Chaquita Brooks-LaSure, Deputy Director of Insurance Oversight at HHS

(Music)

Mark Masselli: This is conversations on Healthcare I’m Mark Masselli.

Margaret Flinter: And I’m Margaret Flinter.

Mark Masselli: Well , Margaret we’re just back from Best Practice Conference in Boston,
where some of the greatest minds in Healt hcare together to share ideas about ways to
improve health care delivery and outcomes it was a strange drugs to position though.
Such a positive gathering of likeminded individuals against the backdrop of the
marathon bombing that was griping the city and the nation all last week our hearts go
out to all the victims of the tragedy.

Margaret Flinter: You know if there’s a silver lining anywhere we’re so fortunate that the
victims had access to some of the best trauma care and best medical institutions in the
world. It was very impressive to watch the entire healthcare community mobilize to treat
the many victims as well as first responders and volunteers.

Mark Masselli: It’s also amazing to witness the mobilization of the public safety
community across the city in reason to track down the suspect while keeping everyone
safe and Governor Deval Patrick showed great leadership employ ee s throughout the
whole ordeals. They presented a clam voice admit much chaos and uncertainty.

Margaret Flinter: And gover nor has also been a guest on the show speaking about the
S tate of Massachusetts and their role and distinctions being the first in the nation to
embrace near universal access to health coverage for all citizens in the base state. And
that’s kind of given the rest of the nation a primer on what happens when an entire
population gains access to health coverage, general health improves.

Mark Masselli: Our guest today will be addressing the same issue Chiquita Brooks -
LaSure is Deputy Director at the Center for Consumer Information & Insurance
Oversight at the D epartment of Health and Human Services. She’s a key player in the
role out of the insurance exchanges under the Affordable Care Act.

Margaret Flinter: Well , Mark even for those of us who study this all the time it’s safe to
say there’s still confusion and uncertainty about how the online insurance exchanges
are going to work for millions of American seeking affordable health insurance. So we
are looking forward to some up to the minute information f rom our guest.

Mark Masselli: We’ll hear it from Fact C heck s . o rg’s Lori Robertson, but no matter what
the topic you can hear all of our shows by Goggling CHCradio .

Margaret Flinter: And as always if you have comments e - mail us at CHCradio.com or
find us on Facebook or Twitter because we love to hear from you.

Mark Masselli: We’ll get to our interview with Chiquita Brooks - LaSure in just a moment.
But first here is our producer Marianne O’Hare with this week’s headline news.

(Music)

Marianne O’Hare: I’m Marianne O’Hare with th e s e Healthcare headlines. Blame the
economy, analyst looking at the slowdown in recent years in the peace of growth in
healthcare cost which had seen double digit inflation in the years past well seems the
growth in healthcare s pending has gone down in recent years due to the economic turn
down, not because health delivery has gotten more efficient. More Americans are
opting out of seeing a doctor, seeking elective procedures and / or putting off preventive
care due to unemploymen t, underemployment, no insurance or more Americans been
given high deductable insurance policies through employers. Good for the employer
seeking to control cost, but it’s forcing Americans to put off spending their dollars out of
pocket on healthcare.

A nd the trend is impacting earnings in the healthcare industry with week first quarter
earnings reports from across the healthcare sector. Analysts are looking at spending
growth for 2013 and predicted many American s will put off care until the healthcare law
kicks in 2014.

Meanwhile , there’s a pretty abundant lack of awareness about benefits to many
Americans under the Affordable Care Act according to report on CNN 26 million
Americans are likely to qualify for some kind of tax credit under the healthcare law,
families making up to $96,000.00 a year would get a rebidded in the Affordable Care
Act to all set the cost of insurance, but most don’t even know about it.

New York City is at it again taking a bold step towards impacting public health . They’re
co nsidering a measure that would raise the age for being legally able to buy cigarettes
for 18 to 21 in an effort to reduce smoking among the age group in which most smokers
take up the habit. The bill introduce by the city council has the backing of mayor
Michael Bloomberg and would make New York City which already has the highest
cigarette taxes in the nation , t he first big City or State to set the smoking age at 21.

I’m Marianne O’Hare with these healthcare headlines.

(Music)

Margaret Flinter: We’re s peaking today with Chiquita Brooks - LaSure, Deputy Director
for Policy and Regulation at the Center for Consumer Information & Insurance Oversight
at CMS the Centers for Medicare & Medicaid Services. Ms. Brooks - LaSure oversees
regulations related to the im plementation of the Affordable Care Act . S he was
previously Director of Coverage Policy at the Office of Health Reform at HHS
overseeing consumer protection exchanges in Medicaid. She was the staff member at
the Ways and Means Committee which played an i mportant role in developing the

Affordable Care Act in Medicare Part D. Chiquita , welcome to Conversations on
Healthcare .

Chiquita Brooks - LaSure: Thank you so much, thank you for having me.

Mark Masselli: You know your task at HHS is to oversee how st ates are preparing to
comply with the full implementation of the Affordable Care Act as it relates to offering
insurance coverage to the uninsured. You know, the exchanges are suppose to provide
affordable consumer friendly online insurance marketplace s, that offer access to
healthcare coverage for millions who currently needed, and I think it’s safe to say there
are many consumers and small business owners who still have no idea what the
insurance exchanges are, and much less how they’re suppose to work. So can you
describe for us if you would, who will be able to buy insurance on the exchange and,
how that will work.

Chiquita Brooks - LaSure: Yes the marketplace was envisioned as a place that would
allow consumers and small businesses to easily shop for private health insurance plans.
The marketplace will provide comparison tools, simplifying the process for buying
insurance. Tax credits with be available for low and middle income families to help
them afford insurance. Consumers will be able to enroll the other web telephone in
person or paper application. For the federally facilitated marketplace, we’re developing
a 24 hour call center so that consumers will be able to get information on the process,
compare plans and then get enrolled. I would like to encourage listeners to visit
HealthCare.gov to learn about the many changes that have already occurred and what’s
been coming in the next couple of months.

Margaret Flinter: Well , Chiquita , now we’ve got 33 S tates around the country who are
not plann ing to set up their own insurance exchange all of them are going to rely on the
federal exchange. But what sort of differences will exist for consumers between the
different exchanges?

Chiquita Brooks - LaSure: Sure . Well there are number of states that are making
progress towards establishing state basic changes. And consumers in stats without
their own marketplaces will have access to the federal marketplace, we’re developing a
single streamline application that consumer will be able to access and that means that
when consumer apply no matter where they are, whatever state they’re in they will have
the same experience of being able to go online and enter information to determine
whether or not they will be eligible for some type of subsidy. They can th en proceed to
look at plans that are available to them in their location, and make a choice to what
coverage might be best for them. State base marketplaces have the options of using
the same application or they can create their own but with rules that ar e consistent
across the state.

Mark Masselli: You know, Chiquita , I want to talk a little bit on some of the policy
wrinkles that been thrown in at the secretary -- Arkansas is certainly one of those who’s
come and ask the secretary for a little relief a s they try to think out they’ll managed their

particular state coverage and they really want to rely on the use private insurances and
blew off Medicaid expenditures. What’s the status if you can tell us of the Arkansas
approach in what implications might it have on different possible exchanges in some
other states.

Chiquita Brooks - LaSure: So we are completely committed to working with all states and
my understanding is that our Medicaid team is working with Arkansas and is actively
engaged in conversati ons with other states as well about the options and resources
available to them as we -- I have been working on development of the ACI states have
come to us with different ideas and we’re very open to hearing what the innovations that
states are thinking about and of course being consistent with making sure the
consumers have the protections afforded under the Affordable Care Act.

Margaret Flinter: Chiquita , there’ve been numerous rules issued by health and human
services governing what are called the essential benefits. Benefits that have to be
included in those plans being often in the -- in this insurance exchange I think we’re
calling those qualified health plans. Could you tell us more about the so called ten
statutory categories of essential be nefits what they are ---

Chiquita Brooks - LaSure: Yes under the statue -- essential health benefits must include
ten categories ambulatory, patient services, emergency services, hospitalization,
maternity and new born care, mental health and substance use disorder services,
prescription drugs, preventive and wellness services and chronic disease management
and finally pediatric services. We’re working with the states in terms of enforcement,
but they continue to be the primary enforcers of the Affordable Care Act and we do seek
to preserve that role for them.

Mark Masselli: Were speaking today with Chiquita Brooks - LaSure, Deputy Director for
Policy and Regulations at the center for Consumer Information and Insurance Oversight
at the Centers for Medicare and Medicaid at the Department of Health and Human
Services. Chiquita states in the federal government suppose to have the insurance
exchanges in place and ready for consumers by October first of this year. But there’s
still seems to be quite a bit of c onfusion not just among consumers but among many
small business owners and even some policy folks on how these plans will be
navigated, what’s being done to get the word out about the exchanges especially the
federal exchange that will be providing coverag e to so many millions of Americans.

Margaret Flinter: We’ve recently released the navigator funding opportunity
announcement which enables community and consumer focus non - profits to apply for a
grant to help spread the word to consumers, and to help th em enroll in the market place.
We encourage people to follow HHS social medial channels located on HealthCare.gov
to get up to date information on the marketplace.

Margaret Flinter: So Chiquita let’s take a look at the affordable part of that online
insu rance exchange. So I’d like to maybe ask you to take a look at some of the rules
that have been put in place certainly the medical laws ratio -- already provided billions of

dollars in rebates to consumers and then there’s the three Rs risk adjustment,
re insurance and something called risk cor ridors. Tell us how these protections are
going to keep insurance rates affordable.

Chiquita Brooks - LaSure: With millions of new potential consumers, insurance
companies can anticipate significant increases in reve nue in the coming years. The
marketplace s will allow consumers to compare plans side by side, dramatically
increasing competition insures there are designing their plans to compete. And they’ll
have to work to be more efficient with their dollars, instea d of passing along cost to
consumers. As you mentioned the Affordable Care Act create three new programs to
stabilize in moderate rates and allow for the purchase of lower premium coverage under
a catastrophic plan for young people and individuals who oth erwise can’t afford
insurance. The permanent risk adjustment program will assist health insurance plan to
provide coverage to individuals with higher risk populations. And will reduce the
incentive for issuers to avoid enrolling only help the individuals . The transitional
reinsurance program is three year program design to reduce premium and ensure
market stability by helping issuers cover the cost of high risk enrollees in the in the
individual market. It will lower premiums in this market by an estima ted 10 to 15% in
2014.

Mark Masselli: Chiquita that was very helpful there’s going to be a lot of information
with those new customers coming in and HHS is really promoting a culture of sharing
big data and the data associate with this role out -- is obv iously going to be quiet
massive. So managing all that data and making a consumer friendly seems like a
challenging proposition, tells about the tools you’ve developed called the data service
hub, tell us how there hubs are suppose to facilitate the insur ance purchasing
experience.

Chiquita Brooks - LaSure: So the data services hub is a backend tool that will provide
one connection to common federal data sources that are needed to verify information
such as income, citizenship, immigration status and acces s to minimum essential
coverage. We have completed the technical design and reference architecture for the
hub, it’s really important to know that the data hub will not store any information, it is not
a database. The hub exists solely so that marketplac e s will be able to securely submit
questions about application information and the federal government will provide
information back to the marketplace s.

Margaret Flinter: Chiquita the department of health and human services also had
recently announce tha t there would not be multiple insurance plans available to choose
from for small businesses or their employees that use the federal exchange until 2015
and not 2014 as was the original date. What’s your thought about the impact of this
delay on small busi nesses and on the plans are available to small business are there
any other strategies being thought about?

Chiquita Brooks - LaSure: We believe that in the -- as we called the employee choice
provision is a very important part of the Affordable Care Act. For the first time starting in

2014, small business will be able to comparison shop for coverage for their employees.
And they may qualify for a tax credit for the coverage, marketplace s will give small
business the purchasing power of a large employer a nd their employees will benefit
from this lower cost of coverage. Just for transitional purposes we’ve p ropose that in --
just, 2014 a shop may elect to have business choose one plan to offer their employees
through the marketplace s. But in 2015 employee s will be able to choose from the full
range of plans in the marketplace .

Mark Masselli: Tell me -- let me ask one question if I’m a low income individual who’s
going online and I might have the sort of approximation of my income I take at those
service hubs go out grab from the IRS or maybe from our department of labor from
whoever sort of verification of my income. When I’m done with this will I have that as a
printable form, so it will say hey by the way Johnny Smith your income was X your
number of p eople in your family is Y here’s where you finally end up on the exchange,
you’re going to pay 4% of your adjusted net income into the exchange, does it come
back with that type of specificity?

Chiquita Brooks - LaSure: So if you are entering in online it’ s a -- either of the process of
that make sense so you’d see the screen and says this is what we think your income is,
and you would go through a verification process. Once you went through the process of
figuring out exactly let’s say you do qualify for a tax credit, then what would pop up is
how much you would pay per plan, because it’s going to vary based on whichever,
whatever plan you’re choosing so ---

Mark Masselli: And is that net of what I get back from -- because I’m -- I’m kept -- let’s
say at 4% I made a 175% of income I can pay no more than that on my adjusted , is that
what you’re finally -- did it -- okay.

Chiquita Brooks - LaSure: No , because it depends, so you’re kept it 4% if you chose one
of the two lowest cost plan s , but it say you chos e a plan that was the fourth lowest, you
would pay more than your 4%. And so -- but what would come back to you is, if you’re
doing this online you would see that your tax credit gives you different buying power
depending on which plan you chose and then you would see back. Okay if I want to
chose this plan this is how much I would pay.

Mark Masselli: Tell me this, do my credits roll back to me automatically, are they front
loaded?

Chiquita Brooks - LaSure: So you get as an individual a monthly amount t hat is paid
directly to your insurance company, once you finish enrolling your insurance company
gets it directly and then you pay whatever the difference is, on a monthly basis. So it is
provided per month, you do have the option to pay the entire premiu m all year, and then
get it back as a tax credit on your income taxes. So you could enroll to the exchange
and say I don’t want to take the tax credit till the end of the year and then you’d get back
and so at the end of the year it’s all reconcile the am ount and we encourage people to --
if their income changes midyear significantly to come in and get an adjustment so that

they’ll have a better sense of what they may get back -- you get, you always get the full
benefit it’s just that if you -- if you want ed to kept at a certain amount of income yes you
would need to chose the -- one of the two lower plans and that’s because the tax credit
is tag to the second lowest what we call the silver plan. So if you chose one of those
plans you’re guaranteed to pay less than whatever the income cap is, there may be
other options that’s still are lower like you could chose a bronze plan and have an even
lower premium or perhaps even no premium, but you also have the option to say I want
to ch ose one of the more expens ive plans because it’s offering a better network.

Margaret Flinter: Chiquita there’s been some talk about individuals versus individuals
with dependent. So if it’s a -- when we talk about the income and the premium sharing
is that just for an individua l implying for insurance but if the -- individual for instance is
also putting their 23 and 24 year old on the plan, each of them have to apply individually
to get the premium or is there a family component to this?

Chiquita Brooks - LaSure: You don’t have to apply as an individual, the family can apply
as long as they are all part of the same tax household if that make sense, so people
who are on the same tax return apply together and the tax credit is adjusted based on
family size etcetera. When you’re a pplying online all that information is part of the
eligibility process so the individual doesn’t -- they just need to know how to build enter in
their information and then the hub is helping in the marketplace determine exactly how
the premiums work.

Mark Masselli: We’ve been speaking today with Chiquita Brooks - LaSure Deputy
Director for Policy and Regulation at the Center for Consumer Information and
Insurance Oversight at the Center for Medicare and Medicaid at the Department of
Health and Human Service s. Chiquita thank you so much for joining us today on
conversations on healthcare.

Chiquita Brooks - LaSure: Thank you.

(Music )

Mark Masselli: At conversations on healthcare we want our audience to be truly in the
know when it comes to the facts about healthcare reform and policy Lori Robertson is
an award winning journalist and managing editor of Factcheck.org a non - partisan non -
profit consumer advocate for voters that aim to reduce the level of deception in US
politics. Lori what have you got for us this week.

Lori Robertson: Well Mark and Margaret senator Dianne Feinstein of California has
been the target of viral attack, conservatives websites and bloggers have claims that
Feinstein all military veterans are mentally ill and should not be allowe d to own guns,
that’s not what Feinstein said, instead she said that Veteran Should Not Be Exempt
from an Assault Weapons Ban she had proposed. She said post traumatic stress
disorder was one of her concern s. S he had no way said that all veteran suffer f rom
PT S D or that no veteran should won guns. Her remarks were made at a March seven

Senath Hearing on her assault weapons bill. Senator John Cornyn of Texas offered an
amendment to exempt military veterans from the ban . The bill already exempted active
military and law enforcement.

Feinstein said that there had been no exemption for Veterans in the Assault Weapons
Bad that was enacted in 1994 and expired in 2004 . S he went on to say that she was
concern about Prost Traumatic Stress Disorder , she said sh e was open to a
compromise but Cornyn would have to “ find a way that veterans who are incapacitated
for one reason or another mentally don’t have access to this kind of weapon ” . Cornyn
then misrepresented her remark saying he wouldn’t want to suggest that all people who
serve in the military suffer for debilitating illness and Bloggers and Facebook post
quickly twisted her words as well. Feinstein concern is not misplaced of course it’s well
documented that veterans or anyone else suffering from PTSD can be a danger to
themselves and others.

And that’s my fact check for this week . I’m Lori Robertson Managing Editor of
Fact C heck.org

Margaret Flinter: FactCheck.org is committed to factual accuracy from the country’s
major political players and is a proje ct of the Annenberg Public Policy Center at the
University of Pennsylvania. If you have a fact that you ’d like checked email us at
chcradio.com. We will have FactCheck.org’s Lori Robertson check it out for you here on
Conversations on Health Care.

(Music )

Margaret Flinter: Each week, Conversations highlights a bright idea about how to make
wellness a part of our communities and everyday lives . Around the world there are
some 300,000 health facilities that do not have adequate electricity or lighting . A nd in
th e s e clinics and hospitals in the third world many women give birth in near or total
darkness . When Berkeley California OB/GYN Dr. Luara Stachel change careers after a
life altering back injury she decided to focus her attention on confronting thi s global
health issue which is one of the factors in the high rated maternal infant death in the
world.

Dr. Laura Stachel: You lost the light and the only way to get light was to burn the
calendar.

Female: Yeah , burn the calendar.

Dr. Laura Stachel: So you could see enough to cut the cord. Okay you get the price for
the most amazing story.

Margaret Flinter: In Nigeria where the problem is particularly pronounced tens of
thousands of women and newborns die during child birth.

Dr. Laura Stachel: So much of what we do requires electricity, the monitors , the lights ,
the machinery for helping with deliveries that never occur to me that in other parts of the
world that the things that we assumed to be completely fundamental to medical care
would be abse nt.

Margaret Flinter: Dr. Satchel’s husband Hal Aronson is a solar power engineer and
together they form “WE CARE Solar ”. They developed a portable solar power and
lighting kit that could charge via solar panels by day and be installed in clinics to pro vide
power at night.

Hal Aronson: What was remarkable was that when they saw that they want to keep it.

Dr. Laura Stachel: And they said please leave it here because this will help us save
lives even right now.

Hal Aronson: And that was the light bul b moment for us, even a little bit of power could
go a long way towards saving a life.

Margaret Flinter: The kids come equipped with everything a clinician would need for
communication and a medical emergency, electricity for walkie - talkie and cell phone
powering. Empower enough for a variety of lights and enough power to run some
diagnostic equipment in the advent of a surgical emergency.

Dr. Laura Stachel: We had a doctor who requested a solar suitcase last Thanksgiving ,
he called us five weeks later and he said I want to tell you what happen ed. The night
that I came I was able to save a wom a n with twins using the light and I would have
called you the next day but there was an outbreak of cholera the next day. And for the
next 30 days every m e n , wom en and child that had cholera came to our clinic and we
use the solar suitcase every night. He said for the first time in the history of this village
no one died of cholera, we saved a 122 patients and he said in the past 50% of these
people would have di ed.

Margaret Flinter: WE CARE Solar has grown from a backyard manufacturing operation
with friends pitching in , to a full scale manufacturing plant in Berkeley California. They
have provide the kits to a hundreds of clinics around the world and are hopi ng to scale
up their operation to meet the pressing need not just in remote clinics, but also during
disasters as well. WE CARE Solar providing power and light for clinics around the
world, improving the outcomes of the patients being served, now that’s a bright idea.

(Music)

Margaret Flinter: This is Conversations on Health Care. I am Margaret Flinter

Mark Masselli: And I am Mark Masselli, peace and health .

Conversations on Health Care broadcast from the Campus of WESU at Wesleyan
University, strea ming live at www.wesufm.org and brought to you by the Community
Health Center .