142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

Governance of State-Based Health Insurance Exchanges: The impact of legislative decisions establishing business entity and governing board structure on HIE independence and accountability

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014 : 2:30 PM - 2:50 PM

Reinetta Thompson Waldrop, Dr.PH, MSHS, FACHE , Master of Public Health Program, Morehouse School of Medicine, Atlanta, GA
Joel M. Lee, DrPH , College of Public Health, University of Georgia, Athens, GA
Su-I. Hou, DrPH, CPH, MCHES, RN , Health Promotion and Behavior, University of Georgia, Athens, GA
Deborah Murray, EdD , College of Family and Consumer Sciences, University of Georgia, Athens,, GA
Curt Harris, Ph.D. , College of Public Health, Health Policy and Management, University of Georgia, Athens, GA
The Patient Protection and Affordable Care Act (PPACA) allowed states to determine the type of business entity and governance structure they would implement when creating their state-based Health Insurance Exchanges (HIEs).  While HIEs are mandated by federal statute, decisions related to their business model, board apportionment, composition and member selection and qualifications occur at the state level and can be the result of legislative actions or executive orders. Because HIEs are new to the insurance market and are in their infancy, there is no quantitative or operational data available on the most effective business model or governance structure.  Legislative decisions to create HIEs as non-profit corporations, or as multi-state regional agencies, or entities operated by new or existing state agencies all carry with them differing administrative standards that guide their operation.  However, research shows that certain administrative and ethical standards must govern their establishment to ensure independence and accountability. Likewise, how governing board apportionments, member composition, and member selection are legislatively defined is important to ensure operations that are free of political interference.  Research revealed that 59% of states enacted HIEs as quasi-governmental business entities, and governing authority bodies ranged from 5 member to 19 member boards, with one state establishing 5 regional councils that seated a total of 180 members. This presentation will present an analysis of the business entities and governance structures put in place by sixteen state based HIEs.  It will also examine several administrative, and ethical standards believed to ensure political independence and HIE accountability, namely: 1) apolitical management; 2) the prevention of conflicts of interest; 3) subjection to government agency administrative rules and regulations; 4) equity in board apportionment; 5) legislative requirements for board representation; and 6) legislative guidance on HIE finances including continuity of operating funds, financial reporting requirements, oversight, and monitoring.

Learning Areas:

Public health or related organizational policy, standards, or other guidelines

Learning Objectives:
Describe the legislatively enacted business entity and governance structure of sixteen state based health insurance exchanges Discuss the range of administrative and ethical standards that promote HIE independence and accountability

Keyword(s): Affordable Care Act, Politics

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I serve as the public health program subject matter expert on the topic of the Affordable Care Act, have conducted health reform roundtables featuring state legislators, presented to county health officials on the challenges faced by local health departments in benefiting from health reform programs and activities, and researched this subject matter extensively as part of a doctoral dissertation.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.