2013-03-21 / News

Islander leads way to affordable benefits

Christine Ferguson directs health-insurance exchange
By Ken Shane

Jamestown resident Christine Ferguson recently returned from a trip to Washington, D.C., where she was asked to testify to the Senate Finance Committee on the merits of state-based exchanges for health insurance. Rhode Island, unlike some states, is creating its own insurance exchange.

Gov. Lincoln Chafee a year ago named Ferguson the director of the federally mandated program.

Ferguson has lived in Jamestown since she was 14, although she spent 15 years in the nation’s capital working for Chafee’s father, U.S. Sen. John Chafee.

The Rhode Island Health Benefits Exchange is an initiative of the Affordable Care Act that goes into effect in 2014. The federal statute – better known as Obamacare – is the largest government overhaul of the U.S. healthcare system since Medicare was passed 50 years ago.

The law mandates each state to create a health-care exchange that will initially be funded by the federal government. In the states that refuse to set up such an exchange, the federal government will create it for them. The purpose of the program is to provide people with opportunities to purchase affordable health care. Beginning in 2014, failure to have health-care coverage will result in escalating financial penalties. People whose income is within 400 percent of the federal poverty level will be eligible for tax credits to defray the cost of premiums.

According to Ferguson, the exchange will allow people to compare and buy health insurance. The exchange will negotiate with insurance carriers to get better offers and good predictable prices so that health insurance becomes more affordable for more people.

Ferguson was quick to point out the benefits of having a state-run exchange rather than one set up by the federal government.

“There’s a huge difference,” Ferguson said. “In the federally run exchange, they’ll be doing much more of a one-size-fits-all. In the state-run exchanges like ours, we’re working collaboratively with the business community and with insurers, as well as getting information about what consumers want.”

Ferguson said the exchange would work with insurers, doctors and hospitals to make sure that what the people of Rhode Island need and want gets delivered. In the federal approach, she says that kind of oversight is just not possible. Ferguson added the federal government couldn’t possibly know what is needed in a particular state.

Right now consumers in Rhode Island have a choice between national coverage – which Ferguson says is often not effective – and Blue Cross. Beginning October 1, when the exchange opens, people will be able to choose between the existing options, as well as companies like Tufts and Neighborhood Health Plan. The three carriers will each offer different plans with different provider networks and deductibles. Ferguson hopes to add more choices in each successive year.

“The universe of things that are available to you is going to open up,” she said.

Consumers will be able to visit the exchange website, consult with the call center, or have a face-toface conversation about the right plan for them. They will be able to discuss personal health issues and get help finding a new doctor or plan. Once insurance is in place, consumers will be able to voice concerns over the way their insurance is being administered. Ferguson says this will make insurance companies, hospitals and doctors more accountable.

Plans are in the works for a future Rhode Island call center to provide new jobs for state residents. The face-to-face visits will be handled by people who will be assigned to work in each community. Ferguson couldn’t say exactly how many people would be employed by the call center, but a volume of approximately 60,000 calls a month is anticipated. On average, she says, each call is expected to last for 20 minutes.

“We’re talking about a pretty intense interaction,” said Ferguson. “This is like a start-up in state government, starting from literally three of us. What we’re trying to do now is build out what that capacity is, but it will be a substantial team of people. We have a lot of consultants now, but much of that will flip over to either service agreements or state employees.”

According to the terms of the Affordable Care Act, federal appropriations will pay for the costs of the exchange for the first two years while capacity is built. After that, evolution and maintenance of the exchange will be state funded. Ferguson pointed out that funding will probably come from a dedicated revenue source.

“We are using the federal dollars to really invest in building the capacity and getting people on board to do specific work. And then we will make the shift away from federal dollars. I don’t think we’ll ever end up 100 percent away from federal dollars because this is a huge new revamping of the health-care system. I expect that there will be quite a few focused efforts around delivery reform and other issues after the two years.”

Ferguson has substantial experience in the health care arena. While working with the late Sen. Chafee in 1993, she helped craft the first health-care bill that contained the concept of an individual mandate. Ferguson became director of public health in Massachusetts in 2003, and the legislation, while not successful in Washington, D.C., served as a model for the highly successful Massachusetts health-care law. Subsequently, the Bay State law was in turn used as a model by the Obama administration for its proposal.

“If you cut right down to the bone of the health-care piece, there are three reasons why everybody thinks it’s important,” she said. According to Ferguson, those reasons, in no particular order, are to protect people from catastrophic costs, like car or homeowners insurance; to raise the level of health in the United States; and to make sure that people can be productive in society.

“That means from a work perspective and a school perspective,” she said.

Ferguson said that if it can be shown that the influx of dollars has achieved those things, then the program will be judged to have been a massive success. But she added that if all it does is get a few more people covered but doesn’t lead to real improvement, then it won’t be much of an achievement.

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