Q&A with Cover Oregon Director Aaron Patnode

Cover Oregon’s latest director, Aaron Patnode, sat down with The Lund Report this week and gave insights into how the state could operate a SHOP exchange while avoiding more IT catastrophes. He maintained that Cover Oregon still has important functions despite the shift of enrollment responsibilities for health insurance on the individual marketplace to the federal government website, healthcare.gov. The Cover Oregon board meets again on Oct. 9 to continue the debate on the future of the marketplace.

The Lund Report: Let’s start off the top with the most pressing issue for Oregon consumers. How prepared will the exchange be for Oregonians to re-enroll through healthcare.gov on November 15?

Cover Oregon Director Aaron Patnode: Well, that obviously pertains to the transition project. From my perspective, the transition is going really well on the commercial side of things. What we’ve seen is that 12 of the 15 carriers that will be selling plans in 2015 have successfully engaged or completed that transition, and the three remaining carriers are in progress. I have a lot of confidence in those three remaining carriers to get the connections established that they’ll be successfully able to sell products through healthcare.gov.

And that’s not including Health Net?

That’s correct. Though it’s 15 not including Health Net, who decided they are not interested in participating in the exchange for 2015.

You’re not expecting any hiccups when people go online?

No, so healthcare.gov did experience some challenges last year when it opened up but the federal government was able to work through those challenges and provide a valuable resource in 27 states that are using the federally facilitated marketplace. So really they’ve learned from their experience and did it in real time. They have actually have a functioning platform that consumers are able to shop successfully. I’m actually looking forward to the opportunity to use a technology that’s been demonstrated as workable and seeing how that can actually benefit the state of Oregon in terms of the availability of commercial coverage to consumers.

Could you please explain what remains of Cover Oregon now that nationally it’s seen that Cover Oregon was giving up and going to healthcare.gov, and I don’t think people really understand what Cover Oregon still does.

Yeah, you’re exactly right, there’s a misconception out there about what is going to the federal government and what is staying with the state. Will anything be left with the state? Well, so the activities that are transitioning to the federal government are eligibility and enrollment, which are in large part are healthcare.gov, the website, if you will, and the appeals process, meaning anybody who has an issue with the coverage they’ve obtained, going in and being able to appeal the decision that was made on that coverage. And those two kind of go hand and hand because the eligibility and enrollment, people will be appealing their eligibility and enrollment, so those two are really tied together. Everything else is the responsibility of the marketplace, so plan management, which is working with the insurance carriers to ensure that quality and adequate coverage are provided to consumers in the state. Working with agency brokers, community partners and navigators, outreach, education. There’s a whole list of activities that states are required to perform as a marketplace that will remain with the state, and Cover Oregon is currently responsible for maintaining those functions and ensuring that consumers have them to use for the 2015 open enrollment.

And how are they different than what the Insurance Division already does with the Consumer Advocacy Unit?

Sure, I’m not entirely familiar with the OID’s Consumer Advocacy Unit but the OID is the regulator of the insurance markets. I would envision Laura [Cali]’s probably the better person to talk to about what exactly they do but the OID will continue to regulate the insurance market so: Do plans meet the criteria to be sold in the market in the state of Oregon? Are the prices justified to go along with those benefits? That sort of thing. As it relates to the consumer advocacy side of it, I’d say Laura’s probably a better person to talk to about their activities.

The responsibilities you listed -- how does it help Oregon maintain these things at a state level versus a state like Montana or Wyoming that just hands those responsibilities to the federal government?

It’s local support. The 27 states that are using the federally facilitated marketplace, they all get the same thing. To assume that what is right for a consumer, or resonates with a consumer in say the state of Georgia compared to the state of Montana, you know, you have to take the average and apply it to all states. In the state of Oregon, the benefit we maintain with keeping our own marketplace functions is that we get to tailor those communications, those activities to best suit the needs of the consumers that live and work in the state and in addition the needs of the carriers, the agency brokers, all of the other stakeholders: the people who are impacted by the activities of the marketplace.

How has your background, including your time at Kaiser Permanente, prepared you for this job and leading Cover Oregon through this transition?

Yeah, that’s a great question, so, my experience on the insurance carrier side prepared me with the perspective that I now use as I worked through the day-to-day activities of Cover Oregon, and I think about the implications of the future. It’s a great perspective to have, it’s one that I look back on, and there are times that I put my carrier hat on, I put my Cover Oregon hat on and it’s invaluable experience that gives me perspective to put myself in one of our most important partner’s shoes and understand the implications of the marketplace.

What are the key advantages of remaining a stand-alone corporation?

Sure, so what we’re interested in doing regarding the governance of Cover Oregon moving forward is ensure that we’re working with decision-makers to provide the most value to consumers that live in this state. You know, I feel there are a number of different benefits regardless of the governance situation that Oregon consumers will retain given the functionality remaining here in the state. Fundamentally, what we need to do is make sure we provide valuable benefits -- value-added benefits to consumers and those need to be provided regardless of whether we’re a stand-alone corporation or a program of one of the other state agencies.

You think they could be provided either way?

We need to provide them either way. It’s a federal requirement that we provide those functions, so you know, as legislators and other decision-makers have conversations regarding what they would like to see in the marketplace moving forward, Cover Oregon will continue to participate in those conversations to ensure that those folks get the information they need to make the decisions in front of them.

How would it work if the Cover Oregon became a unit within the Insurance Division or some other state agency?

Yeah, so, you know, we’re not quite at that point yet. You know, and we need to have conversations with folks once decisions that pertain to our governance are made so what’s in front of us right now in terms of our focus is the coming open enrollment period so it’s difficult to say at this point in time what a particular function would fit into one agency versus another or in other kind of governance situation but what’s important is that we continue to provide information to the decision-makers that ultimately will make determinations about where the functions should live and we’re happy to continue in those conversations.

How much work would it be for the state to keep its own SHOP program? How would that get put together?

So SHOP is really important obviously to the state of Oregon, just given the number of small employers in the state and the state is committed to having an option for small employers in the future of the marketplace. How much work would it take to implement the SHOP? That’s you know part of the evaluation that will take place when we consider future options for the marketplace. It’s difficult for me to say at this point and time how much work it would take, but what we do know is that there are other states that have successfully implemented SHOP, and we’ll look to learn on their experience and build upon that in Oregon.

What are some of those states?

Any of the state-based marketplaces that are out there, so, California, Mississippi, New Mexico is working on SHOP-implementation this year. There are a number of them out there. If you go to Kaiser Family Foundation you can see what states are implementing SHOP, you can probably find information about their experiences there.

Has Deloitte been hired to evaluate how the work involved with the state is running its own SHOP?

So Deloitte is under contract to be the systems integrator for the transition project, and there’s a portion of that transition that’s related to the QHP market or the commercial market. In the scope of their responsibility, it doesn’t pertain to actual SHOP implementation. But like I said, what we’ll be doing is looking to other states to learn from their experiences and then apply those here in the state.

Do you have any reason to believe it would take less IT infrastructure than the individual market exchange?

The SHOP marketplace?


What I know is that our history in owning and operating technology has been our ability to do what has been proven -- or disproven, if you will. I’m apprehensive about owning and operating any technology moving forward. What we will do is continue to provide input into conversations at the legislative-level, the decision-maker level, about what the options are related to SHOP.

So the federal SHOP could still be used just like healthcare.gov is used?

Yeah, we’re gonna evaluate any and all options that are out there as it pertains to the small-group market or the option for small employers. The federal SHOP will be up and running for 2015. It’ll be the first instance that the SHOP has been available through the federal website. We will definitely be looking at that as a potential option for us.

And for 2015, employers will still have that kind of--

The direct enrollment.

Direct enrollment.

So, the option for small employers in Oregon in 2015 is exactly what it was in 2014. If a small employer would like access to the tax credits that are available for providing insurance to their employees, they can purchase a small group plan that’s eligible for them to receive those tax credits, directly from a carrier, and then Cover Oregon will work with the carrier to ensure that ultimately the small employer receives the tax information they need to receive the tax benefit.

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