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Published December 27, 2010, 12:00 AM

Health reform to be big legislative issue

North Dakota lawmakers face decision on who will operate health insurance exchange
The 2011 North Dakota Legislature will grapple with how to implement national health care reform in the state.

By: Patrick Springer, INFORUM

The 2011 North Dakota Legislature will grapple with how to implement national health care reform in the state.

One of the most basic questions lawmakers will decide: Should the state operate its own health insurance exchange or forfeit that role to the federal government?

A bill introduced by Rep. George Keiser, R-Bismarck, would establish a state exchange, intended as a health insurance marketplace that would allow consumers to do comparison shopping for their coverage.

Insurance Commissioner Adam Hamm is proposing to add four new staff members in the 2011-13 biennium to gear up for a state health insurance exchange.

He also proposes to add staff to handle enforcement of health reforms and to oversee independent reviews of claims appeals – all roles Keiser, who is chairman of a key committee, seeks to add through legislation.

“The common theme is maintaining state control over those issues,” Hamm said. “There’s no question the Legislature’s going to have some big policy decisions to make.”

Altogether, Hamm is seeking to add 13 staff members, with four or five others likely in 2013-15, as more health reforms take effect. The department currently has 45 employees.

“Substantial growth in the department as a direct result of the health care reform law,” Hamm said.

Both Hamm and Keiser said the state’s plans for implementing federal health reforms are hampered by the slow pace of regulations that are fleshing out the law.

A case in point is the definition of what will be considered essential benefits that insurance plans must meet to be offered on the exchange.

That definition isn’t expected until May or June – long after the Legislature will have adjourned, and might not come until later, Keiser said.

“It’s one of the most central issues because it has great impact on what the premiums will be in the state,” he said.

If the definition of essential benefits is more expansive than what North Dakota law currently requires, health insurance premiums would go up, Keiser said.

In light of the delays and uncertainty, Keiser is proposing that legislative leaders set aside a couple of days so lawmakers could reconvene after the normal session to decide key elements.

The other alternative, he said, would be to pass enabling legislation allowing Hamm’s department to resolve issues that remain after the session.

Health reform has far-reaching ramifications, Keiser said. For instance, state human services officials estimate they might have to rewrite 23,000 child custody orders to clarify which parent is responsible for providing health insurance for their children.

“That’s just one example of the work that’s yet to be done,” Keiser said.


Readers can reach Forum reporter Patrick Springer at (701) 241-5522

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