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Published November 14, 2012, 11:30 PM

North Dakota direction on health care to emerge next year

Minnesota moving ahead to create own exchange
FARGO – North Dakota still must decide whether to allow the federal government to create a health insurance exchange for the state or to run one in partnership with Washington.

By: Patrick Springer, INFORUM

FARGO – North Dakota still must decide whether to allow the federal government to create a health insurance exchange for the state or to run one in partnership with Washington.

The North Dakota Legislature decided last year not to establish its own online health insurance marketplace. Legislators and Gov. Jack Dalrymple said there were too many unknowns about cost and implementation for the state to take the lead.

Because North Dakota already has opted not to create its own exchange, a Friday declaration deadline for states taking that avenue doesn’t apply. Minnesota, on the other hand, is moving ahead to create its own exchange.

“Gov. Dalrymple has kept an open mind to what will be the best solution for North Dakota, including the option for an exchange that is jointly managed by the state and federal government,” Jeff Zent, the governor’s spokesman, said Wednesday.

Regardless of which path the state takes – to defer entirely to the federal government or opt for a hybrid partnership – the next Legislature will have to agree to appropriate money, including federal dollars. So the final decision about which path North Dakota takes will be made in the upcoming legislative session, which begins in January.

“If the Legislature chooses not to pursue a state-federal partnership and a federally operated exchange is implemented in North Dakota, the state still has the option of taking over the exchange’s operations in the future,” Zent said in a statement for The Forum.

State-based health care exchanges are a key component of the 2010 law often referred to as Obamacare. The online exchanges are supposed to give consumers a way to compare plans and will also be the mechanism for delivering new federal subsidies to help those who qualify for coverage.

They’re required to be set up by the start of 2014, and in states that don’t establish their own systems, the federal government will run the exchange instead.

Blue Cross Blue Shield of North Dakota, the state’s dominant private health insurer, has been a vocal advocate of a state-created exchange.

Short of that, the insurer has been urging Dalrymple to pursue what’s called a State Partnership Exchange, which would allow the state to keep “many of the core regulatory functions that exist in the state today,” according to a letter to the governor from the North Dakota Blues’ top executive.

Under that scenario, state insurance regulators would review insurance plans to determine that they qualify under the federal health reform law, wrote Paul von Ebers, chief executive officer of Blue Cross Blue Shield of North Dakota.

That option also would allow the 2013 North Dakota Legislature to plan for a transition that would enable the state to operate its own exchange beginning on Jan. 1, 2015, according to von Ebers.

Sen. Tim Mathern, D-Fargo, who serves on a health reform review committee, said the state still has a lot of flexibility in choosing a path to an exchange.

Mathern, a proponent of the health reform law, said North Dakota might actually end up with a better exchange if it simply allows the federal government to take the lead.

“It’s not black and white,” he said, referring to the complexity of the issue and different opinions about the best course.

Adam Hamm, North Dakota’s Republican insurance commissioner, is much more skeptical about the workability of health insurance exchanges in light of lingering uncertainty over how much they will cost to implement.

“Let the federal government prove to North Dakota and to other states that exchanges can work financially,” Hamm said in a statement. “If the federal government can prove that, North Dakota could, if it wanted to, take over the exchange operations at some point in the future.”

North Dakota’s decision not to take the lead on an exchange was made when many Republicans were counting on “Obamacare” being struck down by the Supreme Court or repealed if the GOP captured the White House and control of the U.S. Senate – scenarios that didn’t happen.

Now that it appears health reform will proceed, most of the law is yet to take effect, with many of the provisions set to go into effect in 2014.

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