Tough health care decisions ahead for ND in wake of Supreme Court ruling

FARGO – North Dakota is one of about 36 states that must decide whether it should take the lead in establishing a state health insurance exchange under the health reform law upheld last week by the Supreme Court.

North Dakota legislators, in a special session last November, decided to let the federal government take the lead in establishing any exchange, an online marketplace to guide consumers in choosing coverage.

Under current deadlines, North Dakota likely would not be able to have a planned exchange certified as ready to go by Jan. 1, 2013. But Insurance Commissioner Adam Hamm said it might be able to get conditional approval.

Blue Cross Blue Shield of North Dakota executives are exploring the possibility of having a “standby” exchange template ready to go in the event the federal government grants the state an extension.

Otherwise, unless the law is repealed – a scenario that would require Republican control of the White House and a majority in the House and Senate – North Dakota could be left with a “one size fits all” federal version of an exchange, as the law now stands.

Paul von Ebers, president of Blue Cross Blue Shield of North Dakota, believes a state-designed health insurance exchange would be better suited to the state’s needs, since it could be tailored.

Noridian Administrative Services, the North Dakota Blues’ affiliated Medicare claims processing arm, has the lead contract for setting up Maryland’s health insurance exchange.

“We’re still pushing for the idea of a state exchange,” von Ebers said.

“It’s now late,” he added, referring to early target dates in setting up an exchange, which must be certified by Jan. 1, 2013, for implementation a year later. “We’re past the federal deadline.”

But if the Obama administration grants extra time for states, including North Dakota, to pursue a state exchange, the North Dakota Blues, in partnership with others, might be able to offer a “fighting chance,” von Ebers said.

The task of setting up an exchange could be attractive to information technology firms, he said.

Hamm, a critic of the health reform law, said the Legislature’s interim health committee plans to meet late this month.

One major concern is whether the cost of operating an exchange would be self-sustainable after federal funding evaporates in 2015.

As of December, North Dakota insurance regulators had rough cost estimates for setting up an exchange ranging from

$9 million to $89 million, with annual operating budgets ranging from $4 million to $47 million, based on figures from other states.

“That’s why you’re seeing so many states holding back,” Hamm said of the uncertainty that still plagues health reform, even after the Supreme Court’s landmark decision last week upholding the law.

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

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