HLM: How would you characterize the progress of Delaware's state-federal insurance exchange?
Landgraf: Delaware is rather unique because of our size, and that presented challenges as we looked at what model we wanted to use. We initially evaluated doing our own state-based exchange. Because of our population being less than a million, when we did the modeling from a cost perspective, it really was cost prohibitive for us. We really felt like that [state based model] would drive up the premium cost.
We sat down early on with primarily CMS and HHS and started talking about some of those challenges, and, I believe, that's when the idea of a state-federal partnership began taking shape. Delaware was one of the first states that committed to that, and I really think Delaware was really poised to craft what this hybrid will look like.
The thing we're concentrating on right now are the Marketplace Assisters. As part of the implementation, the Marketplace Assisters are that consumer outreach identity that we will be contracting with—probably organizations.
Those organizations will hire Marketplace Assisters; the state will need to certify them. The federal government will have some standards that the Marketplace Assisters will need to have in order to become certified. But their role is to assist that consumer base that is shopping on the exchange and then if the consumer actually wants to have more details, they'll hand that over to a broker.
PPACA also provides for Navigators. The difference between the Marketplace Assisters and the Navigators is the population you are outreaching to.
I believe the Navigators will be outreaching to the high risk population and we're still waiting for guidance as to how to define that population. That's why I think you see us getting a little anxious because we really want to be able to start training individuals, getting them on the ground.