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Challenges Ahead For Oregon's Health Exchanges

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Oregon is one of the states that's furthest along in setting up its health insurance exchange. But the exchange's executive director, Rocky King, still has much work ahead if that state is to meet the federal deadlines that are part of the Affordable Care Act. Weekends on All Things Considered host Guy Raz checks back in with King about the challenges Oregon faces to finish its exchange by 2014.


And if you're just joining us, this is WEEKENDS on ALL THINGS CONSIDERED, from NPR News. I'm Guy Raz.

As Gov. Deal just mentioned, Georgia is still undecided over whether it will participate in Medicaid expansion - that's part of the Affordable Care Act. Last month, when the Supreme Court upheld most of it, it also allowed states to opt out of Medicaid expansion. But the other part of the new health-care law will require states to offer health insurance through exchanges, places where consumers can comparison shop for insurance.

Very few states have actually started to set up that infrastructure; Oregon is one of them. Rocky King is in charge of the process in that state. His staff is furiously trying to meet a January 1st deadline, set by the government, to have a working model of the exchange up and running.

ROCKY KING: First of all, you've got to build the technology. You got to make sure the technology works for everybody. The second is building the customer-service network. Whether it's using community partners, social service agencies, schools - what's going to be that piece out into the community, that people can turn to for assistance? Then really, it's just that - the corporate piece of this: the marketing, the outreach, the communications to folks. So there are a lot of pieces; bringing on the staff to do that, and making sure that they have the resources to carry out that.

RAZ: What happens if you don't meet the deadlines?

KING: If we don't meet the deadlines, I'll probably go play golf so nobody can find me. The deadline can be met. The issue's going to be, how much of the scope of work, how many of those bells and whistles, can we bring to the Oregon citizens to really navigate that system? Will they have 10 carriers, or will we have to build this system that really, has fewer choices and fewer carriers? And on the Medicaid side, are we going to be able to automate, you know, not just eligibility, but also planned selection and enrollment?

It's the scope of the work. It's so huge, the issue is not whether we can start on that day. The issue is, how much of all of those elements can we make sure, on day one, are ready?

RAZ: I mean - but with all due respect to Oregon - a great state, but we're not talking about one of the most populous states. I mean, imagine: If it's so challenging and tough for you, imagine what it's like for states like California or New York.

KING: Well, I don't want to imagine that because I'm having enough trouble meeting my own challenges.


RAZ: It seems like the states of Florida and Louisiana, for example, will not participate. They are just not going to begin setting up their own exchanges. That means the federal government is going to do it for them. Is there a disadvantage, in your view, of having the federal government do it? I mean, why even bother setting it up, if the federal government's going to do it instead?

KING: We wanted the state to be responsible for that, primarily because we want the state to decide - you know, our own citizens, our own boards making decisions around quality and criteria, for participation of carriers in the exchange. We wanted our own folks to be answering phones. If somebody has a problem with finding a resource in Multnomah County - which is our state's largest county here - we wanted them to be able to phone somebody who knew Oregon, not somebody that was stationed in Washington, D.C.

So from a customer-service standpoint, from a quality standpoint, from a coordination with our carrier standpoint, we felt it was extremely important that this be an Oregon product, not a federal product.

RAZ: Rocky King is the executive director of the Oregon Health Insurance Exchange. That's a group charged with implementing the Affordable Care Act in the State of Oregon. Rocky, thanks again.

KING: You got it.

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