HLM: What is it about the federal partnership that prevents premiums from going as high as they would had Delaware decided to run a state-based exchange?
Landgraf: We're going to get economy of scale. When the federal government actually builds that level of infrastructure for an exchange, they will be able to leverage that across populations that are either going to do a full federal exchange or will elect to go to the partnership model.
Originally they were looking at regional exchanges. And early on I did outreach to the larger states... and what I found early on [was] the states that were interested in what we thought would be regional exchanges were states very much like Delaware. It was the low population states. The higher populations states, they don't need us. They can create their own state based exchange and don't have to worry about what's happening across state boundaries.
What we really believe is important for the state of Delaware is to retain that regulatory responsibility. We also wanted to retain responsibility to the consumers, too.
HLM: Will it be easier to replicate better health outcomes in certain populations in Delaware because your population across the state is smaller?
Landgraf: I think so. The benefit for Delaware is we can literally bring everybody to the table. I can travel the state in two and a half hours so we can touch every county. We also think of ourselves as an incubator state because we also have a rather large rural population as well as a rather large urban population.
HLM: How responsive have insurance plans been to Delaware?
Landgraf: Like any new program, we rely heavily on the ability to have information in a timely fashion; many times that's challenging. Many times, I will go back to HHS and say, "In order for us to really implement by October 2013, the plans will need certain information to be able to have time to return to us how their costing out their premiums and how they want to promote the plans on this exchange, and then for us to be able to certify them."
Some of that has presented challenges; however, I've had to personally make those calls to HHS and HHS has always been responsive in trying to secure that information for us.