Third: "The public has to be involved in the creation of the exchange, to make this a success. So we're going to make this a transparent process."
To hear from the public, the Insurance Commission is sponsoring six forums statewide and setting up four advisory committees. (See schedule, this page.)
The next step: State lawmakers must give the official green light if West Virginia is to have its own exchange. Otherwise, West Virginians become part of a national exchange.
States must tell the feds their plans by 2013. If West Virginia has its own exchange, many questions must be answered. For instance:
| Should we combine small business and individuals into one big pool for more negotiating power?
| Which insurance companies will participate? "We have had detailed discussions with many," Samples said.
| What kind of staff and experts will be needed to review and approve premium increase requests, as the health reform law requires.
| How can the state avoid the scenario in which healthy people pay the penalty and only sick people sign up? "That would poison the pool," Samples said.
| How will insurance policies be reviewed, described and categorized?
| Precisely how many people qualify for subsidies?
| Does West Virginia have a large enough pool of customers to make an exchange viable? "We're going to run economic models on that question."
| What if the state requires all insurance to be sold through the exchange? "We're bringing in actuaries to answer questions like that."
| What if a lot of people pay the penalty and stay out while they're healthy, then sign up as soon as they get sick? A strict enrollment period policy can help, Samples said.
| How will massive data be transmitted between Washington and the states?
West Virginia could also combine forces with other states to make a bigger pool. "We've talked about that with several states," Samples said, "but we are a small state with a lot of chronic disease, and right now, most states are still trying to figure out what their exchange will look like. We're going to have to wait to answer that one."
Samples will not answer policy questions, he says. "The exchange board answers those," he said. "I'm the facilitator, the organizer of information."
Who will be on the exchange board? Will insurance companies be represented? Consumers? Brokers? Lawmakers will answer that question.
The Legislature must also decide whether the exchange will be run by the Insurance Commission or be an independent board like the Public Employees Insurance Agency board.Do no harm
Samples knows that various members of Congress have vowed to repeal the health-reform law. He knows 20 states have sued to stop the mandate that everyone have insurance. "Our job is to make this work as well for West Virginians as it can," he said. "Till somebody tells us the law is different, we'll keep trying to do that."
West Virginia applied for federal money to create an exchange at a time when the national health-reform law was in doubt, he notes. "People thought it was a good idea" to give people a place to review approved insurance.
West Virginia was already working on its exchange when the national law passed, "so we were ahead of the curve." They had brought in national technical experts and consulted with states that have exchanges.
Several other states have asked West Virginia for help in the past year, he said. "We're seen as a leader in this," he said. "We recently helped Arkansas with some technical matters."
In October, his boss, Insurance Commissioner Jane Cline -- also president of the National Association of Insurance Commissioners -- told the Gazette-Mail that the Governor's Office had not let the commission hire enough staff members to create the exchange.
They have now received permission to hire three more analysts. "Once we get them on board, we'll be humming along," Samples said.
The workdays will stay long, he said. "But it's temporary, and this is a very exciting time to work in health care. I wasn't around when Social Security or Medicare were passed, but this affects as many people."
On a dry-erase board in his office, he has written his overall goals. "They remind me of the big picture when I get lost in the details," he said.
In red letters, he wrote: "Better organize West Virginia health insurance market ... facilitate access to health care for working uninsured . . . drive system efficiency and cost containment . . . provide portal to all health-care services in West Virginia"
At the bottom, in big blue letters, he wrote: DO NO HARM.
"That sums it up," he said.
Reach Kate Long at 304-348-1798 or katel...@wvgazette.com.