New ND health agency means more money, workers

DALE WETZEL - Associated Press
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North Dakota state Rep. George Keiser, R-Bismarck, speaks at a meeting on Thursday, Oct. 20, 2011, in the North Dakota Capitol in Bismarck, N.D., of a legislative committee that is drafting health care measures to be considered by the North Dakota Legislature's special session next month. Keiser is chairman of the committee. (AP Photo/Dale Wetzel)

BISMARCK, N.D. (AP) — Proposed health insurance changes required by the federal government may provide North Dakotans more benefit options, but the package's $83 million price tag will make it a difficult sell, lawmakers predicted Thursday.

A legislative committee has been working since June to craft a bill that makes the changes before the North Dakota Legislature's special session begins Nov. 7. The panel's chairman, Rep. George Keiser, R-Bismarck, said the committee should finish its work Friday.

The measure is intended to assimilate major provisions of a federal health care reform law that President Barack Obama signed into law last year.

It would establish a state-run health benefit exchange, which supporters say will have more standard insurance benefits and pricing, and make it easier for consumers to compare health plans. Blue Cross Blue Shield of North Dakota and other insurers will use the exchange to market benefit packages.

The proposal also includes money to make the computer software changes necessary to expand eligibility for Medicaid, a state and federal medical benefit program for the poor, and the Children's Health Insurance Program, or CHIP, which offers coverage for children of lower-income families.

The federal health law used broader eligibility for the two programs as a way to help extend coverage to people who do not have health insurance.

The proposed state legislation now would allow agencies to hire 50 people to set up and staff the health benefit exchange, and to do the technology work needed to change eligibility rules for Medicaid and the CHIP.

Most are permanent positions, although at least 10 of the jobs would be eliminated once the software work was completed.

The legislation also authorizes $83 million in spending through June 30, 2013, when the state's current two-year budgeting period ends.

Lawmakers expect that most of the money will initially be provided by federal grants, but they said the federal health care law requires the state to shoulder the cost after 2015.

The complex legislation will have to compete for attention with other proposals during the special session, which begins Nov. 7.

Aside from drawing new borders for legislative districts, lawmakers also expect to take up flood relief measures and a proposed repeal of a law that requires the University of North Dakota to keep its Fighting Sioux athletics nickname and American Indian head logo.

One of the key questions North Dakota lawmakers must answer is whether they want to set up — and pay for — their own state health benefit exchange, or let the federal government handle the job.

Keiser advocates having the state set up its own exchange, although he acknowledges that the expense of doing so, and the need to hire dozens of new state workers, makes the option tough for many lawmakers to swallow.

Giving the job to the federal government would mean a loss of control over administration and expenses, Keiser said.

"If we go with a state-based plan, it does require an awful lot of effort, time, resources (and) money," Keiser said. "But I believe that we will operate the program more economically, than allowing the federal government to operate the program for North Dakota and then send us the bill."