The Future Health Care Marketplace: Understanding Health Insurance Exchanges

  Presentation:  John Kingsdale: Insurance Exchanges: What the "Shiny New Thing" Means for States

This session focused on a key feature of the Affordable Care Act – health insurance exchanges – that states must begin operating by Jan. 1, 2014.

But for states, “January 1, 2014, is tomorrow,” said Jason Helgerson, Medicaid director for Wisconsin and principal project sponsor for the state’s BadgerCare Plus.

These exchanges, said Jon Kingsdale, former executive director of the Commonwealth Health Insurance Connector Authority in Massachusetts, essentially do five things: determine eligibility for public subsidy; enroll unsubsidized market segments, specify plan designs and cost-sharing; rate, contract and sell health plans; and provide education and outreach.

States must start planning now, Kingsdale said, and will have to make some early decisions to get the ball rolling. First, states must decide whether they even want to undertake the effort to operate the exchanges or, instead, allow the federal government to run them. States can choose to operate regional exchanges, though Kingsdale doubts the interest is there to operate across state lines.

If they choose to operate exchanges, states must determine the form of governance, policy goals, level of transparency and sources of funding. Policymakers also will have to address the “Thou Shalt Nots.”

“You’re going to get pressure to put in a lot of ‘thou shalt not do anything that hurts me in this legislation,’” Kingsdale said.

Anya Rader Walleck, president of Arrowhead Health Analytics and a health care consultant to state governments and multi-state organizations, said states will have many options on how to operate the exchanges.

“You should as state decision-makers keep those options open,” Walleck told attendees.

While the coming year will focus on governance of health exchanges, Walleck said policymakers need to begin educating themselves on second-tier issues that will be coming up for states.

Speaker Biographies:


  • Presenter: Jon Kingsdale, Former Executive Director, Massachusetts Commonwealth Health Insurance Connector Authority
  • Reactor Panelist: Jason Helgerson, Medicaid Director, Wisconsin
  • Reactor Panelist: Anya Rader Wallack, Ph.D., Health Policy Consultant, Arrowhead Health Analytics
  • Reactor Panelist: Vernon K. Smith, Ph.D., Principal, Health Management Associates

Jon Kingsdale, Ph.D.

Dr. Jon Kingsdale is the former Executive Director of the Commonwealth Health Insurance Connector Authority.  The Health Connector is an independent state agency which leads the implementation of several key elements of health reform in Massachusetts, and which provides subsidized coverage for the low-income uninsured, and also offers a broad array of plan options to individuals and small employers purchasing health insurance.  The Health Connector also served as a model for federal health reform.  Prior to leading this health insurance exchange initiative, Kingsdale was a senior vice president at the Tufts Health Plan for almost 20 years.  Kingsdale received a doctorate in economic history from the University of Michigan and a B.A. from the University of Pennsylvania. He has taught at the Harvard School of Public Health and the Boston University School of Public Health.

Jason Helgerson

Mr. Helgerson became Medicaid Director for Wisconsin on March 19, 2007. He serves as principle project sponsor for Governor Doyle’s signature health care initiative, BadgerCare Plus. Through this new program, 98% of Wisconsin residents will have access to affordable health care. He has also served as Executive Assistant/Policy Director to the Secretary of the Wisconsin Department of Health and Family Services (DHFS) and Executive Assistant for Wisconsin Department of Revenue. Prior to joining the Doyle Administration, Mr. Helgerson served as the Senior Education Policy Advisor for Mayor Ron Gonzales of the City of San Jose, CA.  He has also worked for the Milwaukee Public Schools and Milwaukee Mayor John Norquist. He received his Masters of Public Policy degree from the University of Chicago in 1995, and his BA from American University in Washington, DC in 1993.

Anya Rader Wallack, Ph.D.

Anya Rader Wallack is President of Arrowhead Health Analytics.  Dr. Wallack established Arrowhead after serving as interim President of the Blue Cross Blue Shield of Massachusetts Foundation (BCBSMAF) and Executive Director of the Massachusetts Medicaid Policy Institute (MMPI).   For the past two years she has been deeply engaged in Massachusetts health care reform through her service at MMPI and BCBSMAF.  Dr. Wallack has served as a consultant to state governments and multi-state organizations for most of the past decade.  From 1995-1998 Dr. Wallack ran the Vermont Program for Quality in Health Care, a quasi-governmental agency that specializes in quality measurement and improvement at the state level.  Dr. Wallack earned a Ph.D. in social policy from Brandeis University’s Heller School.

Vernon K. Smith, Ph.D.

Vernon Smith is a Principal with Health Management Associates, where he focuses on Medicaid, Medicare, SCHIP, state budgets and trends in the health care market place. He has authored several reports on enrollment, spending and policy trends in Medicaid and SCHIP, on the Medicare prescription drug benefit, and on state directions to address the uninsured. Dr. Smith is a frequent speaker before national and state policymakers and commentator to major media, including the New York Times and National Public Radio.  Before joining HMA, Dr. Smith served as Michigan Medicaid director and as budget director for the human services agency during 30 years of public service. He holds a Ph.D. degree in economics from Michigan State University.


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