Kan. struggles to iron out healthcare exchange details

After Kansas Gov. Sam Brownback rejected the recommendations of Insurance Commissioner of Kansas Sandy Praeger regarding the state's online healthcare exchange, the state may have a more difficult time setting its own benchmarks to comply with the Affordable Care Act (ACA).

Praeger's agency made recommendations for the healthcare exchange based on benchmarks outlined in the ACA, according to an article in the Topeka-Capital Journal. But the governor's office rejected the recommendations, claiming that the ACA would increase costs and mean fewer jobs. Now the responsibility falls to the U.S. Department of Health and Human Services (HHS) to set the standards.

States had a soft deadline of September 30 to submit their own benefit mandates that are in compliance with federal mandates outlined in the ACA.

"In the absence of that, the HHS will start reaching out to states one by one to discuss what the default is going to be," explained Linda Sheppard, a project manager and director of the Accident and Health Division at the Kansas Insurance Department, in an interview with DrBicuspid.com. "I expect that call very soon."

Most forms of medical coverage would not be affected, except for pediatric dental and vision coverage, according to Praeger. HHS will recommend that the state adopt Blue Cross and Blue Shield of Kansas, the state's largest insurer, which is the same recommendation Praeger's agency made, the article explained.

What about dental?

However, requirements for pediatric dental and vision coverage are not included in HHS' recommendation. Consequently, Praeger's agency proposed that Kansas' HealthWave and Medicaid fill the gap in coverage.

"We wanted to use the benefits that are currently being used in our Children's Health Insurance Program (CHIP) so that there would be that continuity of care," Sheppard explained. "Our expectation is that there will be some families that will be toggling on and off between CHIP coverage depending on their employment or financial situation. They may move into the private market from time to time. So if the benefits and the benchmarks were similar to what they were in the CHIP program, that would help reduce that disruption that may happen with the child moved back and forth between the public and private program."

Sheppard admitted that her agency would be "disappointed" to lose the opportunity to set the benefit benchmarks for the state, but said that they will be available regardless of the outcome. "But it's a question of what benefits, what type of benefits," she added.

The governor has decided not to move on the highly politicized ACA until after the November presidential election. Praeger said her office will continue to operate within the framework of the law regardless of the election's outcome. However, she expressed concern that the window of opportunity for the state to set its own standards may be closing.

Sheppard is more optimistic.

"Based on our interaction with HHS officials over the past couple of years, working with them on implementation of the law, I think they have tried to be pretty flexible with the state and have recognized the difficulties the states are having," Sheppard said. "Everybody is very aware that these things have become much more complicated because of the politics involved, and, in recognition of that, the feds are trying very hard to give the states an opportunity to impact what happens in their state."