Create Iowa insurance exchange with care

By The Des Moines Register

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The new health reform law relies on private-sector insurance to get millions of Americans covered. Government-regulated “insurance exchanges” will connect people with that coverage. Individuals with pre-existing conditions will be able to buy plans there, and lower-income people will get help from taxpayers to pay for them.

But these exchanges aren't simply going to appear in all 50 states.

States have to create them - or the federal government will step in to do it for them. The exchanges must be largely set up in 2013 and operating in 2014. That isn't so far away - especially considering it's a monumental task.

Iowa is among the states with a lot of work to do.

The first step: Passing legislation to simply establish an entity to focus on creating Iowa's exchange. This state can't even get started tackling some of the major decisions that will need to be made without establishing a body of people to get to work.

Right now, state Sen. Jack Hatch is crafting legislation to set up such an entity. He stresses it will be independent, and has given much thought to ensuring it won't be comprised of industry insiders with their own agendas.

“There won't be insurers or agents or brokers or hospital administrators” running the show, said the Des Moines Democrat. That's the right idea, and involvement of industry insiders should be only in an advisory capacity. This would make the best use of their expertise, but avoid potential conflicts of interests.

Next session, Iowa lawmakers must put their political differences on federal health reform aside and create this body.

It must be done right. It must be independent. A half-baked plan isn't acceptable for something so important.

A recent report from Andrew Cannon of the Iowa Fiscal Partnership notes California could be a good model for Iowa to follow. That state's exchange will be governed by five board members appointed by different government authorities. It prohibits members from being employed by or affiliated with insurers, brokers or health providers.

“The success of Iowa's exchange will be determined by its structure and the commitment of state legislators and executive agency leaders to make it work,” according to the report. .

The number of Iowans relying on the exchange could grow by leaps and bounds in coming years. If lawmakers do not get the basic infrastructure of the exchange on a solid foundation, this state will be in for nothing but problems in the future.

“You have to create a body just to start making decisions,” said Anne Kinzel, coordinator of the Iowa Legislative Health Care Coverage Commission. “There is a lot of federal money at stake and if you don't have a structure in place, that money is just going downstream, never passing go in Iowa.”

The time to start ensuring that doesn't happen is now.