As a medical student in the Alaska WWAMI biomedical program who cares deeply about health care access, I was excited to learn of Gov. Sean Parnell’s September decision to move forward with planning for the state health insurance exchange as a part of the Patient Protection and Affordable Care Act (ACA). Under the ACA, each state is required to implement a health insurance exchange system within which individuals and small businesses can compare and enroll in health insurance programs. Alaska follows 47 other states in implementing this important aspect of the ACA, which is projected to serve as many as 120,000 Alaskans. While this progress is encouraging, Alaska now faces difficult realities in implementing the exchange within ACA timelines. While most states have been working at full-speed since early this year to plan their exchange systems, Parnell — until his September announcement — rejected the notion of creating such a system for Alaska and was the only governor to pass up a $1 million federal health insurance exchange development grant awarded last year. Now, lacking this federal grant, Alaska must devote $500,000 of state money to the planning process and work at a swift pace to make up for lost time. In order to meet federal deadlines and ultimately provide this needed service to Alaskans, the state must act quickly and attentively in planning and implementing its health insurance exchange.
In designing its exchange, Alaska will first hire consultants to develop potential plans and subsequently seek a vendor to implement the most appropriate recommendation. This project’s request for proposals (RFP) for consulting assistance is illustrative of the challenges Alaska faces in implementing its own exchange system under such a short timeline. According to the RFP, the Alaska Department of Health & Social Services was scheduled to award the consulting contract by Oct. 24, with the awardee beginning work on Tuesday. As of now, it appears that no contract has yet been awarded. This is concerning given that the very same consultant is expected to produce a comprehensive report by Jan. 30, 2012.
The timeline for planning and implementing state health insurance exchanges is tight, even for the states that have been diligently preparing all along. Many states have reported that it will be difficult to meet the Jan. 1, 2013 deadline for approval by the U.S. Department of Health and Human Services and the official Jan. 1, 2014 date when exchange systems must be operational. Given Alaska’s late start, there should be a great deal of focus on ensuring that the consulting team meets stated deadlines. In the RFP, it is clear that the state is starting from ground zero, as illustrated by such statements as “no formal meetings (regarding the exchange) with substantive recorded results have been taken” and “stakeholder involvement to date has been cursory.” From failing to accept federal funding, to starting the planning process much later than most states, Alaska is starting at a disadvantage in shaping its health insurance exchange and the state must now focus wholeheartedly on implementing an effective system that is responsive to Alaska’s needs. If the state fails to meet the aforementioned deadlines, the federal government will implement the exchange itself. This is an undesirable option, as a federally run system would not be as well tailored to the needs of Alaskan consumers. In order to avoid this outcome, the state must act quickly to implement an effective exchange system.
While it was a long time coming, Parnell’s decision to actively shape a health insurance exchange system for Alaska is exciting. The exchange will go a long way in addressing Alaska’s health care cost crisis and ensuring fairness for Alaskan consumers. With just over a year to assemble this system, Parnell owes it to the state of Alaska to work efficiently to produce an exchange that is responsive to the needs of all Alaskans. If you also believe that the governor has an obligation to deliver a quality insurance exchange system, please write him and let him know how important this vital component of the ACA is to you and to the many Alaskans who will rely on it.
• Hale is a 2008 graduate of Yale University and is currently pursuing a dual degree in medicine and public health at the University of Washington through the Alaska WWAMI Biomedical Program.