramge said the department is just now moving into the “stakeholder engagement” phase.
Just because some other states have already decided what kind of exchange they want doesn’t mean they’re any farther along in planning and design than Nebraska, he said.
“I believe our planning and design is on par with any other state,” Ramge said. “I’m confident that we are as far along as any other state.”
Swanson said a consultant has estimated the cost of a state-based exchange at $61 million to $87 million, plus $17.5 million in annual operation costs. That’s a substantial increase from earlier estimates.
Omaha Sen. Jeremy Nordquist continued to call on Heineman’s administration to have more public engagement in the planning process, rather than closed-door meetings.
After the briefing today, Nordquist said he was glad the insurance officials said they’re about to engage stakeholders, and said he shares Schumacher’s concern about whether the governor has the authority to decide what kind of exchange to create.
“That’s a question,” Nordquist said. “A special session may have to happen.”
During the last session, Nordquist introduced a bill that would have created an exchange governance board that incorporated consumers, small businesses, health care providers, health insurance carriers and agents and state agencies.
Reported by Deena Winter, deena@nebraskawatchdog.org.
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