February 13, 2015
From the desk of
SHADAC Director Lynn Blewett
In March 2013, Governor Mark Dayton signed legislation that created MNsure, Minnesota’s health insurance marketplace. MNsure was developed as a quasi-public entity governed by a seven member board of directors appointed by the Governor (including the Commissioner of Human Services who is a standing member).
During the current legislative session, several bills have been introduced to refine the governing structure of MNsure. Among them is a bill by Senator Tony Lourey (SF 139), which moves MNsure into the infrastructure of Minnesota’s state government system. The goal of this legislation is to provide greater legislative oversight over the activities of MNsure. As a state agency, the Governor would appoint a Commissioner to oversee the agency and the Governor and Legislature would review and approve MNsure’s budget, which would be part of the public record. Under Senator Laurie’s bill the MNsure board would be disbanded but the Commissioner would be required to establish and consult with advisory committee(s) to provide input on MNsure operations.
We have compiled a list of the SBMs and an overview of their governance structure. To date there are 14 states, including the state of Minnesota, that have elected to operate their own State-Based Marketplace (SBM) under the Affordable Care Act.
- Nine of these SBMs are operated as “quasi-governmental” entities in the form of independent public or non-profit agencies with governing boards. State-specific rules, including data privacy rules, open meeting laws, and others, may apply to these marketplaces.
- One state--Hawaii--has set up its exchange as a private independent entity.
- Four states have used existing state agencies to house their state-based marketplaces: Kentucky, New York, Rhode Island, and Vermont. Information on each of these four State Based Marketplaces is presented below.
State Agency Governance of SBMs: An Overview
Kentucky
An executive order established the Office of the Kentucky Health Benefit Exchange, kynect, which is housed in the existing Cabinet for Health and Family Services. Within the new office are four divisions: (1) the Division of Health Care Policy and Administration; (2) the Division of Information Systems; (3) the Division of Financial and Operations Administration; and (4) the Division of Communication and Outreach. The office is headed by an executive director who works with a 19 member advisory board appointed by the governor.
New York
An executive order established the New York Health Benefit Exchange, NY State of Health, located in the New York State Department of Health. The exchange is led by an executive director and five regional advisory committees consisting of various stakeholders.
Rhode Island
An executive order established the Rhode Island Health Benefit Exchange, HealthSource RI, in the Executive Department. The exchange is governed by an executive director and a 13-member board, which is required to consult with the state’s Health Insurance Exchange Workgroup and an Expert Advisory Committee.
Vermont
Legislation was passed to establish the Vermont Health Benefit Exchange, Vermont Health Connect, as a part of the Department of Vermont Health Access under the Deputy Commissioner. The exchange is governed by the Green Mountain Care Board, which consists of five state employees. The board and exchange receive counsel from a 22-member Medicaid and Exchange Advisory Committee.